Some patients have extreme anxiety about any type of medical / dental care.
They avoid treatment for so long that ultimately they need major procedures on one or more teeth or even extensive full mouth treatment.
They may build up their fear level so high that they feel the only way to get needed treatment is with general anesthesia - sleeping through it all.
We hear radio ads and see printed ads on every media including the internet that offer patients the alternative of sleep dentistry. Some make it sound easy to have everything done in one session including cosmetic treatment. While this sounds wonderful at first glance, there are significant reasons not to undergo general anesthesia for complete dental care:
1) Local Anesthetics are much safer.
2) Some procedures, especially cosmetic procedures and very large restorative cases require interaction with the patient. Patients need to open and close, smile, offer their opinions and approval.
3) Many restorative procedures - from simple fillings through complete bridges or dentures require that the bite be checked. This can only feasibly be done with an alert and co-operative patient.
4) Many dental procedures require water cooling, irrigation and rinsing. When patients are completely sleeping, this is difficult and very compromised.
5) Complex dental work requires much time making and fitting temporary restorations. This will greatly extend the amount of time a patient remains under general anesthesia.
While there are certainly indications for complete general anesthetics, I believe that its use should be limited. Perhaps a few procedures that are the most fearful should be performed under general anesthetic. Some patients may have a medical condition or handicap that necessitates having dental treatment done while completely sleeping.
Other patients may just not be aware of other alternatives and some may simply not be trying to deal with their anxiety. Perhaps they would benefit from some of the techniques that we use:
1) Gradually overcome anxiety by having a small procedure done comfortably in order to gain their trust and ease their fears.
2) Witness that gentle technique, generous use of topical and local anesthetics, testing the effectiveness of the local anesthetic and a gentle approach to the treatment itself will improve their outlook and ability to deal with treatment.
3) Rather than be completely asleep, undergo sedation. By having nitrous oxide (laughing gas) just prior to treatment and throughout the "scary" parts a patient can be relaxed. They will still be able to participate in checking the bite, having discussions, etc. when needed. An even greater level of sedation can be reached if Valium, Xanax or similar drug is taken roughly 30 - 60 minutes before treatment. Some patients may also benefit from having a sedative to get a good night's rest before. The best dental care is done carefully and with proper water cooling for instruments and rinsing for removal of bacteria, debris and having a clear area for use of impressions, adhesives and other materials. Most extensive dental treatment is not due to sudden trauma but rather the result of many months or years of not receiving care.
Thank you for reading,
Dr. Ray
Please call our Palatine, IL dental office for an appointment: 847-359-1292.
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