Sunday, November 7, 2010
Afraid Of The Dentist?
If you are afraid to go the dentist, then you've come to the right Place
Did you know that dental phobias and anxiety stem from a variety of things? From a psychological point of view, this fear could result in “conditioned” response:
Dental anxiety or fear of the dentist is a major stumbling block for many people just like you. It usually prevents otherwise intelligent, rational people from optimizing and maintaining their dental health.
Sometimes when someone has had a painful or negative experience during visits to a dentist's office they may develop “dental phobias”. This can even include careless comments made by a dentist or hygienist to you during a past appointment. Another possible cause of dental fear is a severe discomfort with your vulnerability and/or feeling out of control in the dental situation. People want to be capable of taking care of their own mouth. Sometimes if you are embarrassed of your dental neglect and are afraid of ridicule or belittlement when you’re at the dental office, you might end up with a dental phobia.
Scary stories of bad dental experiences learned through family and friends may cause you to fear the dentist and dental appointments to an extent in which your behavior intervenes in your normal daily routine. Negative, menacing portrayals of dentists in movies, TV, newspapers and magazines also contribute to the many causes of dental phobia, as well as a sense of lack of individual attention. This is intensified by today's necessity for the use of barrier precautions, such as masks, latex gloves and shields. Added to this, you might just be afraid of the unknown, which is undoubtedly a primary factor of dental phobia.
Now, of course it’s not enough to just mention causes concerning this fear, it’s also important that you consider the possibilities, which put simply is a self-reflexive question: “What can I do?” Overcoming the fear is foremost on the list. Once you see that fear is a learned behavior, you can also learn to change it.
You should feel comfortable expressing your fears and concerns. You need an audience, which is to say, you need to be listened to. If you think that your dentist and/or staff are not genuinely concerned and listening to you, then you are not out of line to seek out referrals to other offices. Compromising necessary communication levels is, by no means, as beneficial as a sense of control over your dental office situations.
Remember too that if you’re educated, you’re less anxious. Make sure your dentist explains each and every procedure that is undergone. Good dentists usually have videos, pamphlets, or books for you, explaining the procedures they perform. A good dentist will answer the questions you have, which is likely to lessen your anxiety.
Other ways you can handle dental phobia is to ask your friends and family for dentists they would recommend. You ought to feel free to ask any potential dentist about his or her practice, about their practice philosophy and about the steps he or she takes to make dentistry a positive and beneficial experience. Remember, you shouldn’t be intimidated. You are the patient, the consumer, and it’s the dentist who should be selling you his or her service.
It’s possible that some dentists may go over relaxation techniques with you, which is often beneficial and, for many, a foundation for a solid, controlled experience. Other dentists will play peaceful music for you in the background or allow you to bring in a walkman and headphones. Some dentists even have virtual reality goggles that you can wear during the procedure, which may seem excessive, is allowing more Americans to see that there is a way to over come their fears now more than ever before.
A good relationship between you and your dentist, with good communication, is the key factor in overcoming dental anxiety. You should feel comfortable discussing anxieties with your dentist and should be confident that he or she will do everything possible to reduce your anxiety. If this isn’t the case, than it is time to look for a new dentist who is willing to meet your needs.
Sedation Dentistry for Children and Young Adults
Managing Pediatric Dental Anxiety and Phobias
In dentistry, even with the best intentions and chairside manner of the dentist and dental team, some children and young adults are so apprehensive and fearful that no amount of talking or calming by the dental team will allow the treatment to be completed.
These patients can be helped with sedation dental appointments. A consult with the child's medical doctor is typically completed before a sedation appointment is scheduled.
The child is fully monitored and only the minimum amount of sedation medication is used to safely complete their dental care. The sedation medication can be delivered by mouth, I.V. or I.M.(intramuscular).
Dentistry has come a long way to help children and young adults complete their needed dental care. For those children who just cannot handle regular dental appointments, there is hope with sedation dentistry.
Some commonly asked questions and answers:
1. I hate needles and getting shots in my mouth, can anything be done?
Answer: For regular, non-sedation appointments, a topical anesthetic gel is used on the gum prior to the injection. Some doctors use a topical, Tricaine, which is a combination of three different strong numbing gels. The Tricaine gel is applied and usually left on for a few minutes. It totally numbs the area so you do not feel anything, even a small pinch when the injection is given. As your tooth starts to get very numb, the anesthetic is placed in other areas around your tooth, as needed, as treatment progresses.
