You can schedule the appointment, but you also keep rescheduling it. You drive to the dentist’s office, but you can’t get out of the car. If anyone in the dental office comes near your mouth, you grab their hand. All of these factors likely indicate that you have dental anxiety or dental phobia. A sedation dentist can help.
If you really want to take care of your oral health, but dental appointments make you nervous, a sedation dentist can help. Don’t have one? Before you select a sedation dentist based on an online search or how close the dental office is to your home or office, there are three things to remember.
1. You need to like and trust the dentist
If you don’t like or trust a dentist in general, you probably won’t trust him or her to provide you with sedation before a dental appointment. Choose two or three experienced sedation dentists, schedule time to check out the office and meet the dentist and staff members. Pay attention to how they treat you and treat each other. If you’re comfortable, schedule an appointment for an exam.
2. What levels of sedation are offered?
There are three levels of sedation—nitrous oxide (laughing gas), oral conscious sedation, and IV sedation. An option is chosen based on your anxiety level, the length or complexity of the dental procedure, and what levels of sedation the dentist offers. Find out which levels a dentist offers. Ask for details about how the dentist administers sedation and what you can expect. Also, ask about his or her training in sedation dentistry.
3. It gets better
Many patients who receive sedation dentistry find that over
time, they are less nervous for future appointments. Some patients require
sedation less frequently or are able to switch to a lower level of sedation.
Cooperate with your sedation dentist by sharing the history
of your dental anxiety. Ask questions to learn about your options. Remember
that it is possible to relax, keep your dental appointments, and maintain good
oral health.
Some estimates show that 80% of Americans have at least some anxiety about dental appointments. Sedation dentistry can help. In Plano, TX Dr. Miranda Lacy is a female dentist who provides sedation to help you remain calm and have productive dental visits. But should you sedate yourself before your dental appointment? Doing so can be risky. And there are several reasons you should allow your dentist provide medication to help you relax.
1. How Much
Sedation Do You Need?
Your dentist can make an accurate determination. There are several factors that affect how much sedation you need.
Complexity and length of
your dental procedure
Your anxiety level
Your medical and
prescription history
If you decide to self-medicate for sedation before your
dental appointment, you can take too much or too little of the medication. Either
condition won’t agree with your dental procedure.
Too little – You won’t be relaxed enough, and your dentist won’t
be able to proceed with treatment.
Too much – You won’t be able to respond to your dentist’s
questions or instructions.
Adequate sedation – It relaxes you enough to relieve anxiety,
yet allows you to respond to your dentist during treatment. It also decreases
your sensitivity to pain. Your relaxed state will increase the amount of
dental work that can be completed in a single visit.
2. Will Your Own
Anti-Anxiety Medication Work?
Dr. Lacy provides sedation with either nitrous oxide or oral
conscious sedation.
Nitrous oxide – It is colorless, odorless gas, also known as
laughing gas. You breathe it in to achieve a sense of calmness and
well-being.
Oral conscious sedation – Dr. Lacy will give you an
anti-anxiety pill to take in advance of your appointment.
If you already take anti-anxiety medication, let Dr. Lacy
know the name of the medication, dosage, and how often you take it.
3. What about DIY
Sedation before a Dental Appointment?
There are various ways that people try to sedation
themselves before a dental appointment. But you shouldn’t try any of them.
Smoking – Smoking of any kind—whether it’s tobacco or marijuana—causes inflammation and slows down the healing process. Depending on the type of dental procedure you receive (e.g., dental implants to replace missing teeth, extractions), your dentist will recommend that you stop smoking at least a few weeks before. Mental impairment from smoking marijuana can affect your judgment if the dentist asks you to make an unexpected decision during a dental procedure.
Alcohol – Alcohol can thin blood, inhibit blood clotting, depress the central nervous system, and cause rapid or irregular heartbeat. Those factors can negatively affect any dental procedure. Don’t use alcohol to help you relax before a dental appointment.
