Whether you get funny in the tummy just thinking about it, or you have serious dental-chair trauma, it can help to learn about what’s what in dental sedation – so you’ll know exactly what’s going on when you’re called into the dental room.
Here we talk with Dr David Kerr. about the options for people who suffer from dental fear and dental anxieties.
The majority of procedures in the chair are done with local anaesthetic, with the patient fully conscious. They receive an injection in the mouth, numbing the area but leaving them aware of what’s going on, the noises and the vibrations. They’re awake during the whole thing, but they won’t feel any pain. The anaesthetic lingers for a few hours afterwards, then everything is fine.
For some people, though, the noises, vibrations and awareness of what’s going on in their mouth is just too much for them. If it’s a minor procedure like a filling but a patient is so anxious they can’t cope, we’ll consider doing an intravenous (IV) sedation.
If the scope of work includes a lot of surgery, such as for dental implants or tooth extraction, we can consider other sedation methods such as general anaesthetic.
Intravenous sedation involves the intravenous injection of a drug called Midazolam, which puts you in a happy place! You’re conscious, reacting and loving life… I treated a lady recently and she was so anxious that she was freaking out unbelievably, so we used IV sedation. It puts you in a different place, but you still stay quite conscious. If we say, “Open wide,” you’ll open wide. You’ll do those things, but it has an amnesiac effect, so you don’t really remember what happened.
With general anaesthetic, you’re what a lot of us call ‘put under’ – you’re unconscious and completely unaware of everything. You’re put on a ventilator, you go to sleep and go all floppy, then later… you wake up.
A medical specialist called an anaesthesiologist will administer either the intravenous sedation or general anaesthetic. The anaesthesiologist takes care of the patient, pre- and post-op, working with registered nurses, usually in a private hospital.
Twilight sedation is just another name for IV sedation. It doesn’t put you under, but it gives you a happy and relaxed feeling.
Not really – it’s a different thing. IV sedation is an intravenous medication, whereas nitrous oxide is a gas.
In my opinion, it has a very minimal effect on people and for some it has more of a placebo effect. In comparison, IV sedation is like having 20 gin and tonics!
Local anaesthetic is very well tolerated. While being very safe, general anaesthetic is a bit more involved. Some people don’t react well coming out of it, depending on the length of the procedure.
The main thing about both, particularly for general anaesthetic, is that these procedures need to be supervised by a qualified specialist anaesthetist and you need to be medically sound. We’ll check your medical history before the procedure and we must know your height and weight. If you’re unwell, IV sedation is usually done in preference to general anaesthetic. There’s just less risk.
For tooth fillings and simple procedures, IV sedation is better because you can get patients to bite properly and they can be cooperative.
When we’re doing more complicated work like extraction dentistry or dental implants, general anaesthetic can probably be considered the better way to go because you have complete control.
What if a patient has a fear of the dentist?
Dentistry shouldn’t be painful. We know it can be a big ordeal for an anxious patient, but we’ll do whatever we can to help you.
If it’s all too much, we can definitely talk to you about what other avenues we can consider. There’s actually no particular procedure – taking out wisdom teeth, whatever – that can’t be done under a local anaesthetic. Other methods are simply tools for patients to deal with pain and anxiousness.
In general dentistry, it’s commonplace for dentists to refer patients to an oral surgeon for more complicated surgery like wisdom teeth extraction or dental implants, where you’ll be treated in a private hospital. Conventionally, these hospitals are set up for operations but don’t have the equipment for general dentistry.
Today’s Dentistry now has its own dental theatre in the Brisbane CBD, which is exactly the same as a dental surgery but it has all the proper dental care that we need to perform procedures under a range of sedative and anaesthetic, from nitrous oxide to intravenous sedation and general anaesthetic. It’s one of the few Brisbane dental facilities that offer this.
From a patient’s perspective, they don’t have to worry about seeing two different people – a dentist, as well as an oral surgeon. We’ll be happy to do the treatment. Anything we can do in our own surgery at Today’s Dentistry or at a private hospital, we can do at this specialised clinic.
Dental fear Brisbane: We can talk to you more about specialised treatments for highly anxious patients. Or if you’re coming in for a dental check-up and are feeling worried, please just let our understanding staff know. Call Today’s Dentistry now on 07 3263 2677 or book an appointment online.