How do you deal with dental anxiety while in the dental office? My experience with most patients is that the anxiety that they are having mostly stems from the fact that they have had something that hurt them when they were in the dental office – and the thought of going back again for additional treatment brings them a lot of fear and anxiety.
There are several approaches when dealing with anxiety. I prefer the least pharmaceutical approach possible for many reasons. Let me discuss the different ways anxiety can be addressed while in the dental office.
1. The most effective method of overcoming anxiety about dental procedures is helping the patient understand their condition and their options for treatment, thus developing a relationhsip and trust they may have never experienced before in a dental office. The importance of this can’t be underestimated! Knowing what their situation is and what is going to happen soothes many patients’ anxiety. Additionally, I remind the patient they have absolute control about what goes on during their appointment. If they are feeling anything that is the slightest bit unpleasant and they need me to stop, I will stop and do something about it. If I am unable to do anything about it we can always stop treatment wherever we are and try again another day with a different approach.
2. For some patients that are looking for a little bit more relief, nitrous oxide – commonly known as laughing gas – is available. Nitrous oxide provides a very light and mild sedation. In my practice, it is available for any procedure any time anyone wants to use it. For many people that have anxiety issues about dentistry, combining nitrous oxide usage with the relationship and trust that has been built between the patient and me, along with the control that they have over the progress of the procedure is usually more than enough to help them receive the care they want.
3. The next level of anxiety control is that of use of oral medications. Oral medications can work well, although they are a little unpredictable on how they are going to work, since people respond differently to medications. However, adding an oral anti-anxiety medication prior to a dental appointment and using that in combination with nitrous oxide – and building on the things that I’ve already mentioned, most patients will easily get through the procedure, even if they have significant anxiety concerns.
As a side note, one type of sedation you may have heard of because of the significant marketing done by many dentists is “oral sedation”, which essentially is the use of oral sleeping pills to put a person “to sleep”. To make this type of sedation useful, patients take these medications when they are in the office and continue to take more over time until they achieve a state where they are still conscious and breathing on their own, but they are not very aware of anything else that is going on. Again, in my experience, anything taken by an oral route is not very predictable, nor is it easily reversible. There is a significant preparatory and recovery time for this type of sedation, and it is not without risk.
4. Another option for anxiety control is that of intravenous sedation (“IV”) of much more powerful medications. IV sedation does have quite a few risks, which should be understood by a patient. Also, there are additional expenses with the cost of an anesthesiologist who has to administer the medications. There is also the preparatory and recovery period prior to these type appointments. Only in severe cases of anxiety would IV sedation be necessary or desireable. Nevertheless, IV sedation is useful in the right situations when other options have been exhausted.
5. The final option is general anesthesia, where a patient is actually ‘put to sleep’. This is a much more predictable way and a safer way – compared to IV sedation – to help a patient get through the severe anxiety that they may feel about dental treatment. As you might guess, it does require an anesthesiologist and special arrangements, and it does significantly increase the cost of the care due to the anesthesiologist’s fees. It is the same type of anesthesia a person would have if they were going to have a surgical operation in a hospital.
Knowing that these options are available hopefully will help you deal with anxiety you may feel in a dental office. I’ve had many patients come to me with anxiety issues around receiving dental care, and I’m happy to say that most of them do not require any special type of intervention once we develop the relationship and trust and work through the concerns that they may have around receiving dental care.