Prescribed sedatives – You must fully disclose your current prescriptions, prescription history, frequency, and dosage when you complete patient forms for the dentist. Even if you’re an existing patient, keep your dentist informed about any new medications you take. A record of your prescriptions will help Dr. Lacy determine which type of sedation medication to use for your dental appointment. If necessary, she will consult with the prescribing doctor.
Sedation dentists are trained to safely administer medication before your dental appointment. Don’t try to do it yourself. If you’re interested in learning about your options, call us to request an appointment, or complete our Request an Appointment form.
Sedation dentistry can help calm a patient before an appointment. Often, past negative experiences are a trigger, including those like the one described below where a patient had a reaction to local anesthetic.
It’s weird how a person’s body changes over time. Prior to 3 years ago, I had very few allergies or sensitivities. Now I am gluten sensitive and sensitive to nuts. I have not been that concerned about food allergies, because there are so many other things that I can eat. My concern comes from a dental visit earlier this month. I had a nagging toothache that came from damaged pulp in my tooth due to an impact on the left side of my face. The dentist gave me a painless injection of lidocaine. Within 10 minutes my gums were burning and itching like crazy, and I got chills. She said that it looked like I was having an allergic reaction, and I was. My dentist was nice and calm and gave me something to counteract the reaction. She wasn’t able to start the root canal. The tooth still hurts, but now I’m nervous. I know my dentist won’t give me lidocaine again, but now my anxiety level is high. What if I can’t get numb? She tells me that she can safely get me numb, but I’m concerned. What do I do now? Katia
Katia,
We are sorry to hear about your reaction to lidocaine. It’s good that your dentist quickly resolved this issue. Lidocaine is in the amide group of local anesthetics. Other types of anesthetic in this class include:
Mepivacaine
Bupivacaine
Ropivacaine
Sedation Dentistry Can Help
Sedation dentistry helps you relax
Sedation dentistry can help you relax in advance of your dental appointment. But now that you and your dentist know that you’re allergic to lidocaine, what can be done? Your dentist knows to provide a different class of anesthetic. Patients who cannot tolerate amides often do well with local anesthetics in the ester group.
What you can do
Be certain to record your history on future medical or dental history forms that you complete.
Speak with your dentist about your concerns about anesthetic, as well as the types of sedation she offers to help you remain calm.
If your dentist doesn’t offer sedation dentistry, search for a dentist who is able to provide it.
Nitrous oxide, oral conscious sedation (anti-anxiety medication in pill form), or both are offered by many dentists. You can be confident that the right level of sedation will help you relax and continue to have positive dental experiences.
I’m really struggling with how much I am to blame for not taking my son, Chase, to a sedation dentist. He’s six years old and is a bit fidgety. 3 weeks ago, after an exam, the dentist said Chase had a cavity that needed to be filled.
The dentist offered to do the filling immediately, and I saw no reason to object. Chase seemed a little apprehensive but not overwhelmingly. The dentist asked me to leave the room saying sometimes it helps kids relax when their parents aren’t there. About 15 minutes later, I heard Chase screaming and the dentist began yelling at him. I ran into the room and saw Chase on the floor crying with the dentist standing over him and telling him to get off the floor.
I immediately jumped between the dentist and Chase, took Chase by the arm, and prepared to leave. I didn’t know what had happened, but what I saw and heard didn’t look right. The dentist left without saying anything. Chase was hysterical, so I sat down with him for a moment in the treatment room. One of the assistants came in and explained that Chase had bitten down while the dentist was drilling, his tooth cracked, and now he needs a crown. She gave me a referral to a pediatric dentist and then left. The lady at the checkout desk was pleasant but said nothing about the incident.
I still haven’t taken Chase to a dentist to see if he really needs a crown. He has not complained about the tooth, but he has said that he doesn’t want to return to our dentist. Neither do I.
Although my son hasn’t directly said that he is afraid of going to another dental appointment, I’m now wondering if he should start seeing a sedation dentist Is it possible that I missed signs that Chase has some dental anxiety? Kyla
Kyla,
Family and pediatric dentists make visits fun for children
Please don’t blame yourself for what happened. If Chase handled dental appointments well in the past, you had no way of knowing how he would react during the most recent appointment.
