The fear of visiting dentists is a universal phenomenon that limits access to dental care for many people. TV shows and movies routinely depict dental visits as terrifying experience that you may even be better off without.
Dentists, however, have gone to great lengths to address this anxiety issue which mostly stems from past bad experiences. Multiple approaches, including both behavioral and pharmacologic, have been used to reduce anxiety and make dental visits comfortable. A recent pharmacologic approach that is becoming very popular is conscious sedation achieved by prescribing pills that are taken before dental visits to ensure a relaxed experience.
Conscious sedation is a state of minimally depressed consciousness where patients always maintain their own breathing and protective nerve reflexes and are able to respond to physical and verbal stimuli. In contrast, general anesthesia is a state of complete unconsciousness where patients need assistance in breathing.
The most commonly used medication in conscious sedation is Triazolam (Halcion). This drug relieves anxiety by slowing down the central nervous system. Most patients describe feeling relaxed like you might experience after having alcoholic drinks. This medication also provides a period of amnesia, which explains why some patients believe that they were actually asleep. Although patients are still conscious, oxygen level in the body, heart rate, and blood pressure are constantly monitored during sedation.
Patient safety is always the paramount concern. Averting the risk of over-sedation starts with open communication between the doctor and the patient, identifying high risk situations in advance so that special measures are taken and doses are adjusted accordingly.
For example, grapefruit inhibits some of the body’s enzymes that metabolize Triazolam and thus increases the clinical effect of this medication. Alcohol and some recreational drugs depress the central nervous system and also amplify the effect of sedatives. These should not be consumed prior to sedation.
Elderly patients and those taking central nervous system depressants should have half the average dose of Triazolam initially and additional incremental doses should be administered carefully. Obesity puts patients at high risk because it increases their susceptibility to heart and respiratory incidents. Adherence to strict protocols by both, the doctor and the patient, is crucial to successful and safe sedation.
If someone has complex health conditions, a consultation with a medical doctor is required. In some cases, sedation may not be possible in a regular dental office setting; but it may still be possible in a hospital setting under the supervision of an anesthesiologist.
People should not let the fear of going to the dentist stand in their way of attaining good oral health especially when dentistry today acknowledges this fear and offers multiple options to ease it.
— Samer Alassaad is in private dental practice in Davis. Contact him at DrSamer@childressdentaldavis.com