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Medical Forum / General / Dentistry / February 2007Lessening the trauma of dental work
I'm gonna get my questions in since I'm on a dental kick. One of the biggest problems for me in going to the dentist is the anticipation of pain. It isn't the pain itself, which under my current dentist is very minimal to non-existant, but the anticipation. The first time I went in for my cleaning, after years of neglect, the hygenist stuck her pick right into a cavity at the gumline. I nearly bit off her finger due to the sensation. Ever since then I've been a nervous wreck going to the dentist for cleanings. Over time its getting better and better, obviously when you have good hygiene cleanings aren't a big deal. The same is true for cavities. This one that I'm waiting to have filled for instance, right on the gumline but yet when it was filled it didn't hurt at all. It helps that he only uses composites, but when the biggest pain involved is pushing the gums down and out of the way, it can't be too bad. So I'm wondering to myself, given the almost universal hatred for dentistry, given that anticipation and anxiety is largely the only real reason why people avoid the dentist, what's being done to alleviate that? Nitrous? Bah, he'd have to give it to me in toxic dosage before it would relax me. Valium, tried that and it didn't help. Massive dosage of lidocaine - it helps nicely, although it doesn't relax the very sensitive nerves for the next 2 to 3 weeks. So what else? Hit people on the back of the head with a whiskey bottle and wake them up when it's over? Personally I become very relaxed when the dentist or the hygenist TALKS to me during the process. They don't have to have a conversation, but just talking about something focuses my mind on their words and not their hands. Unfortuntately my dentist hardly talks at all - maybe because he's working under a microscope on a patient who's leg is shaking like a leaf and he's too busy to talk. I'm not sure how much "talking" the dentist or hygienist has to do to get you relaxed. Keep in mind, we have a job to do. Although a hygienist is in a better position to talk to you a lot during the visit, a dentist may not given everything that's in your mouth during the procedure (eg. rubber dam and other equipment). Before and after the procedure is completed, sure, the dentist can talk your ear off. If your not happy with the mannerism of your current dentist/hygienist, find a new one. However, I suspect that no matter how much someone talks to you, you will still feel a degree of anxiety with the visit. Find a dentist to provide you with an intravenous deep sedation. At least try it once and see if its for you. You will have little recollection (if any) of the visit. Before they come to me, many of my patients are like you....anxious but get through the appointment with difficulty...they've, tried nitrous and/or oral sedation with other dentists without success. Once they have the intravenous, they look back on how much they've struggled with dentistry up until then and realize it could have been much easier. J Suljak DDS > I'm not sure how much "talking" the dentist or hygienist has to do to get > you relaxed. Keep in mind, we have a job to do. Although a hygienist is [quoted text clipped - 17 lines] > > J Suljak DDS The only reason why I would be opposed to that is because it turns a reasonably routine visit into a major expedition. It's not just hop in the chair, shoot up with lidocaine, and away we go. Now its far far more complicated, that in a way reinforces the anxiety the patient feels - now they have a reason to justify their fears. However that said, when I had my wisdom teeth removed I was eternally grateful he put me under, even if I did wake up 3/4 of the way through the process and he had to knock me out again. But more importantly it doesn't really treat the anxiety, the pain isn't the problem, the anxiety is. I had 3 back teeth completely recontructed (again, penalties for my years of neglect) and had I known of the extensiveness of the procedure he was planning I would have required a whiskey bottle to the back of the head. Instead he downplayed the process and essentially duped me into thinking this would be a small appointment. As much as I resent that he fooled me in the chair, in reflection I appreciate what he did - in not giving me all the details I had less information to worry about. I don't expect that I'm as anxious as others in the chair. I get nervous, but not to the extent that I will avoid a procedure or delay one any longer than necessary. Talking does help me, again I totally understand that the dentist may not have that luxury and I certainly won't have that luxury in the chair, but listening does help me - it humanizes the procedure. > The only reason why I would be opposed to that is because it turns a > reasonably routine visit into a major expedition. It's not just hop in [quoted text clipped - 7 lines] > But more importantly it doesn't really treat the anxiety, the pain isn't > the problem, the anxiety is. After years of treating patients who are anxious (mildly, like yourself, or significantly, like others), I have come to realize that few are able to completely overcome their anxiety without psycological intervention of some sort. Very few patients chose this route of therapy. In today's society, most people want the quick fix, which isn't really a fix at all, and its an intravenous sedation. At least it allows them to get procedures done with comfort and for some patients, they wouldn't have had the treatment at all without it. J Suljak DDS > I'm gonna get my questions in since I'm on a dental kick. > [quoted text clipped - 29 lines] > because he's working under a microscope on a patient who's leg is > shaking like a leaf and he's too busy to talk. Hatred for dentistry is far from universal. The reason I say