Normally, kids who have trouble during a dental appointment get quite fidgety long before there is an issue. Ultimately, it was the dentist’s responsibility to assess the situation, and it sounds like he failed and was very unprofessional in handling Chase’s anxiety.
Should You Take Your Child to a Sedation Dentist?
Below are four considerations:
Results of delaying treatment – Your son should have his tooth examined. Don’t wait until he is in pain, because it could lead to anxiety about going to any dental office. Even routine dental exams should not be delayed due to a child’s anxiety or fear. Delays in treatment can contribute to a buildup of plaque and decay, and treating those issues makes dental appointments even longer.
One step at a time – You may need to gradually help your child get comfortable again, perhaps by taking him for an office tour or consultation the first visit and then an exam on the second visit.
Does the dentist regularly treat children? – Your child might be a good candidate for dental sedation, but if you decide to try it, visit an office, such as a family dentist, that regularly treats children, or visit one that specializes in dental care for children.
There are levels of sedation – The mildest form of sedation, nitrous oxide (laughing gas), might be sufficient to help your child relax. The gas is breathed in during the procedure, and it is quickly reversed with pure oxygen. An experienced sedation dentist can determine which option is best for your child.
I need sedation dentistry for dental implants. I’m wondering whether I should go to a prosthodontist, an oral surgeon, or a periodontist to place my dental implant. Do these specialists handle sedation dentistry differently? I’m not sure what the difference is between all of these specialists anyway. I normally see a general dentist and he’s a great guy, but I guess he won’t do the actual surgery when placing an implant. He says he always refers patients out to a specialist and that he only does the crown on top. He gave me three different referral sheets and told me I could go to anyone. I didn’t really look at them while I was in the office, but now that I’m home, I see that one specialist is a prosthodontist, another is an oral surgeon, and the last one is a periodontist. How do I know which one to choose, and will each of them be willing to give me sedation dentistry?
Great question! Basically, any dentist can do dental implant surgery. And dentists who provide oral surgery offer some level sedation. From a general dentist who just graduated from dental school to a specialist—all of them can place dental implants. But if you’re going to have extensive work done, you want an expert. Statistically speaking, the doctor’s level of training and experience is the most influential factor in the outcome of dental implants.
Even some general dentists have taken extensive post-graduate training in implantology and are highly qualified to place implants. But your dentist is referring you to a specialist. So how do you choose your specialist, and will he or she be willing to provide sedation dentistry?
Which Levels of Sedation Dentistry Will Be Offered?
Most general dentists often offer nitrous oxide (laughing gas). Specialists offer higher levels of sedation, including oral conscious sedation (anti-anxiety medication in pill form) and I.V. sedation. You can call each specialist’s office and ask what levels of sedation will be offered to you.
Dental Implant Specialists Who Offer Sedation
Oral Surgeon
After finishing dental school, doctors can begin practicing right away, or they can continue school for several more years to become a specialist in one of the nine specialties recognized by the American Dental Association (ADA). They define the area as:
“Oral and maxillofacial surgery is the specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.”
Periodontist
The ADA defines this area as:
“Periodontics is that specialty of dentistry which encompasses the prevention, diagnosis, and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.”
Prosthodontist
From the ADA:
“Prosthodontics is the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth and/or oral and maxillofacial tissues using biocompatible substitutes.”
Which Specialist Should You Choose?
Regardless of which specialist you choose for dental implant surgery, each of them will offer adequate sedation dentistry to relax you and minimize your sensitivity to pain.