2. Am I unconscious or will I feel pain?
Answer: No, you are not totally unconscious but you are extremely relaxed. You will be able to communicate with us and follow our directions but you will have little memory of the appointment, if any at all. This light type of sedation is termed "Conscious Sedation" and all of your protective breathing reflexes are intact. You are continually monitored with a sophisticated medical device during your entire sedation appointment. In our practice we use a Poet 8100 monitor from Criticare Systems. It monitors a 3-level EKG reading, blood pressure, respiration, and heart rate. A pulse oximeter reading of your blood oxygen content which is monitored through the nailbed of one of your fingers with a comfortable external finger monitor and an end tital volume CO2 (Carbon Dioxide) reading as you exhale through your nose. A permanent record is printed out every 5 minutes of all of these vital signs. We monitor your vital signs closely through out the entire sedation appointment. If during the appointment you become too sleepy, we can use a reversal medication to lighten your sedation level. You will not feel any pain during your sedation appointment as you will not perceive any pain or discomfort.
3. What kinds of sedation dentistry are available?
Answer: The most popular are oral, I.V., I.M., and Nitrous Oxide or a combination of these options. Nitrous Oxide (relaxing air) helps you achieve a relaxed state where you are less apprehensive, stress - free, and are able to complete your needed care. Many patients who are apprehensive or fearful can complete their dental care comfortably with the help of nitrous oxide.
For phobic or fearful patients who want to be totally relaxed and have little memory of their appointment, I.V. (intravenous) or I.M. (intramuscular) sedation is recommended. By the time your I.V. is started you are already extremely comfortable and relaxed because you have already taken an oral sedative pill dissolved under your tongue one hour prior to your appointment. In addition, you have been on Nitrous Oxide air, so starting the I.V. will not bother you at all. The I.V. provides your fluids during your sedation appointment. Through the I.V., we use .9% Sodium Chloride (normal saline) to keep you hydrated and provide the necessary medications to keep you very relaxed during your appointment.
Certain sedation medications can be given I.M. (intra-muscular) in an arm or leg muscle or even by drops in the nose (intra-nasal sedation). With any sedation method, doctors typically use only enough sedation medication to keep you safely comfortable throughout your appointment.
4. What Kind of Sedation Medicines Are Used?
Answer: A popular oral medication - sedation that is used is called Halcion. It is a Benzodiazepine that relaxes you, causes drowsiness, and has effects to help you get a great nights sleep the night before your dental appointment. This sedative is placed under your tongue and dissolves, taken up immediately by your bloodstream. Its action starts much sooner and more effectively versus taking the pill by swallowing it. If swallowed, it must pass through your stomach where it is diluted and taken up much more slowly. This is also the reason that I.V. sedation appointments can have a great advantage over oral sedation alone. Sedation medications that can be introduced by intravenous route (I.V.) go directly into the blood stream and the effects take place within minutes. We can titrate, or deliver, the sedation medications slowly and judiciously over lengthy sedation appointments lasting 4, 6, or 8 hours long safely and comfortably. The I.V. medication most commonly used in our office that has the best results and safety record is a Benzodiazepine called Versed (Midazalam). It is a Valium like medication that has a shorter half-life than Valium so it wears off by the end of your sedation appointment. It gives you a wonderful feeling of peace and well being, takes anxiety and apprehension away, and produces amnesia. It is kind on the veins, has a stellar safety record and is widely used in the medical profession during out patient procedures for a number of invasive medical exams such as colon, heart, G.I. procedures to name a few.
If you become too sleepy and relaxed, some doctors may use a reversal agent in the I.V. such as Romazicon (Flumazinil). This medicine takes up the sites of action of the Versed, thus waking you up enough so treatment can continue. You will be unaware you are more alert, but if needed as your appointment proceeds, more Versed can be used to ensure you are comfortable.
A second I.V. medication we commonly use is a synthetic morphine called Fentanyl. It is 10 times stronger than morphine and is classified as a central nervous system (CNS) pain blocker. It is used in conjunction with the Versed to block out the pain receptors in your mouth and body in general to keep you relaxed, pain free, and sedated even during difficult dental procedures.
