The Ultimate Guide to Sedation Dentistry in Boston, MA
It’s not a mystery that several grown adults—avoid trips to the dentist. According to a study in 2015, over 58% of the population exhibit dental anxiety and approximately 17% of those people avoid going to the dentist because of it. That’s a lot of unnecessary frightened people.
Many factors contribute to dental anxiety, but if you or a family member are avoiding the dentist due to anxiety, then it might be worthwhile to consider if sedation dentistry is right for you.
Just like you would want to be sedated for a colonoscopy or other medical procedures, it’s understandable that you consider sleeping through dental procedures. Sedation dentistry is an effective and safe method for overcoming dental anxiety and resting comfortably during dentistry from simple restorative to complex dental surgery. This article, written by a nationally leading sedation dentist, will explain everything you need to know about overcoming dental anxiety and how sedation dentistry can help.
Why Patients Fear the Dentist
Everyone has something they fear. Absolutely everyone. For some people, it might be public speaking, for others it might be a fear of heights, and for some, it’s a fear of going to the dentist. For some, dental phobia may even be their biggest fear. We all harbor fears deeply rooted in our past. It could be from a negative previous experience that we will never forget or a series of uncomfortable experiences. However, just as the past has a powerful effect on us, the present and future can too. Let me tell you the elephant story.
Do you remember those old fashioned circuses? Think of the elephant for a moment. They secured that elephant by a small wooden stick in the ground. If you’re like me, you’re looking at that stake and thinking…one of the largest animals on earth, and that stick is going to stop them? Yeah right! That elephant is a classic example of how previous experiences become rooted in fears.
Here’s why: The elephants are conditioned by the past – just like all our fears. When the elephants were babies, they were trained. The baby elephant fights against the rope to try to break free but they are not strong enough yet. What happens is, after a while…they stop trying. The elephant decides, ‘I’m not capable of pulling this out.’ So even when they grow up, their belief that they are not capable has been cemented by the past. According to motivational speaker Tony Robbins, “Once that becomes the identity of anyone” – an elephant, in this case – “they don’t even try, anymore.” Our previous experiences have a powerful ability to distort the reality of our present and future. This is the foundation of all fears.
The fear created by dental anxiety is normal and common, but we must not let our previous experiences lead us to believe that the future will always be the same as the past.
What is Sedation Dentistry?
Sedation dentistry is a solution to a dental phobia that helps many patients overcome their fear of the dentist. Here’s how sedation dentistry works: depending on how severe your anxiety is you can choose between different levels of sedation for your procedure in addition to also being numb from local anesthesia. Dental sedation offers patients relief from anxiety and pain and ensures a pain–free procedure. Sedation dentistry can be utilized for many simple dental procedures, even dental cleaning for those patients that are severely dentally anxious, or it can be used for very complex dental procedures.
There are several levels of sedation commonly used by dental sedation specialists. At an initial consultation, you will discuss with your sedation dentist your fears and the treatment needed. With those facts in mind, together you will decide the best type of dental sedation for your needs. Here is a breakdown of the varying types of sedation dentistry also commonly called sleep dentistry typically used:
- Nitrous oxide: This is the mildest form of dental sedation, and while it can’t break through severe anxiety, it can help reduce mild anxiety and decrease discomfort for less invasive dental procedures. Although the technical name of the gas used is called nitrous oxide, the more common layman’s term is known as laughing gas.
The way nitrous oxide works is the patient wears a small mark on their nose known as a nasal hood. Nitrous oxide is combined with oxygen, and the patient breathes normally during the procedure. The nitrous oxide reduces anxiety and dulls the sensation of pain similar to the effect of having a couple of glasses of wine.
The benefit of nitrous oxide in the dental office is that it is completely reversible within seconds, and the patient can drive themselves home after the dental procedure without any effects or hangover. There are also very few contraindications to use of nitrous oxide with the primary contraindications being pregnancy and respiratory infections.
- Oral sedation: Also known as enteral sedation, this option involves all forms of sedation in which a patient is given a pill to take or place under their tongue at the dental office. This option can produce a deeper level of sedation than laughing gas alone, and it can even be combined with laughing gas for a synergistic effect.