Oral surgeon – Oral surgeons are trained to surgically treat diseases, injuries, and defects. In other words, it’s their job to treat damage, trauma, and malfunction. This could include:
Cleft palate
Jaw trauma
Wisdom teeth extraction
Dental implant placement
Periodontist – The periodontist description, mentions “teeth or their substitutes” and talks about maintaining health and function. Periodontists typically
Periodontal disease
Bone loss, including bone grafting
Structural problem
Prosthodontist – The description for prosthodontics says, “clinical conditions associated with missing or deficient teeth.” Prosthodontics is an entire specialty for missing tooth replacements, ranging from dentures to dental implants.
Request Consultations
We suggest that you review each dentist’s website to learn about his or her qualifications. Look for the following:
Education
Years of experience
Credentials, including state board certification, fellowship, or mastership in dental implant organizations
Published works on implantology
Patient testimonials or reviews (some might be published on external sites)
Choose at least two specialists and schedule consultations with each. This gives you an opportunity to ask questions about dental implant placement, as well as your options for sedation dentistry.
Sedation dentistry helps you relax, but you need a trustworthy caregiver
I’m supposed to visit a sedation dentist to have a tooth pulled. Apparently, the roots are somewhat curved and the doctor wants me to be sedated for the procedure. I don’t have any friends or family nearby. I usually use a discounted cab service that is available to me because I am disabled. I asked the dentist’s office if that was good enough and they told me no because the person driving me has to go into the office with me.
I thought about using Uber or Lyft and asking the driver to do it, but you never know who you will get, and I’m not sure they’ll do something outside the normal service for me. The only thing I can think of is Craigslist. That way, I can hire someone and they can stay there then drive me home after the appointment. I’m afraid to tell my dentist’s office this because if they say no, I’m out of options and I may have to do it anyway. What are my choices? Thanks. Deidre
Deidre – Think about it this way… when you visit the sedation dentist, you’ll be given medications that will relax you. They won’t make you unconscious but will relax you so much that you’re not really concerned about an extraction. The medication doesn’t wear off right away. It can take a few hours before you feel like yourself and you’ll probably be drowsy for the rest of the day. Most people go home and sleep until the medication wears off.
Why Be Selective about Your Driver for a Sedation Dentistry Visit?
Craigslist can be a great service, but it can also be a dangerous one. You don’t really know who is responding to your inquiry until you meet them, and sometimes not even then. Unfortunately, while sedated, you probably still won’t care much what’s happening around you.
Would you entrust yourself to a stranger? Would you let a stranger take you inside your home? Probably not, and you shouldn’t.
One of the reasons you must have a trusted adult be your companion during and after these visits is that you’ll need someone to watch and care for you. Generally, offices worry about you stumbling at home, but if you’re with someone you don’t know, not only do you not know if they’re equipped to help you in a situation, you don’t if they are safe or if they will assist you.
Suggestions for Finding a Trustworthy Driver
Talk to your dentist’s office and see what they recommend. If they don’t have any ideas, check in with your church (if you have one) or any other community groups you belong to.
There are also community programs that sometimes offer transit and support as a service—sometimes even free.
Depending on your insurance, you may qualify to have a caregiver assist you for the day.
If those options are not available, you may want to consider hospital care or going without the sedative if the doctor approves. Obviously, having the tooth removed is a medical necessity. However, your doctor may be able to do other things to keep you comfortable or petition your insurance company for extra coverage based on medical necessity.
You have a few options to consider, but Craigslist is a bad idea.
In May I got a new partial denture and I think I’m going to have to go back under sedation to have it fixed. A metal clasp on the left side of my mouth is putting a lot of pressure on the next tooth. I thought that maybe it would loosen with time but it’s quite uncomfortable. Can this clasp be adjusted? If it can be, should I have to pay out of pocket for sedation dentistry? I’ve used all of my insurance allowance for sedation. I just can’t get through a dental appointment without it. If this is an issue my dentist is responsible for, shouldn’t she cover fixing the partial and waive the fee for sedation? – Patrick T.
Patrick,
Although partial dentures are made at a dental lab, most general dentists are able to loosen a clasp on the denture. Partial dentures are usually uncomfortable when you first receive them. The tight clasp might not necessarily be your dentist’s fault. Ask her to explain the reason for the discomfort.
