Pain and Anxiety Are Real!
Pain and anxiety are the main fear factors for visiting the dentist. There are even dental fear forums on the web with thousands of posts. These issues are real and very little is told to dentists in school about them. So, when a “new” dentist begins a practice, they find it frustrating and time-consuming to deal with the ‘fearful patients.’ Hence, both the patient AND dentist get anxious and stressed, which worsens the situation. Some dentists will take post-doctoral courses on ways to manage pain, fear, and anxiety, which fall into four general categories: laughing gas, pills, IV sedation, and general anesthesia.
Laughing Gas (Nitrous Oxide)
Nitrous oxide is a dissociative anesthetic. Meaning it hurts… but you don’t care! Since dental procedures are performed under anesthesia, pain is generally not the issue. It is the dissociative (anti-anxiety) properties that you/we want.
Nitrous oxide is safe, arguably the safest, and most dentists have it available. It is generally acceptable to most insurance companies and it is relatively inexpensive (approximately $45) at our office. It is definitely a great entry-level and very safe sedative.
Oral sedatives are nothing new – valium has been around for over 50 years. It is also safe and its use in dentistry is on the rise. A dentist must take extra continuing education to acquire the skills, licenses, and equipment necessary. We don’t upcharge for oral sedation… you say what? Yeah, the calmer you are, the calmer I am… the better work I can do, so it is a win-win.
I just ask that you pay for the pill only. Sounds perfect, right? Well, not so fast. The pill's effectiveness is all over the map. I can have one patient work well with oral sedation and the next one won’t work at all, which can be very frustrating. To make things worse, it is different at different times of the day, etc. So, much of the effectiveness of the pill is due to your particular chemistry in the stomach at that time. I still use oral sedation quite often for those who just need the “edge” taken off for moderate sedation. I don't find it effective. That's where IV Sedation comes into play.
IV sedation can use the same drugs as oral sedation but in liquid (IV) form. The concept is quite simple. Basically, you use the same sedatives as you would with pills, but here is the magic word: “titrate” to effect. When we start an IV, it allows us to incrementally manage the dose that goes “immediately” into effect so it can be adjusted as needed. Statistically speaking, IV sedation is safer than local anesthetic on its own. IV is many times more predictable than pills and many times more effective.
Click here to help decide if IV is for you and about why you should choose pills vs. IV sedation. It is fairly cost-effective, about half of having general anesthesia. In our office, however, about 1 out of 20 patients need general anesthesia; the IV route just doesn’t do it.
This type is the most predictable and our patients like the fact that it’s safer. Just think about it. If you are prescribed pills, there are many factors to be considered. Pills are absorbed in the intestine. Variables such as food, stress, time, weight, etc., all have an effect, so it is tough to predict the proper dose needed at your appointment. The ability to give you just the right amount is challenging and doctors make errors on the light side to prevent an overdose which can be severe.
So, what if you are still anxious? Take more pills? How many? How long will it take? Hard to adjust when you are in the office? I think you can see some of the problems. By administering drugs directly into your system by IV, we can give you the perfect dose for your needs. It is safer because, by titration of the dose, we can immediately monitor your level, so the dose is tailor-made for you right when you need it, no more, no less. Not like pills. Further, we have reversal drugs that can be used immediately, if necessary. With pills, it is just not possible to reverse a dose quickly, which is why a lighter dose is used in the first place.
General anesthesia works well in dentistry. However, there is a significant difference. You are no longer using sedatives; you are most likely using Propafal, a hypnotic/amnestic. It requires a separately licensed doctor to administer (an anesthesiologist) because the dentist (the operator) cannot manage an unconscious patient safely and perform dentistry at the same time. If, at any time, you get general anesthesia and the anesthesia is being performed by the operating doctor, think about getting a second opinion.
This is true general anesthesia, just like in the hospital. It is the only true “sleep dentistry.” We do not upcharge for the same service and therefore keep costs low, but it is still about three times more expensive than IV Sedation. I have worked with Dr. Abreu for many years and have performed anything from cleanings to multiple surgeries under general anesthesia and it is useful, especially to those for whom sedation does not work.
Contact Fear Free Dental in Portland, Oregon, if you have any concerns about sedation dentistry. Call Dentist in Portland, OR (503) 291-0000 or visit 4455 Sw Scholls Ferry Rd Suite 101 Portland, Oregon, 97225 to schedule an appointment.
Contact West Hills Dental Center in Portland, Oregon, if you have any concerns about sedation dentistry. Call Dentist in Portland, OR (503) 291-0000 or visit 4455 Sw Scholls Ferry Rd Suite 101 Portland, Oregon, 97225 to schedule an appointment.