Thursday, September 14, 2006

Overcoming Dental Anxiety

For some people the fear of visiting the dentist outweighs the pain of a toothache. If you’re afraid of going to the dentist, you’re not alone. About 8%–15% of Americans avoid regular treatment solely for this reason. But refusing to visit the dentist out of fear has a paradoxical effect. Procrastination almost invariably leads to more advanced oral health problems and lengthier, more complex procedures.

Most adults who suffer from dental anxiety can trace their fears back to negative childhood experiences. Fortunately, improvements in techniques, medications, and equipment over the last 30 years mean that even the most skittish patients can be assured that their visits now will be more comfortable than those of their youth.

Medications for pain and anxiety Many medications can relieve dental pain and anxiety. These can be used individually, in combination, or along with relaxation techniques. Local anesthetics.

Dentists use a thin needle to in­­ject these pain control medications at the site of the procedure.

In most cases, the medication takes effect within a few minutes and deadens pain for about three hours. Lidocaine (Xylocaine) and mepivacaine (Car­bo­caine, Isocaine, and Polocaine) have replaced procaine (Novocain) as the most commonly used drugs. Many dentists prefer to use one of these drugs along with a small amount of epinephrine, which constricts the blood vessels and keeps the painkiller working longer.

However, this mixture is not an option for people with high blood pressure or other forms of cardiovascular disease. Topical anesthetics. These can ease the sting of an injection or minimize the discomfort of cleanings and minor gum treatments.

Topical preparations typically come in the form of a numbing gel or spray, which your dentist applies to the gums a couple of minutes before beginning work. Some dentists are now using a small adhesive strip that sticks to your gum and releases the painkiller into the tissue.

Antianxiety drugs. Your dentist can offer you diazepam (Valium) or a similar drug to calm your nerves before a dental procedure. You’ll need to arrive for the appointment about an hour ahead of time if you choose this option. You should also ar­range for someone else to drive you home. Conscious sedation.

This approach dulls your awareness without inhibiting body functions such as breathing and swallowing. Drugs of this type usually are used to quell anxiety, but they can be combined with other drugs to reduce pain. One of the most common choices is nitrous oxide, sometimes called "laughing gas." You inhale it through a mask in a mixture with oxygen.

Nitrous oxide produces a sense of relaxation that begins almost immediately and ends when you stop breathing it. It has very few side effects and is safe for most people. For lengthy dental procedures, though, drugs administered intravenously may work better.

Your dentist will mix a sedative or antianxiety medication with a narcotic and sometimes a barbiturate drug. Only specially trained and certified dentists are qualified to offer this type of sedation. General anesthesia. With this form of sedation, you are unconscious and unable to breathe or swallow independently.

General anesthesia is usually reserved for surgical procedures on the mouth or jaw. It’s also used for people whose dental anxiety is so overwhelming that it makes routine care otherwise impossible, and for individuals with mental or physical disabilities that interfere with treatment. Although safe for most people, general anesthesia carries more risks than other forms of sedation. Only professionals trained in anesthesiology can administer it.

From the Harvard Health Publications Special Health Report, Dental Health For Adults: A Guide to Protecting Your Teeth and Gums. Copyright 2003 by the President and Fellows of Harvard College.

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