Sedation
For many people the thought of a visit to the dentist can be a daunting experience. Despite the vast improvements in dentistry over the past decade, which mean that most dental procedures can be delivered in a pain free and stress-free manner.
Everybody has some experience or situation that causes them anxiety and for some people it can be a visit to the dentist. A figure proposed by a range of studies put the figure at 33% for people experiencing dental anxiety, and this fear can be so great sometimes that it leads to people avoiding dental treatment in it’s entirety leading to great pain for themselves, a deterioration in dental health and also in their quality of life.
Anxiety tends to be a learned response, acquired from personal experience or secondarily through the experiences of others. Anxiety arises from anticipation of an event, the outcome of which is unknown. The signs that may be noticed are an unnaturally stiff posture, nervous and fidgety, white knuckles, perspiration of hands and forehead, the anxious patient will often answer quickly to questions, and may well be uncooperative. The symptoms associated with it may linger or may even be present in varying degrees before an actual encounter with the feared situation, or even when the stimulus is not present or readily identifiable.
Thus anxiety is what happens in anticipation of a visit to the dentist whilst fear is what happens actually at the surgery.
These components may also develop into a which can be defined as a pervasive fear associated with high levels of anxiety, usually linked to a specific object, situation or event. It involves some degree of social incapacity as a result, such as in our case the person not being able to visit the dentist. They can cause most individuals to manifest shame and helplessness, to become chronic avoiders constantly making up excuses such as not feeling well or the car braking down. This response protects the individual from the stimulus and often more importantly the unpleasant physical symptoms that are associated with them. It is not responsive to reasoning, although the sufferer may have some insight into the irrationality of their fear.
In this situation the fight or flight response is very marked.
With the knowledge of the anxiety that dentistry can evoke in people, we need to be mindful of helping those people for whom dentistry is a stressful event in their lives.
There are many measures that we can take to make a visit to the surgery as pleasant an experience as possible. in brief some of the ways in which we try to achieve this is by creating a friendly and welcoming atmosphere. We try to achieve an informal environment , combined with pleasant surroundings.
For those people who require some greater assistance to overcome the anxiety associated with a visit to the dentist we are able to offer several types of sedation, which aims to suppress the anxiety, produce relaxation and make the visit to the dentist an altogether more acceptable experience.
It must be stressed that dental sedation is different to general anaesthetic. General anaesthetic aims to produce unconsciousness in the patient, sedation does not aim to render the patient unconscious, but instead achieves reduction in anxiety, relaxation and drowsiness, but verbal contact is maintained throughout the procedure. Thus sedation is an inherently safe procedure if used within the guidelines that we strictly adhere to at Laburnum Dental Practice.
All of the dentists in the practice have attended postgraduate training in sedation, David Robinson in addition also attended a one year Diploma at Newcastle Dental School in Conscious Sedation. We have two Dental Nurses who have gained qualifications in Sedation.
The practice has been fully equipped with all the required equipment to carry out safe sedation, with items such as a “pulse oximeter” we are able to continually monitor patients undergoing sedation to make sure they are oxygenated to optimum levels.
Sedation does not aim to render the patient unconscious, but instead achieves reduction in anxiety, relaxation and drowsiness. Verbal contact is maintained throughout the procedure so it is an inherently safe procedure, if used within the guidelines, to which we strictly adhere at Laburnum Dental Practice.
There are three types used by our dentists:
Inhalational Sedation ("Happy Air")
A mixture of nitrous oxide (25-30%) and oxygen is inhaled through a nose-piece. This gradually causes mental and physical relaxation, euphoria, headiness and sometimes a feeling of floating. Also, patients may experience a warmth and tingling of extremities. Sounds may appear distant with buzzing in the ears often noted. After the procedure 100% oxygen is breathed for 2 minutes and then the patient is fit to leave after a further 10 minutes breathing air. Two advantages of this type of sedation are the lack of need to use a needle for the drug and some analgesia (pain relief). It is a pleasant experience and there are no after effects so adults are fit to continue their day normally.
Oral Sedation
This is more difficult to regulate as the patient must take the drug themselves. Medication is usually given the night before appointment to help a restful nights sleep and provide some degree of sedation before the appointment.
Intravenous Sedation
The drug (midazolam) is given intravenously and sedation is fairly rapid. Patients are drowsy later and must always
be accompanied home and will not be able to work, look after children or sign any legal documents. This is because midazolam is an amnesic - it causes loss of memory. So even though the patient will be able to talk all the way through the procedure, most of the events will be completely forgotten!
Full instructions are given before any sedation appointment and blood pressure readings are taken to ensure the patient is fit for treatment.