Many factors can contribute to a child’s fear of the dentist. On top of that list is a bad experience at a previous dental appointment. The younger the age, the higher likelihood that a child will have a fear of the dentist. It has even been shown that parents can pass along their own fear of the dentist. Children are very perceptive and can sense that a parent is stressed when talking about a dental visit. I employ a number of techniques to help allay a child’s fear. We have TV’s in the ceiling with cartoons playing which helps distract the child. Just something as simple as using a gentle, friendly voice and a smile can also put the child at ease. The “tell-show-do” technique works great. I tell them about the “water sprayer” that will flush out all of the “cavity bugs”, then I will take the dental hand piece and spray water on their hand so that they can see that there is nothing to fear. Then, for the “do”, I touch the anesthetized tooth which produces a gentle vibration so that they can see that there is no pain. And speaking of the numbing process, they are never shown the needle. They just get a little “pinch” to put the tooth to sleep. By employing just a few simple techniques can greatly reduce a child’s fear of the dentist and make it a pleasant experience.
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IV Sedation in Dentistry
It is not unusual to have some apprehension before a dental appointment. Most, if not all, of that normally goes away once the area to be treated has been numbed. However, some people have dental phobias, usually related to past, unpleasant experiences that make even a routine dental visit a stressful occasion. For most of these people, either nitrous oxide and/or oral sedation is adequate to quell the fears, but there are still a few who need deeper sedation. There are a number of wonderful medications that can be delivered intravenously. Since these are given IV, they can be titrated (adjusted) to the perfect level for each individual patient. We use Versed (midazolam) in our office. It is a very safe sedative that can fully relax a patient, but keep their protective reflexes and their ability to respond to commands intact.
Monitor vital signs
We monitor vital signs continuously to assure the highest level of safety. It is important that the patient does not have anything to eat or drink after midnight. They also must have a ride home after the procedure and should not drive or operate machinery for the next 24 hours. The addition of IV sedation to a dentist’s armamentarium can make a dental procedure extremely pleasant for even the most fearful patient.
Nitrous Oxide Sedation
Administration of Nitrous Oxide
Nitrous oxide (laughing gas) is an extremely helpful adjunct for dental treatment of the fearful patient. It was first discovered by Joseph Priestley in 1772, however, it was not until 1844 when Horace Wells used it as a medical anesthetic. Today, nitrous oxide is used in conjunction with local anesthetic when performing dental treatment on apprehensive patients. Nitrous oxide on its own cannot reliably anesthetize a patient profoundly enough for a patient not to feel a thing. Therefore, it must be used with novocaine to numb the area. Nitrous oxide is administered with pure oxygen and is breathed through a nasal hood. The machine that delivers the gas is a fail-safe machine which will turn off if the oxygen level falls below 35%. Nitrous oxide is not meant to put one to sleep, but merely relax. When given before the anesthetic injection, it can make that part of the procedure much more comfortable. It will put a patient in a state of mild euphoria and will alter the perception of sights, sounds, and time. It also has a mild amnesic effect leaving much less memory of the procedure. Another extremely nice feature of nitrous oxide is that the patient can be flushed with pure oxygen after the procedure and be totally lucid and able to drive home. Nitrous oxide can make a dental appointment a very pleasant experience.
Oral Sedation for Dentistry
Fear of dental treatment is very common. Some times, good anesthetic technique, behavior modification, and nitrous oxide (laughing gas) may not be enough for someone who is very fearful. Oral sedation comes to the rescue. It is important to get a good night’s sleep before a dental appointment, but with dental phobics, that can be difficult to do.
Ativan 2mg Tablets
At our office, we use Ativan (lorazepam), a relatively long acting sedative. We prescribe two pills. One of those pills is taken before bedtime which helps a patient get a good night’s sleep. The other pill is taken an hour before the appointment. Since Ativan is very long acting, there will still be some blood level left from the initial dose, thus providing for an extremely relaxed state once the dental appointment begins. Conscious sedation is very safe because the patient still has their protective reflexes and is able to respond to commands readily. However, they are extremely relaxed to the point that the sights, sounds, and vibrations associated with dental treatment are minimized immensely. The concept of time is altered so that the appointment seems to fly by and there is also an amnesic effect so that the patient has very little memory of the procedure. Afterwards, the patient is delightfully drowsy and will go home and have a very restful nap.
Tips to Overcome One’s Fear of the Dentist
There are many ways to overcome one’s fear of the dentist. First of all, don’t wait until the tooth hurts. It makes it more difficult for the dentist to get you numb. Plus the pain leading up to the appointment can be associated with the dental visit itself. The dental appointment itself is really nothing to be fearful of as long as good local anesthetic technique is used to numb the area. Try to get a good night’s sleep and avoid caffeinated drinks that could raise the anxiety level. For the novocaine injection, try to relax your muscles, especially your hands. Try this the next time you are in rush hour traffic and notice that your hands are tightly clasped to the steering wheel, consciously relax your grip and notice how the rest of your body will follow suit. Another trick is to find something on the ceiling to fixate on. We have televisions in our ceiling. This way patients can either watch cable TV or a serene aquarium movie to help keep their mind on things other than the injection. By flooding one’s brain with visual stimuli and concentrating on relaxing the hands, the anesthetic injection experience can be minimized greatly. Once the initial numbness has been achieved, further injections can be done relatively pain free. The remainder of the appointment should be a piece of cake and should be fear free.
Fear of the Dentist
Fear of the dentist is a very common problem. It is not unusual for one to be somewhat apprehensive before one’s dental appointment, however, a higher level of anxiety can be a result of a real dental phobia. Dental phobia can cause a person to avoid dental treatment. Many dental phobias start with a bad experience at the dentist, especially as a child. In our office, we never do any potentially painful treatment without first numbing the area. Since we are a sedation practice, we see a high number of dental phobic patients. The common source of their dental fears came from an experience where their dentist kept drilling on their tooth even though the individual indicated that it hurt. Another common problem comes from the patient delaying treatment until they are in extreme pain. Not only is it extremely difficult to get someone numb in that situation, but also even if you can get the tooth numb, just the experience alone can be enough to cause the patient to avoid further dental treatment.