Call your dentist to let her know your concern. If you’ve had the partial denture for longer than a month, she will want to promptly check it. A clasp that is too tight on a tooth for a long period can potentially damage the tooth.
Ask Your Dentist about Sedation
You should speak with your dentist about your need for sedation and ask if she is willing to waive the fee. You can also contact your insurance company, explain the circumstances, and ask for special consideration for any insurance claim that will be submitted for sedation fees.
Options for Replacing Missing Teeth
Dental implants are an option for permanently replacing teeth without the adjustment period or the discomfort of partial dentures. But dental implants are a more expensive option, and your dentist must determine if you are a candidate for them. They have several advantages over a partial denture:
Surgically implanted in your jawbone
Stimulate bone growth and prevent shrinkage
Look and feel like your natural teeth
Don’t need to be secured to an adjacent tooth
More cost-effective in the long-term because they are permanent
If your budget permits, you can consider dental implants as an alternative in the future when you need a new partial denture.
We hope you have a successful outcome with adjusting your partial denture and getting assistance with the cost of sedation dentistry.
I’ve been putting off getting my teeth whitened because of the pain. I have two friends that got their teeth whitened and both of them said that it hurt. I am wondering if I can find a dentist who does sleep dentistry with teeth whitening. Thanks. Ethan
Ethan– Sedation dentistry, often referred to as sleep dentistry, is used during restorative dentistry. When you receive procedures such as a root canal treatment or a dental crown, sedation may be administered.
Generally, the process of whitening your teeth is not painful. The sensitivity in your teeth is felt after the whitening process, so sedation dentistry won’t help. Most of the sensitivity in your teeth is felt 24 to 48 hours after the whitening treatment. But if you need help relaxing, your dentist will provide some form of sedation to help.
Did your friends receive teeth whitening from a dentist, or did they use a do-it-yourself kit? There are several factors about teeth whitening that, when completed at home, can create sensitivity in your teeth.
You can have a consultation with a dentist for teeth whitening. Let him or her know your concerns about sensitivity in your teeth after whitening. A dentist can prescribe heavily fluoridated mouthwash or toothpaste that you can use for a period in advance of your appointment. It will help reduce the sensitivity after whitening.
I’m afraid that my wife may be using sedation dentistry as a crutch. I don’t really blame her for wanting to have the meds, but it throws us into a bit of chaos every time she needs to have dental work done. Without going too much into detail, her childhood dentist was pretty brutal. He left her with an intense fear of the dentist. Her teeth looked fine when I met her, but as the years went by, they deteriorated quite a bit and she refused to see a dentist. We found a sedation dentist to help her and I will say that she has been a godsend. We made it through the series of appointments necessary to get her smiling again and life is good.
However, every time something comes up now- even if it’s a tiny cavity being filled- she asks for oral conscious sedation (OCS). We’ve got a good relationship with this doctor and my wife seems to trust her, but it’s hard for me to take the day off work just because my wife needs a filling. Plus, our insurance doesn’t cover it, so you know who’s paying for it- me. I don’t mean to sound insensitive, but it seems like this has gone on long enough. At some point, she should be able to go without the meds, right? At what point can I safely interrupt this trend and tell her to be mature about this?
Thank you,
Raymond
Dear Raymond,
This is a particularly interesting question with no definitive answer. However, we can explain what might be happening.
Any Kind of Trauma Can Leave Lasting Emotional Scars
We don’t know what happened specifically with your wife, but a trauma of any kind can have a lasting impact on a person. For example, a child who is ridiculed in school may begin to think that a school is a bad place where he or she does not belong. The child will associate learning with ridicule and have trouble excelling. A child who is beaten by a parent learns to avoid their parent and often avoids relationships later in life as a result. Some children never learn how to form close bonds with others.
A person who witnesses a violent event, such as a shooting, may also develop post-traumatic stress disorder (PTSD). They can become hypervigilant and anxious and be unable to return to the place where the event happened. Or they might be constantly on alert waiting for it to happen again. These people can often muddle through life without treating the underlying problem, but their quality of life diminishes. For example, the bullied child may never finish school. The abused child may never have a healthy relationship. The crime witness may withdraw from the things he or she loves.