Oral sedation induces relaxing and even light sleep during the procedure and also has the benefit of reducing memory of the procedure. Patients often believe they were sleeping during the procedure even if they were conscious during times. Oral sedation is generally completed with medications in the benzodiazepine family such as triazolam or lorazepam. The dose can be titrated for the desired level of sedation to achieve comfort based on the patient’s anxiety and length of the procedure.
The patient will need to arrange for a drive home from the visit and will also need to fast for 6-8 hours prior to the procedure. The primary disadvantage of oral sedation is the ability to titrate. Because oral medications take approximately 30-45 minutes to enter the bloodstream, the level of sedation cannot easily be increased or decreased without waiting for the medication to take effect.
- IV sedation: Dental IV sedation is the preferred choice of sedation for those patients who have more than mild or moderate jitters about dentistry. IV sedation dentistry allows the greatest level of control of sedation.
Similar medications as oral sedation are used, but the level of sedation can be altered more precisely due to the medications entering the bloodstream more rapidly. Due to the ability to dose more effectively in real-time, IV sedation in the dental office generally allows even the most severely anxious patients to be treated.
With dental IV sedation, the medications will help with anxiety as well as pain, and you will be placed in a deeply relaxed state and feel as though you were sleeping throughout the procedure. You may still be conscious at times during the procedure, but to you, the environment would be carefree. Your dentist will continuously monitor your level of sedation and all your vital signs thoroughly during the procedure and adjust it as necessary. Because the medications are delivered intravenously, the medications can also quickly be reversed if needed which is generally not needed.
- General anesthesia: This is the deepest level of sedation available in dentistry, and it generally is not needed for most patients in the dental setting. General anesthesia should only be performed by highly–qualified practitioners with a degree in anesthesiology and appropriate settings such as a hospital or surgical center. This type of sedation is used most frequently for patients with special needs, those who have complex medical histories, or those who require highly invasive surgical treatments.
Who Benefits Most from Sedation Dentistry?
Anxious patients at the dentist. As mentioned, dental anxiety is a highly present issue among adults. Sedation dentistry is a solution that helps many patients overcome their fear of the dentist. As you build more confidence and positive experiences with your dental provider, the level of dental sedation can often be reduced for future visits. Although it is always an option, many severely anxious patients are totally surprised that they eventually no longer need sedation after several sedation visits. Sedation dentistry helps a patient to face their fears easily and eventually desensitizes them to their fear of the dentist.
Patients requiring numerous or complex dental procedures. When it’s been a while since your last dental visit, the sheer amount of work can be overwhelming. Patients are often stressed to think of having to affect their work schedule to make time for a series of appointments. And for many CEOs and celebrities, it’s not even an option to allow for that number of visits around their travel schedule. Because sedation dentistry allows a significant amount of work to be completed in half a day, many patients find huge value in the efficiency sedation dentistry creates. For a patient even rebuilding their entire mouth, it may often be accomplished in even two or three visits.
Special needs patients. Special needs patients often benefit from dental sedation by making visits physically easier for them and more efficient. Often special needs patients develop a large number of dental needs and are unable to access care for a variety of psychosomatic reasons. Sedation dentistry often helps special needs patients to overcome the sensory challenges of taste, smells, textures, and pain that is often overwhelming at the dental office for their population. The comfort plan for the patient can be customized based on the various needs and degrees that exist in the special needs population.
What if I am Afraid of Needles at the Dentist?
Approximately 20 million Americans have a severe fear of needles. If you fear the dentist primarily because you are afraid of needles, you are not alone. A phobia of needles is a very common fear, and understandably so.
The most common symptoms of needle phobia include:
- Extreme panic attacks
- Fainting, nausea, dizziness
- Rapid heart rate,
- Increased blood pressure
- Difficulty sleeping before the procedure
- Physical resistance
There are ways to overcome needle phobia. For more expansive details about needle phobia at the dentist, visit our blog on how to cope with needle phobia. And yes, you probably guessed it…sedation dentistry has a huge benefit to overcoming a phobia of needles at the dentist. Dentists that specialize in dental anxiety will have all the tips and tricks to aid the patient in overcoming needle phobia. Some of the methods include using an extra-strength topical anesthetic, weighted blankets, and using nitrous oxide and oral sedation prior to using any form of needles.
What does Sedation Dentistry feel like?