Did you know that dental phobias and anxiety stem from a variety of things? From a psychological point of view, this fear could result in “conditioned” response:
Dental anxiety or fear of the dentist is a major stumbling block for many people just like you. It usually prevents otherwise intelligent, rational people from optimizing and maintaining their dental health.
Sometimes when someone has had a painful or negative experience during visits to a dentist's office they may develop “dental phobias”. This can even include careless comments made by a dentist or hygienist to you during a past appointment. Another possible cause of dental fear is a severe discomfort with your vulnerability and/or feeling out of control in the dental situation. People want to be capable of taking care of their own mouth. Sometimes if you are embarrassed of your dental neglect and are afraid of ridicule or belittlement when you’re at the dental office, you might end up with a dental phobia.
Scary stories of bad dental experiences learned through family and friends may cause you to fear the dentist and dental appointments to an extent in which your behavior intervenes in your normal daily routine. Negative, menacing portrayals of dentists in movies, TV, newspapers and magazines also contribute to the many causes of dental phobia, as well as a sense of lack of individual attention. This is intensified by today's necessity for the use of barrier precautions, such as masks, latex gloves and shields. Added to this, you might just be afraid of the unknown, which is undoubtedly a primary factor of dental phobia.
Now, of course it’s not enough to just mention causes concerning this fear, it’s also important that you consider the possibilities, which put simply is a self-reflexive question: “What can I do?” Overcoming the fear is foremost on the list. Once you see that fear is a learned behavior, you can also learn to change it.
You should feel comfortable expressing your fears and concerns. You need an audience, which is to say, you need to be listened to. If you think that your dentist and/or staff are not genuinely concerned and listening to you, then you are not out of line to seek out referrals to other offices. Compromising necessary communication levels is, by no means, as beneficial as a sense of control over your dental office situations.
Remember too that if you’re educated, you’re less anxious. Make sure your dentist explains each and every procedure that is undergone. Good dentists usually have videos, pamphlets, or books for you, explaining the procedures they perform. A good dentist will answer the questions you have, which is likely to lessen your anxiety.
Other ways you can handle dental phobia is to ask your friends and family for dentists they would recommend. You ought to feel free to ask any potential dentist about his or her practice, about their practice philosophy and about the steps he or she takes to make dentistry a positive and beneficial experience. Remember, you shouldn’t be intimidated. You are the patient, the consumer, and it’s the dentist who should be selling you his or her service.
It’s possible that some dentists may go over relaxation techniques with you, which is often beneficial and, for many, a foundation for a solid, controlled experience. Other dentists will play peaceful music for you in the background or allow you to bring in a walkman and headphones. Some dentists even have virtual reality goggles that you can wear during the procedure, which may seem excessive, is allowing more Americans to see that there is a way to over come their fears now more than ever before.
A good relationship between you and your dentist, with good communication, is the key factor in overcoming dental anxiety. You should feel comfortable discussing anxieties with your dentist and should be confident that he or she will do everything possible to reduce your anxiety. If this isn’t the case, than it is time to look for a new dentist who is willing to meet your needs.
Sedation Dentistry for Children and Young Adults
Managing Pediatric Dental Anxiety and Phobias
In dentistry, even with the best intentions and chairside manner of the dentist and dental team, some children and young adults are so apprehensive and fearful that no amount of talking or calming by the dental team will allow the treatment to be completed.
These patients can be helped with sedation dental appointments. A consult with the child's medical doctor is typically completed before a sedation appointment is scheduled.
The child is fully monitored and only the minimum amount of sedation medication is used to safely complete their dental care. The sedation medication can be delivered by mouth, I.V. or I.M.(intramuscular).
Dentistry has come a long way to help children and young adults complete their needed dental care. For those children who just cannot handle regular dental appointments, there is hope with sedation dentistry.
Some commonly asked questions and answers:
1. I hate needles and getting shots in my mouth, can anything be done?
Answer: For regular, non-sedation appointments, a topical anesthetic gel is used on the gum prior to the injection. Some doctors use a topical, Tricaine, which is a combination of three different strong numbing gels. The Tricaine gel is applied and usually left on for a few minutes. It totally numbs the area so you do not feel anything, even a small pinch when the injection is given. As your tooth starts to get very numb, the anesthetic is placed in other areas around your tooth, as needed, as treatment progresses.
