Nervous Patients

In the largest Dental survey conducted in the last ten years, 12% percent of patients were shown to have extreme anxiety, over 33% were classified as having moderate anxiety, and less than half were relaxed about the prospect of dental treatment.

Anxiety is obviously a significant factor in Dentistry.

We offer several techniques to help anxious patients cope with having dental treatment.
1.Oral sedation – tablets by mouth.
2.Inhalation sedation – Nitrous oxide and oxide in a safe mixture.
3.Intravenous sedation – injecting the sedative directly into a vein.

Oral sedation

This is a very simple technique. The patient swallows a tablet about 1 hour before treatment. We usually use 10mg of Temazepam, which is a Diazapine, related to the drug we use intravenously. The effect is usually successful, but absorption from the stomach is less predictable than by the intravenous route.

Patients who take the tablet at home must travel to the practice with an escort for safety and could not drive after taking the tablet that day.

Inhalation sedation

Nitrous Oxide and not less than 30% oxygen (c.f 21% oxygen in the air we breathe) is administered by a face mask. The technique, also known as Relative Analgesia, is similar to that used in childbirth using Entonox which is a 50%:50%.mixture. We vary the percentage according to need.

The heart rate and oxygenation of the blood is monitored using a pulse-oximeter which measures these two important functions for safety. The patient becomes relaxed and the nitrous oxide also has an analgesic (pain reducing) effect.

Recovery is rapid with nitrous oxide being eliminated after about 10 breaths. After a few minutes recovery is complete so an escort is not required and the patient can drive home. Inhalation sedation is very safe and is especially indicated for children and teenagers.

Intravenous sedation

This is a more complex technique, but is very safe provided that the team have the correct training and experience.
At our practice all staff used in this procedure have regular expert training. For most cases we have a dentist and assisting nurse and another nurse solely for monitoring the patient’s condition. By ensuring good oxygenation throughout there are no adverse effects and no hangover. The monitoring nurse continuously observes the heart rate, breathing, and percentage of oxygen in the patient’s bloodstream.

After spraying the patient’s arm with ethyl chloride to cool the arm and mask the injection, we slip in Hypnovel (Midazolam). This is titrated for each individual patient so the patient achieves the correct level of sedation.

There is a deep sedative effect for the first 45 minutes. During this time all pain inflicting procedures like injections, scaling, cavity preparation or extractions are performed. The patient slowly starts to recover while simpler procedures are completed.

The technique has a strong amnesic effect so the patient has no recall of the treatment. The patient is allowed to recover under supervision until he/she can walk out unaided, but protected by an escort who must take the patient home.

Even the most anxious patients can be successfully treated and will return quite confidently for further treatment.

Our friendly, sympathetic staff will ensure that your treatment is a comfortable experience. We have a qualified team with skills in a full range of sedation techniques to treat even the most anxious patients.

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