Posts for tag: sleep dentist

Question: Who is not a candidate for oral and IV sedation?

 

Answer: The following is a list of individuals who would not be candidates for sedation and includes but not limited to:

 

1. Diabetics- unless blood sugar is well controlled and patient is compliant with dietary and prescription regimens. Type II are typically better candidates as patients with Type I (insulin dependent) typically experience larger fluctuations in blood sugar and need a quicker response to this fluctuation.

 

2. Liver and kidney diseases. Patients with liver and kidney disorders are usually not great candidates for sedation because their ability to metabolize drugs is altered or compromised. These metabolism deficiencies can lead to patients hypo or hyperresponding to medications and will also shorten or prolong the response to the medications. Patients with these disorders need clearance from their physician prior to sedation.

 

3. Thyroid and adrenal disorders. Patients with altered responses to stress, altered metabolisms can affect the response to sedation. Patients that are taking steroids on a regular basis can also have adverse reactions because their body is not conditioned for stressful situations. Patients with these disorders or anything else endocrine in origin should consult their dentist and physician for any proposed sedation treatment.

 

4. Pregnancy- Patients who are pregnant are not good candidates due to the teratogenic properties of sedation medications but also due to the altered metabolic demands of a fetus on a mother's body. If absolutely necessary, the 2nd trimester is the best choice but I would prefer to defer sedation or any unnecessary dental treatment until after pregnancy.

 

5. Medications/recreational drugs- Patients that take mind altering medications such as antidepressants and anti-anxiety medications can also respond very erratically or not at all to sedation medications. Patients typically don't respond as well because the body has been conditioned to process mind altering medications that fall along the same categories of sedative medications. Recreational drugs is a huge contraindication as the response is totally unpredictable and could be potentially life threatening.

 

6. Respiratory- This is the biggest and most frequent complication I run into. Factors such as Asthma, COPD, sleep apnea, sickle cell disease, bronchitis, sinus infections, etc. All sedation medications have some sort of respiratory depressing effects that control a person's breathing. Sedation medications can severely hamper the body's ability to maintain normal breathing and furthermore should be taken with caution. An example of someone who is not always a good candidate is someone that snores on a regular basis as this is already an indication of someone who may be developing respiratory problems.

 

While this is not an all inclusive list, these are the most frequent disqualifying conditions for sedation dentistry!

 

Dr.Glasmeier

Question: Are there ways to do dentistry with out the pain or a needle or sound of a drill?

 

Answer: Yes there are, but they are somewhat limited in what they can treat. For example, to not need a needle for treatment either the cavity has to be very small or the dentist uses something called "Air Abrasion" or "Laser Dentistry". These are technologies that enable the dentist to fix cavities without using a needle or drill however they are not as effective when the cavities are deep (close to the nerve) or the tooth is sensitive.

 

I think an injection is much better for pain control and is better for eliminating the "what if I feel this". An injection can almost be next to painless and the discomfort can be controlled by

1. The strength of the topical gel

2. The manner the injection is given by the dentist.

 

I have a very simple rule...if I can't get you numb, I will not work on you that day...sometimes people just don't numb up well and it's hard to explain why but rest assured that if you are uncomfortable then I am too so I will not make you do anything that is uncomfortable! We generally have great success in getting you more than adequately numb which gives you a very comfortable, pleasant experience. Nitrous oxide(laughing gas) will often help drown out some of the sounds of the drill and also with analgesia(pain relief) during the procedure.

 

Regarding the sounds of the drill, we always play music while we are working..I don't like the sounds any better than my patients do? I love music from the 80s and 90s so there is always music in the background or we will play whatever music you like. We also play movies if you prefer to listen to a movie and if that's not enough...I might even sing or dance for you!

 

Back to the original question, the use of injections(i.e. the needle) as well as the handpiece(i.e. drill) is sometimes unavoidable no matter how gentle we are. If this is a concern, then sedation dentistry may be a great way of assisting in eliminating the apprehension/anxiety of these procedures as well as waking up and not remembering what happened.

Question: What is a dental phobia and where does it originate from?

 

Answer: The word phobia is described as an irrational and sometimes disproportional fear that causes the sufferer to avoid the feared experience. In this case the feared experience is the dental visit or the actual treatment. Depending on the severity of the phobia, physical symptoms can be present. Such symptoms might include nausea or "butterflies", increased heart rate, sweating and the inability to concentrate. In rare instances, it can even be to the point where even the chair cannot be reclined. Some people may even experience a full-blown panic attack at the thought of visiting a dentist.

 

The most common fears of the dental patient are pain, lack of control, and the unknown. Many patients present to the dentist either in pain or endured a painful dental visit in the past. This could involve the actual injection, or the treatment or even the events that follow the treatment. Some patients are nervous and fearful that they have no control over the situation and cannot participate or be interactive in the decisions of the treatment. Others simply are scared because they do not know what to expect and have nothing to compare the upcoming experience with. No matter what the issue

While it's true that phobias can be overcome, treating a phobia can be a long process. It often makes more sense to take care of much-needed dental work and deal with issues of fear as time allows. Extreme fear or phobia associated with dental care could make you the perfect candidate for sedation dentistry!

Question: What is oral sedation and how does it help with dentistry?

 

Answer: Oral Sedation involves the use of oral medications in the form of a pill/tablet to relieve mild to moderate anxiety. The most commonly prescribed medications are Halcion, Ativan and Valium, all of which produce a high level of drowsiness but not a complete sleep. The medicine is generally administered one hour prior to treatment but sometimes is also administered the night before the dental appointment as well. You will, however, remain awake and alert throughout your dental treatment and be able to breathe on your own without the fear and anxiety you might other- wise experience. One downfall to oral sedation is that since every patient exhibits different levels of tolerance to drugs and different digestion times, there is no way to measure how much medication has been directly absorbed into the stomach. It is not effective or safe to try to make the patient more relaxed by giving more pills if the initial dose was not effective to relieve the patient's anxiety. Depending on the patient and the treatment being provided, sometimes laughing gas is used in conjunction with oral sedation to help assist with anxiety and pain control. Oral sedation is typically much more effective than laughing gas alone, but not nearly as effective as IV sedation or general anesthesia.

Question: What is laughing gas(nitrous oxide) and how it is used for dental

anxiety?

 

Answer: Nitrous Oxide is a sweet smelling gas administered through a inhaler mask that is placed over a patient's nose. The patient simply breathes in the laughing gas and almost immediately(within 2-4 minutes) experiences a relaxed state. Nitrous oxide is administered to patients requiring relatively short dental procedures and for those with mild anxiety. Recovery time for patients receiving nitrous oxide is very brief, as the effects subside within minutes, allowing patients to drive themselves home if necessary. This is the only form of sedation that the patient can drive to and from their dental appointment. Nitrous oxide works very well with children and does well with adults but less predictable.