Helping Patients Overcome Dental Anxiety
Posted by Howard M. Steinberg, DMD, MDS
Do You Have Dental Anxiety?
Do you feel anxious about going to a dental appointment? Does the thought of a dentist working on your teeth make you cringe? Are you afraid of dentists? If you answered yes to any of these questions, you’re not alone. Between 50% and 80% of U.S. adults feel some degree of anxiety about visiting the dentist.
Dr. Howard M. Steinberg understands dental anxiety and the difficulties that fearful patients experience. Patients often come to him with extreme fear and serious oral health problems. Many of them have avoided dental care for far too long because they were afraid. Dr. Steinberg knows how to talk to people with dental anxiety and has helped many patients overcome their fears and receive the dental care they desperately need.
What is Dental Anxiety?
Dental anxiety is defined as a state of apprehension, unease or fear that some people experience when they go or even think about going to a dentist. There are different degrees of dental anxiety. Some people have more trouble going to a dentist than others. Previous studies have shown the primary reason people avoid dental treatment is fear of pain. The sensation of an anesthetic injection, the sight of a syringe, or the sight, sound and sensation of a dental drill were frequently identified as producing anxiety. Other factors contributing to dental anxiety include traumatic experiences with previous dental treatment, fear of being scolded for oral health neglect, and apprehension about the cost of dental treatment.
Consequences of Dental Anxiety
Dental anxiety often leads to oral disease and emergencies. While many people feel slightly anxious when visiting the dentist, those with extreme anxiety will avoid seeing a dentist for years or even decades. Avoiding regular dental checkups and routine cleanings can lead to tooth decay and other oral health problems. Those with dental anxiety often have a greater prevalence of tooth decay, gum disease and tooth loss. Dental anxiety creates a self-perpetuating cycle, whereby fear leads to avoidance, avoidance leads to crisis, and crisis reinforces the fear. Dental anxiety has negative consequences for dentists as well, including low utilization of dental services, missed appointments, emergency situations and difficulty in providing treatment.
Managing Dental Anxiety
Dr. Howard M. Steinberg recognizes behaviors associated with dental anxiety and communicates with fearful patients to discover why they are afraid. Patients with mild anxiety may only require answers to questions regarding treatment or simple interventions to help them feel more comfortable and reduce their apprehension. Those with moderate levels of anxiety may choose pharmacological interventions such as nitrous oxide or oral sedatives. For patients with extreme dental anxiety, I.V. sedation is highly effective. The anxious patient is given a choice. Patients are also informed of any risks or side effects associated with drugs used to manage anxiety. Here are some of the tools and techniques Dr. Steinberg uses to help patients with dental anxiety feel more comfortable.
Pain-Free Anesthetic Technology
Just the thought of a syringe makes a lot of people afraid. Some dental patients get more nervous than others at the mere sight of a needle. Discomfort from an anesthetic injection is mostly due to the feeling of pressure created by the flow of anesthetic into the tissues. A computerized anesthetic delivery system such as The Wand™ can effectively manage the anxiety resulting from the sight and sensation of conventional anesthetic syringes. This technology administers local anesthetic at a consistent volume and rate, regardless of tissue density or resistance. Several studies have demonstrated that computer-controlled delivery of local anesthetic significantly reduces a patient’s perception of pain.
Sedation dentistry refers to the use of medications to reduce or eliminate dental anxiety. The use of various sedative drugs creates a state of relaxation. Depending on the type of sedation, the patient may not remember much about the procedure. Before considering sedation, the level of fear in the patient is carefully evaluated. A sedation treatment plan is devised based on the needs and goals of the patient. Only then can the appropriate type and level of sedation be determined.
Nitrous Oxide is a sweet tasting gas administered through an inhaler placed over the patient’s nose. It is also known as “laughing gas.” The patient simply breathes in the gas and quickly experiences a state of relaxation. Nitrous oxide is administered to patients requiring relatively short dental procedures and to those experiencing mild to moderate anxiety. The patient remains awake but without any pain or anxiety. Recovery time for patients receiving nitrous oxide is very brief. The effects subside within minutes.
Oral Sedation involves the use of oral medications in the form of a pill or tablet to relieve mild to moderate dental fear. The most commonly prescribed oral sedative medications are Halcion, Ativan and Valium. These drugs produce a high level of drowsiness but not a complete sleep. Oral Sedation is generally administered one hour prior to treatment. The patient remains awake and alert throughout treatment but without the fear he or she might otherwise experience.
Intravenous (IV) Sedation involves the use of medications administered intravenously to produce a totally painless and anxiety-free dental experience. IV can be used for patients with extreme dental fear and for those requiring long dental procedures. The most commonly used drugs for intravenous sedation are Versed and synthetic opiate analgesics such as Demerol. During IV Sedation, the patient is hooked up to a blood pressure monitor, heart rate monitor and pulse oximeter. Though highly effective for managing dental fear, most practitioners are not qualified to administer IV Sedation. Special training and certification are required by most state dental agencies. IV Sedation produces 3 distinct levels of sedation: Conscious Sedation, Deep Sedation and General Anesthesia.
- Conscious Sedation — Conscious Sedation is used for patients with severe anxiety and for those undergoing complex procedures. The patient is very relaxed but not fully asleep. The patient is aware and can respond to questions. Depending on the medications used, the patient will often not remember much of the dental procedure.
- Deep Sedation — Deep Sedation is indicated for dental patients undergoing surgical dental procedures and for the fearful dental patient who says, “I want to be totally knocked out.” During deep sedation, the patient won’t feel any pain and won’t respond to questions.
- General Anesthesia — General Anesthesia is used for patients undergoing extensive surgical dental procedures such as face and jaw reconstruction or the surgical placement of dental implants. This is this the highest level of IV Sedation, where the patient is completely unconscious and not easily aroused.
For all levels of Intravenous Sedation, the dental practitioner must have the proper training, experience, drugs and equipment to identify and manage complications that might occur. Deep Sedation and General Anesthesia should only be performed by a properly trained practitioner, a medical anesthesiologist, dental anesthesiologist or an oral surgeon.
Many people with dental anxiety avoid visiting a dentist. As a result, they tend to develop serious oral health problems. Dr. Howard M. Steinberg understands dental anxiety and treats fearful patients with compassion. With specific tools, technologies and sedation techniques, Dr. Steinberg helps patients overcome dental anxiety.