Treating fearful patients is a huge part of my practice and is very rewarding for my team and me. Every day we see patients that are anxious about getting their dental work done and we’re able to make them comfortable. One thing I have learned over the years is that there is no “typical” fearful patient. People of all ages from children to the elderly are afraid of dental work. Many are afraid of pain but everyone has their specific thing they are afraid of. For some it is a sound. For others it is a loss of control. Fear has nothing to do with a patient’s self control, intelligence, or education. It is often related to past experiences or stories they heard about a poor treatment outcome. We explain to our patients that their anxiety is nothing to be ashamed of but rather something that we should talk about so we can give them a positive experience.
The first approach to the nervous patient is something termed iatrosedation. What it really means is establishing trust. Again, one of the most common fears is pain. If a patient knows we won’t hurt them or will stop a procedure if something hurts, they are often put at ease. Just talking a patient through a procedure and having patience with them can make a world of difference. Sometimes we will start with a short appointment and a simple procedure to gain confidence then move on to a more difficult appointment. We always try to take this approach first. When help is needed we can use sedative and anesthetic techniques.
Nitrous oxide or laughing gas is one of the simplest and most effective methods of sedation for shorter and less invasive procedures. Not too long ago when I suggested some laughing gas to an adult patient for her dental work she said, “I thought that was just for kids?” Nitrous oxide is very effective for children but we use it all the time for adults as well. It is also used frequently in the labour and delivery setting, as well as in ambulances. It does not put you to sleep but just takes the edge off. It gives the patient a feeling of floating tingly warmth; makes time pass more quickly; makes the chair more comfortable; and works as a pain reliever. We are able to administer it at different concentrations depending on what the patient requires and it is extremely short acting. Once the gas is turned off, the patient will be back to normal in just a few minutes and can typically go about the rest of their day.
Typically when people think of oral sedation they think of pills such as Ativan. Ativan is just one of the medications we can use to help a patient feel more relaxed. Other medications have shorter lasting effects and can induce loss of memory. There are pills to swallow, powders dissolved under the tongue, and liquids that are swallowed. Again, oral sedation does not “put you to sleep” but it lessens anxiety, relaxes you, and can make you remember less of a procedure. For safety, we have the patient come to the clinic and administer the medications while monitored by the staff. We can add some laughing gas if needed to deepen the sedation and provide some pain relief. Someone has to drive the patient home and be with them for the rest of the day.
This is a deeper level of sedation for very fearful patients or invasive procedures such as wisdom tooth surgery. Patients rarely remember the procedure itself but may remember leaving the clinic or little tidbits but they are still conscious. Patients often think they were asleep for the appointment but in fact they could speak and follow instructions, they just couldn’t remember it. We can use medications that are very short acting. For patients fearful of intravenous needles, we use a numbing cream on the skin and laughing gas to insert the I.V. The patient needs to be accompanied out of the clinic. Recovery from intravenous sedation is more rapid than with oral sedation.
This is when we put patients to sleep for their dental work. This option is sometimes best for very young children, for difficult procedures, or for patients with certain medical problems. Anesthetic gas is used to put the patient to sleep. Medications are given through an I.V. and a breathing tube is put down the nose to allow access to the mouth. An anesthesiologist is required to put the patient to sleep and the dentist does the dental work. Medicine Hat is lucky to have a facility, Santé Surgical Centre, where we can offer this service locally.
Sun City Dental is a general dental office that provides the full range of sedation services and dental surgical procedures in office. We offer general anesthetic services at our accredited non-hospital surgical center. All services provided by a general dentist.
