Sedation Options for Anxious Patients
The first thing we suggest is choosing a time of day that's good for you. Generally this is in the morning--you'll have less time to worry about the appointment. Don't skip breakfast, then do without lunch so you won't have to brush before you see us. That's a good way to pass out during the procedure, which of course will make you even more nervous next time. Pick a date and time where you won't be rushed getting to the appointment, and don't schedule to sign a house closing 10 minutes after the appointment is over.
For those with mild anxiety, nitrous oxide ("laughing gas") is a good option.
This is not a pain control medication--you'll still need local anesthetic injections. What nitrous does is relax you, make the appointment seem like it's going faster, and make you not care what's going on. You may have what seem like very profound thoughts, but afterward you won't be able to remember exactly what they were, or why the pattern in the ceiling was so important in bringing about world peace. Nitrous is excellent for periodontal work, where some areas may be uncomfortable but not enough to make you want an injection for the few minutes involved. Some people like to have it for the injection part of the dental procedure, but would rather not have the mask on the rest of the time. And some people don't like the feeling at all--they get an out-of-body type experience, and that's not a fun thing, especially if you're not expecting it.
After using nitrous, you will breathe 100% oxygen for about five minutes. This brings you almost completely back to normal, and you can drive yourself home from the appointment at that point. A few people get a mild hangover-type feeling, where they just don't feel really sharp for a couple of hours. (The doctor gets this way--he can't do dentistry for a couple of hours after getting nitrous, so he can't use it for his cleanings.) There is a fee charged for nitrous--reduced for cleaning appointments--and you must reserve the nitrous equipment in advance.
For those with more severe anxiety, systemic medications are useful.
The benzodiazepines are the most useful--Valium (diazepam), Xanax, Ativan, and Halcion (triazolam) are most commonly used. You cannot take these and drive yourself to your appointment, as they impair driving ability significantly. A side effect of Valium is that it is an excellent muscle relaxant, and occasionally we prescribe it for people who have trouble keeping their mouth open for long appointments. It has a fairly long duration; some people are wiped out for up to 24 hours, which is a disadvantage. Xanax and Ativan are similar to Valium, but with a shorter hangover period; currently we don't prescribe these for dental work; if you have a doctor‘s prescription for them for other reasons, please let us know and do not take them for dental appointments without telling us.
Halcion combined with nitrous oxide is the best anti-anxiety agent we offer. Many patients don't remember their dental appointment at all afterwards, although they are awake and responsive the entire time. The protocol we use involves a dose one hour before the appointment, and sometimes an additional smaller dose 15-30 minutes before the start of the procedure. Occasionally we will also give you a dose the night before the appointment if you are very nervous. The nitrous oxide is generally used for the injections, then turned down or clear off for the rest of the appointment. If you use Halcion/nitrous, you will need someone to drive you to the appointment, and take you home afterward. You will also need to follow directions regarding pre-op and post-op care, and since you're out of it for a few hours, that usually means you need someone to stay with you the rest of the day. Halcion appointments are scheduled at 9:30 a.m. since there are eating restrictions. Currently, our fee is $174 per visit.
For those with extreme dental fear, we can refer you to a clinic that will put you clear out.
There are some risks and costs associated with this, but it's much safer than putting off dental work until teeth abscess. Currently the U.W. Dental School is the closest good facility. For extractions, we have worked with Dr. Denise Clarke for many years; she has clinics in Port Angeles and Sequim, and does evaluation appointments in Port Townsend. Recently we have also been working with Dr. Peet in Sequim. Both these surgeons generally require a referral from a general dentist, so you will need to see us first for the initial evaluation and X-rays.
