Researchers report up to 20 percent of Americans experience serious anxiety associated with dental visits. In many cases, the fear is grounded in a bad experience during childhood. Adults who are afraid to go to the dentist often don't get preventive dental care and avoid going to the dentist until severe discomfort or a serious dental problem occurs. When that happens, the patient most likely needs extensive dental work, requiring frequent and/or long dental visits, causing more anxiety.

In addition to avoidance, anxiety can influence the level of pain during a dental visit. Fear heightens the senses. The sensations of touch and sensitivity are magnified. The sounds and sights of the dental instruments and the smell of the office, can increase anxiety levels further. Fear also raises the "fight or flight" instinct. Muscles tense and the patient is unable to relax.

Sedation Dentistry

Dentists typically use topical medications to numb injection sites and injectable local anesthetics to relieve pain and discomfort during treatment. But Todd Thierer, D.D.S., M.P.H., Dentist with the University of Rochester Medical Center, says that's often not enough to eliminate fear and sensitivity in anxious patients.

Sedation dentistry is the use of medications and techniques to promote relaxation and reduce apprehension and fear-associated sensitivity. Patients who receive sedation can have extensive dental work taking several hours. Yet, the time passes by unnoticed and may feel like only a few minutes.

There are several different kinds of medications that can be used in sedation dentistry.

Nitrous oxide. Nitrous oxide (NO) is commonly known as laughing gas. It's combined with oxygen and given through a small mask placed over the nose. NO can be used on adults and children and causes few side effects. Thierer says patients who use NO must remember to breathe through their nose, rather than the mouth, to ensure the gas is delivered to the lungs.

Oral medications. There are several different kinds of oral medications that can be used to promote relaxation or alleviate anxiety associated with a dental visit. Drugs, like Versed®, last only a short amount of time, and are best for simple procedures. Other medications, like Valium®, last much longer and may be a better option when extensive dental work is needed. Some other examples of oral medications used in sedation dentistry include Halcion®, Sonata®, Ativan® and Vistaril®. For some patients, oral medications may be used in combination with NO.

IV Sedation. Intravenous (IV) sedation involves the use of medications that are injected directly into the vein. Thierer says he likes to use IV sedation because the technique induces sedation very quickly. Patients are awake and breathing on their own, yet unaware of what's going on around them. In addition, the dose of the drugs can be adjusted throughout the procedure to provide more control over sedation. If the patient needs to be brought back to full awareness, another medication can be given to quickly reverse the effects of the sedative. With oral medication, once a drug is given, the dentist has no control on the level of sedation and no ability to reverse the drug's effects.

Thierer says sedation dentistry is not an exact science. Every patient responds to medications in different ways. There is a chance of adverse effects that, in some cases, can be life threatening, like respiratory distress. Patients should make sure a dentist who is using sedation practices is trained in the proper use of the drugs and has the appropriate education and equipment to deal with an emergency.

For information, or to find a dentist who offers dental sedation, visit, http://www.sedationcare.com.

For general information on dental topics:

Academy of General Dentistry

American Academy of Pediatric Dentistry

American Dental Association