2. Am I unconscious or will I feel pain?
Answer: No, you are not totally unconscious but you are extremely relaxed. You will be able to communicate with us and follow our directions but you will have little memory of the appointment, if any at all. This light type of sedation is termed "Conscious Sedation" and all of your protective breathing reflexes are intact. You are continually monitored with a sophisticated medical device during your entire sedation appointment. In our practice we use a Poet 8100 monitor from Criticare Systems. It monitors a 3-level EKG reading, blood pressure, respiration, and heart rate. A pulse oximeter reading of your blood oxygen content which is monitored through the nailbed of one of your fingers with a comfortable external finger monitor and an end tital volume CO2 (Carbon Dioxide) reading as you exhale through your nose. A permanent record is printed out every 5 minutes of all of these vital signs. We monitor your vital signs closely through out the entire sedation appointment. If during the appointment you become too sleepy, we can use a reversal medication to lighten your sedation level. You will not feel any pain during your sedation appointment as you will not perceive any pain or discomfort.
3. What kinds of sedation dentistry are available?
Answer: The most popular are oral, I.V., I.M., and Nitrous Oxide or a combination of these options. Nitrous Oxide (relaxing air) helps you achieve a relaxed state where you are less apprehensive, stress - free, and are able to complete your needed care. Many patients who are apprehensive or fearful can complete their dental care comfortably with the help of nitrous oxide.
For phobic or fearful patients who want to be totally relaxed and have little memory of their appointment, I.V. (intravenous) or I.M. (intramuscular) sedation is recommended. By the time your I.V. is started you are already extremely comfortable and relaxed because you have already taken an oral sedative pill dissolved under your tongue one hour prior to your appointment. In addition, you have been on Nitrous Oxide air, so starting the I.V. will not bother you at all. The I.V. provides your fluids during your sedation appointment. Through the I.V., we use .9% Sodium Chloride (normal saline) to keep you hydrated and provide the necessary medications to keep you very relaxed during your appointment.
Certain sedation medications can be given I.M. (intra-muscular) in an arm or leg muscle or even by drops in the nose (intra-nasal sedation). With any sedation method, doctors typically use only enough sedation medication to keep you safely comfortable throughout your appointment.
4. What Kind of Sedation Medicines Are Used?
Answer: A popular oral medication - sedation that is used is called Halcion. It is a Benzodiazepine that relaxes you, causes drowsiness, and has effects to help you get a great nights sleep the night before your dental appointment. This sedative is placed under your tongue and dissolves, taken up immediately by your bloodstream. Its action starts much sooner and more effectively versus taking the pill by swallowing it. If swallowed, it must pass through your stomach where it is diluted and taken up much more slowly. This is also the reason that I.V. sedation appointments can have a great advantage over oral sedation alone. Sedation medications that can be introduced by intravenous route (I.V.) go directly into the blood stream and the effects take place within minutes. We can titrate, or deliver, the sedation medications slowly and judiciously over lengthy sedation appointments lasting 4, 6, or 8 hours long safely and comfortably. The I.V. medication most commonly used in our office that has the best results and safety record is a Benzodiazepine called Versed (Midazalam). It is a Valium like medication that has a shorter half-life than Valium so it wears off by the end of your sedation appointment. It gives you a wonderful feeling of peace and well being, takes anxiety and apprehension away, and produces amnesia. It is kind on the veins, has a stellar safety record and is widely used in the medical profession during out patient procedures for a number of invasive medical exams such as colon, heart, G.I. procedures to name a few.
If you become too sleepy and relaxed, some doctors may use a reversal agent in the I.V. such as Romazicon (Flumazinil). This medicine takes up the sites of action of the Versed, thus waking you up enough so treatment can continue. You will be unaware you are more alert, but if needed as your appointment proceeds, more Versed can be used to ensure you are comfortable.
A second I.V. medication we commonly use is a synthetic morphine called Fentanyl. It is 10 times stronger than morphine and is classified as a central nervous system (CNS) pain blocker. It is used in conjunction with the Versed to block out the pain receptors in your mouth and body in general to keep you relaxed, pain free, and sedated even during difficult dental procedures.
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