For any procedure with dental sedation, regardless of the level of sedation, patient comfort is of high priority. Patients are offered comfort items like weighted blankets, noise-canceling headphones with the music of their choice, and any other special requests at the start of their visit. During the procedure, sedation may induce light sleep for some or all of the time. If a patient does wake up during the procedure, they generally will feel relaxed, euphoric, and careless. The patient will always be numbed with a local anesthetic so they will never feel pain from the procedure. The dentist and team will continuously monitor the patient for comfort and safety, and continuously make adjustments to keep the patient at an ideal level during the procedure.
Am I a Candidate for Sedation Dentistry?
Health Contraindications to Sedation Dentistry: Some medical conditions prevent a person from being a proper candidate for sedation dentistry. Some of the most common contraindications to sleep dentistry are:
- If you are pregnant
- If you are allergic to many sedatives
- If you have a central nervous system compromise
- If you have untreated glaucoma
- If you have severe resistance to medications
- If you have uncontrolled cardiac or respiratory conditions
Commitments Required prior to Sedation Dentistry: Sleep dentistry allows for a large amount of treatment to be completed in very few visits. However, for those visits, there is some planning that the patient must be willing to commit to. The patient should expect the following for their sedation dentistry appointment:
- Plan to fast for at least 6 hours prior to your appointment
- Plan for adequate time for an appointment and some time to recover afterward
- Arrange for a ride to and from the appointment
- Avoid alcohol consumption before the procedure or any medications you haven’t discussed with your dentist
Are there Risks to being Sedated at the Dentist?
As with any procedure, proper planning leads to success. Sedation dentistry involves proper planning and evaluation before undergoing sedation. When performed by an experienced board-certified sedation dentist, sedation dentistry is very safe.
During all sedation dental procedures, the patient is continuously monitored for safety. For oral sedation and IV sedation, the monitoring includes continuous monitoring of pulse, blood pressure, blood oxygen, blood CO2, and respiration. Although reversal is not usually needed, if there is a concern at any point about safety, the medications may be fully reversed with a reversal agent.
Does Insurance Cover Dental Sedation?
Many insurance companies do not pay for the cost of the dental sedation but will contribute toward the dental procedure or surgery. If you require a significant amount of dental work, the investment of sedation dentistry begins to pay itself back when you factor the benefit of efficiency. Because sedation dentistry allows for several dental procedures to be completed in one visit, it helps to recoup cost when you consider there will be fewer visits and less disruption from your work schedule. Moreover, if you’re undergoing dental surgery or any other type of intensive dental treatment, your dental or medical insurance provider may cover the cost of sedation if it allows the procedure to be completed in one appointment. The amount of insurance coverage depends on the specific insurance policy you have purchased.
The Top Five Reasons Sedation Dentistry Has Redefined Dentistry
- Anxiety Control. Dental anxiety is a widespread issue. Many patients avoid the dentist for years due to anxiety which leads to poor dental health, increases the amount of treatment needed, and further increased anxiety. Dental sedation helps patients alter the stress of a dental office and convert it into a more relaxing experience.
- Eliminate of Discomfort. Pain is a part of life that all humans are seeking to avoid, so why not choose to make experiences less painful? Pain during infections and dental surgery cannot be fully managed using local anesthesia only. Sedation dentistry is monumental in systematically controlling pain in addition to local anesthesia.
- Less Interruption to Work Schedule. Patients that have complex dental issues are often discouraged by requiring numerous dental appointments to complete their treatment. Dental sedation helps patients with busy and successful lives condense their treatment to be completed with a high level of quality in less time.
- Gag Reflex Control. The gag reflex is a natural reflex that protects us from injury. Some people’s gag reflex, however, prevents them from proper dental care because it is hypersensitive. Sedation dentistry acts to dull the gag reflex and allows patients to complete dental treatment with a gag free experience.
- Needle Phobia. A study in 2015 showed that approximately 14% of people had avoided the dentist due to needle phobia. That’s a lot of people that are dreading the dentist because of needles. If needles are preventing you from proper dental treatment, sedation dentistry can help you overcome your phobia of needles.
About the Author: Dr. Charles Sutera is a nationally leading sedation dentist that advocates for patient comfort in the dental industry. His practice, Aesthetic Smile Reconstruction is a complex reconstructive sedation practice in the Boston Metro area. Known for high profile smile makeovers of the dentally anxious, Dr. Sutera has treated some of the most anxious patients in the country.
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