The Right Way to Address Trauma Varies
The field of mental health care is filled with many different methods to help people overcome trauma so they can live healthy and full lives. Arguably, the most well-known is talk therapy. There are also other avenues a licensed mental/ behavioral healthcare professional might try, such as Eye Movement Desensitization and Reprocessing (EMDR), coaching, and teaching the person healthy coping mechanisms. We don’t know the level of distress you wife feels or how deep it goes, so it’s difficult to say what type of therapy she needs.
A Sedation Dentist Can Help Reduce Anxiety, Now and Forever
For some, dental anxiety doesn’t go away without some kind of care from a mental health specialist. Choosing OCS or a similar variant is a crutch in some cases, but if it empowers them to get the care they need, it’s worthwhile. For others, the extra care afforded by a sedation dentist lets them build positive memories with their dental care team. In time, with lots of positive experiences, your wife’s prior experiences may diminish so much that she sees the treatment as a positive and enjoyable thing. However, all this is probably happening in her subconscious. Even if she trusts her doctor and knows the office is safe, she’s already been conditioned to be fearful. There is no timeline or formula that flips a switch and allows her to not have anxiety.
In short, there is no right time to take control and insist your wife has dental appointments without sedation. She’s not doing anything wrong and if she’s anxious, she’s likely unable to control it. While there is no harm in having an open discussion with her about how she feels about treatment without the medication, it’s best not to insist on it. If anxiety seeps into other areas of her life, it may be worthwhile for her to talk to a mental health professional and start dealing with some of the underlying causes. If it’s purely dental anxiety, please respect it. Your support will make a world of difference in her confidence and willingness to continue with getting treatment.
My sister lives in California and has been raving because she says there’s a law there requiring insurance companies to cover sedation dentistry. She and I both had terrible experiences as children and don’t do well for any kind of dental procedure unless we have some kind of medication to get us through. This is big news because we’ve always had to pay out-of-pocket for it, and we don’t have the best teeth. I’ve looked and looked, but I don’t see anything that discusses this law- either as something in place or upcoming. Any news?
Thanks, Emilia
Dear Emilia,
California has some incredibly progressive laws in many respects. Many regulations originate in California before they are adopted in other states. California Assembly Bill 2643 amends Section 1367.1 of the Health and Safety Code and Section 10119.9. SB 2643. It outlines a number of regulations that have to do with “the use of general anesthesia, conscious sedation, and oral conscious sedation (OCS) for pediatric and adult patients.”
The current language of the laws stipulates that dental anesthesia only has mandatory coverage in a hospital setting. As you probably know, there are many people who genuinely require anesthesia, but don’t need to go to a hospital for treatment.
The proposed legislation would force new insurance plans to cover it effective January 2019.
The proposed law is being sponsored by the California Dental Association and California Society of Pediatric Dentistry. It is not yet approved. If passed, it could make a major difference for people like your sister who lives in California.
Sedation Dentistry and Insurance
Throughout the rest of the country, coverage for any form of anesthesia or OCS varies based on the insurance policy. While most insurance companies recognize that OCS makes it possible for many people to receive treatment, manage their oral health better, and possibly reduce expenses for insurance companies overall, most insurance companies are reluctant to add sedation dentistry as a necessary and valuable benefit.
It sounds as if you’ve personally made your oral health a priority and have found a way to budget for it, which is commendable. Patients who are still trying to find a way to manage dental anxiety and get necessary treatment may be able to find a plan that specifically covers OCS. It is worth noting that very few offer coverage and when they do, it can be costly.
As an alternative, it’s helpful to speak with your dentist about what your anxiety and finding affordable dental treatment. Most dentists will work with you to overcome the issues, perhaps by doing as much work as possible in a single appointment or doing the work in phases. Your dentist may have additional solutions.
