When it comes to clinical practice of sedation dentistry, it is much more practical to classify the severity of dental fear and anxiety. This classification would allow the sedation dentist to customize a dental anxiety treatment approach depending on the severity of the dental fear and anxiety. Dental fear and dental anxiety can fall into one of three classifications:
Mild Dental Fear and Mild Dental Anxiety
Patients with mild dental anxiety may exhibit a degree of dental fear that is controllable by the patient. Their dental fear and anxiety does not prevent the patient from going to the dentist. The patient may exhibit a mild degree of nervousness and irritability.
Signs and Symptoms of mild dental fear and anxiety
- The degree of fear is controllable by the patient
- Mild degree of nervousness and/or irritability
- The degree of dental fear does not prevent the patient from seeking dental care
- Tendency for missing and cancelling dental appointments
Treating dental patients with mild dental fear and anxiety
The treatment approach is determined after careful assessment, open communication and listening to our patients as to how we can make their dental appointment most comfortable. While the degree of fear may be controllable by the patient, some patients may elect to undergo dental sedation for their dental appointment. Their thinking is, if I have the opportunity to sleep and not remember the appointment, I’ll take it. In other situations the utilization of distraction techniques with movie glasses, headphones or even a mild sedative like nitrous oxide may be sufficient.
Treatment of mild dental anxiety will be discussed after determining patients comfort level and preference:
- Dental sedation may or may not be used depending on the patient’s preference
- Sometimes a distraction with movie glasses and/or headphones may be sufficient
- Mild sedative may be used in certain cases such as nitrous oxide “laughing gas”
- Patients with mild dental anxiety may exhibit a degree of dental fear that is controllable by the patient. Their dental fear and anxiety does not prevent them from going to the dentist. The patient may exhibit a mild degree of nervousness and irritability.
Moderate Dental Fear or Mild Dental Anxiety
Patients with a moderate degree of dental fear and anxiety are unable to control their fear leading to complete avoidance of going to the dentist. Some patients with moderate dental fear and anxiety may visit the dentist only when experiencing severe toothaches.
Signs and symptoms of moderate dental fear and anxiety
- High degree of dental fear that is difficult to control by the patient
- Tendency to avoid seeking dental care, particularly routine dental care
- Difficulty sleeping the night before your dental appointment
- Intense restlessness, irritability, jumpy and heightened sense of danger
- Physical symptoms may include palpitations, nausea , dizziness, stomach ache, sweating, increase heart rate and blood pressure
- Chronic frequency of missing dental appointment and last minute cancellations
Sedation dentistry and the treatment of patients with moderate dental fear
Generally, the sedation dentist initial consultation is conducted with the patient to assess the degree and specific sources of dental fear of anxiety . The dental exam and x-rays may or may not be performed at that first depending on the comfort level of the patient. IV sedation is the most appropriate approach for initial and extensive appointment. Mild pre-appointment anti-anxiety medication and/or nitrous oxide may be used in follow-up, dental exams and cleanings appointments.
- Moderate to deep IV sedation may be used for dental procedures and extensive appointments.
- Anti-anxiety medication may be prescribed prior to dental appointments
- Oral sedation or milder sedation methods may be used with routine appointments depending on the patient’s preference and comfort level.
- If milder sedation methods, such as nitrous oxide, are used for routine dental appointments (i.e cleaning appointments), movie glasses or headphones may be combined.
Severe Dental Anxiety or Dental Fear
Patients with a severe degree of dental anxiety and dental fear are completely overwhelmed by the fear of the anticipated dental experience. Patients with severe dental anxiety tend to be dental phobic patients and they will resort to extreme measures to avoid the dentist even when experiencing severe toothaches.
Signs and symptoms of severe dental fear and anxiety
- Patients with severe dental anxiety are completely overwhelmed by their fear
- Patients with severe dental fear and anxiety would resort to unreasonable means to avoid going to the dentist.
- Patients with severe dental anxiety may seek dental care only when the deterioration of their dental health is threatening their well being or life. In such cases, the cavities may have decayed most or all of their teeth to the gum line causing multiple teeth infections that may involve the neck “Ludgwig’s Angina” which can be a life threatening condition if not treated.
- The vast majority of patients with severe dental fear and anxiety go to the dentist after the deterioration of the majority of their teeth seeking full removable dentures.
- A good percentage of patients with severe dental fear and anxiety manage to live a life with compromised and poor health without ever visiting the dentist.
Sedation dentistry and the treatment of dental patients with severe dental fear
- As a sedation dentist, Dr. Mo Saleh will prescribe a pre-appointment anti-anxiety medication for his patients with severe dental anxiety or fear. This medication is to be taken one hour before the dental exam appointment and the night before to help with sleep. A separate initial consult appointment is usually conducted with the patient prior to the exam / x-rays appointment to assess the degree and sources of dental anxiety and fear. A significant other or a family member is often present during the initial consult as this is usually requested by patients with severe dental fear and anxiety. The presence of a loved one during the consult appointment usually provides a sense of comfort and security.
- An initial consultation is performed to assess degree of dental fear and anxiety. This is often done with the presence and support of a loved one or family member depending on the patient’s preference.
- Some patients elect to have the dental exam and X-rays to be performed under IV sedation combined with a pre-anxiety medication to be taken one hour prior to the appointment and at bedtime the night before to help with sleep.
- Deep IV sedation is utilized for long and extensive dental procedures.
- Oral sedation or moderate IV sedation may be utilized for routine cleaning appointments.
- We encourage on-going communication related to the degree of dental fear and anxiety to assess improvement and the ability to reduce sedation to lighter sedation methods.