this is twofold: Firstly, it is generally easy enough for a dentist to make a living treating primarily patients who are NOT unduly anxious; and second it doesn't matter whether other people are anxious or not so long as YOU are. You have figured out the hard part--going to the dentist regularly makes treatment more manageable and comfortable. If you wait for an emergency every time you are almost guaranteed an unpleasant experience which will of course reinforce your apprehension. It becomes a vicious circle. Patients with absolutely unmanageable anxiety must be treated while unconscious. This isn't for everyone obviously, but there are some patients with special needs that cannot reasonably be managed any other way. John has already spoken about sedation dentistry--his particular area of expertise. It is a very good option for those who can cooperate, but whose anxiety makes treatment difficult for both patient AND dentist. I am happy to have sedation dentists I know that I can send patients to at need. Since you realize that this is largely an emotional rather than a physical trauma, other approaches work well too--I'm aware of some dentists who use hypnosis successfully in their practices. I like to talk to my patients. Maybe this calms some of them down; I rather think some of them would prefer I shut up. Good luck, Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Steve, I think it is important to state that most IV sedation will not make the patient unconscious. Yes, a patient could be treated in an operating room, under very special circumstances, requiring intubation, etc; however, IV sedation itself will only cause the patient to enter a state of intense relaxation. The patient will not be asleep. Too risky for routine dental work. I know here at the dental school, patient's can be rendered asleep for certain oral surgery procedures; however, if a patient who is overly anxious requires a root canal, they will not be unconscious...just HEAVILY sedated. >> I'm gonna get my questions in since I'm on a dental kick. >> [quoted text clipped - 55 lines] > Good luck, > Steve >I know here at the dental school, patient's can be rendered asleep >for certain oral surgery procedures; however, if a patient who is overly >anxious requires a root canal, they will not be unconscious...just HEAVILY >sedated. Having had IV sedation twice, while I appreciate the distinction in practice for me that's been a distinction without a difference. I don't remember a thing. SignatureMelinda Shore - Software longa, hardware brevis - shore@panix.com If you can't say it clearly, you don't understand it yourself -- John Searle I am glad for you...some patients get very upset when they realize they will not be asleep...I had one in my chair this week. She is going to go ahead with the IV sedation anyways, and I am hoping it goes well with her, too. >>I know here at the dental school, patient's can be rendered asleep >>for certain oral surgery procedures; however, if a patient who is overly [quoted text clipped - 4 lines] > distinction in practice for me that's been a distinction > without a difference. I don't remember a thing. ... >I am glad for you...some patients get very upset when they realize they >will not be asleep...I had one in my chair this week. She is going to go >ahead with the IV sedation anyways, and I am hoping it goes well with her, >too. The definitions of "general anaesthesia", "deep sedation", and "conscious sedation" vary widely. I believe the last true general anaesthetic I did for someone over the age of 10 was when I was a resident. My standard technique now for such patients is a nonintubated deep sedation where patients are unresponsive for periods of time, for example when local is given or if the patient is moving too much. Generally much deeper at the start than towards the end. That's why everyone I treat under deep sedation or conscious sedation is warned that they may remember bits of our visit (some more than others), especially towards the end when your patient has to be lucid enough to check occlusion on restorations. I don't think anyone can *guarantee* no memory of a visit. However, as the previous poster said, the end result of recollection between deep or conscious sedation may be the same for some patients while for others it is not. It is good of you to discuss this point frankly with patients as I don't believe enough do, especially those who provide oral sedation only and claim to be "sleep dentists". J Suljak DDS Surely you aren't referring to DOC's. ;-) Steve It is good of you to > discuss this point frankly with patients as I don't believe enough do, > especially those who provide oral sedation only and claim to be "sleep > dentists". > > J Suljak DDS > Steve, > > I think it is important to state that most IV sedation will not make the > patient unconscious. Of course. Yes, a patient could be treated in an operating room, > under very special circumstances, requiring intubation, etc; however, IV > sedation itself will only cause the patient to enter a state of intense > relaxation. The patient will not be asleep. Too risky for routine dental > work. I'm sure you meant to say "routinely" for dental treatment. Operative treatment for a toddler may well commonly require general anesthesia. I'm sure John will object to your characterization of GA as "risky". I agree that general anesthesia (or sedation for that matter) shouldn't be used cavalierly. But when you need it, it should be used--with good training and personnel--without fear. Steve I know here at the dental school, patient's can be rendered asleep > for certain oral surgery procedures; however, if a patient who is overly > anxious requires a root canal, they will not be unconscious...just HEAVILY [quoted text clipped - 59 lines] >>Good luck, >>Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 |
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