In our last blog we learned about some of the history of sedation and the different forms of sedation. Today we are going to focus on how sedation relates to pain management. Most people face two hurdles when heading to their dentist: anxiety and pain. The latter can be controlled and when under control can help remove the former. Let’s explain.
John doesn’t want to see his dentist; he is afraid of enduring pain. This causes him to have anxiety about going to the dentist. This hurts John twofold. Firstly, if he neglects seeing his dentist, he is likely to develop serious issues in his mouth that will require more intensive care. Secondly, he carries with him this anxiety which causes him undo stress.
When we as dentists control the pain a patient receives, we then control the anxiety. We see patients that will come in anxious, undergo IV sedation and leave with a positive dental experience! This experience is powerful enough that at their next visit they might have lost their anxiety enough that they can be worked on with a local anesthetic. This also frees up the patient from the stress they previously experienced over going to a dentist.
Pain Management
-No sedation: Now, how do we manage the pain perceived by a patient? First, an extreme minority are people who do not require any anesthetic prior to a procedure. They do not require any pain control.
-Iatrosedation: The second group desires pain control, but doesn’t want a shot. This second group might opt for iatrosedation. Iatrosedation is loosely defined as the doctor earning the patient’s trust. Simply knowing they are being taken care of by someone who cares about them is enough for some people to go ahead and proceed with a procedure. Iatrosedation is accomplished through trust and clear communication from the dentist to the patient where expectations are clearly outlined and understood by both parties. More typically, iatrosedation will allow a dentist to successfully segue into administering the most common form of pain control, pharmaceuticals.
-Hypnotherapy: Another form of pain management which is very uncommon is hypnotherapy. Many factors have to work in unison to achieve success using this form of pain management. This method is time consuming, difficult to administer, and effective pain management is questionable.
Until now we have discussed iatrosedation. Now let’s focus on pharmacosedation; you guessed it, sedation through pharmaceuticals. It should be noted that if iatrosedation is accomplished properly patients will require less pharmaceuticals.
–Oral sedation: First off, pharmacosedation involves administering a drug to be taken orally before or during a dental visit. The oral route possesses some advantages. First being no shot is required. Most adults have no objection to taking a pill orally. The disadvantages of taking an oral pill include taking the pill at the right time, making sure of a safe interaction with any other drugs or health conditions the patient might have, and inability to titrate the drug.
-Localized injection: The next, and most common approach to pain control is a localized injection. The patient might be in slight discomfort for a moment when the injection takes place. Many dentists have tricks to mitigate any anticipated pain from the shot. Some patients might require more anesthetic than others depending on how their body reacts.
-IV sedation: At the next level of pain control, we visit IV sedation. Simply put, IV sedation works by administering specific amounts of anesthesia into the bloodstream. This allows for quick absorption by the body and will generally cause the patient to fall asleep. While sleeping the patient will not feel anything. It should be noted that a patient will have a level of consciousnesses throughout the administration of the anesthesia, unlike deep sedation. This form of pain control is for those who don’t want to face a needle or who have a lot of work that needs to be done. Instead of consciously keeping their mouth open for hours during a long restorative procedure, a patient can comfortably go to sleep and wake up with everything done. Patients that have suffered abuse also generally need IV sedation as well as the handicapped or mentally challenged to have a comfortable experience.
-Deep anesthesia: Finally, the last level of pain control is deep anesthesia. This form of anesthesia can only be administered by an anesthesiologist or CRNA. This form of anesthesia is for those who cannot undergo IV sedation and require stronger drugs that completely knock a person out. Typically, you’ll see this type of sedation in a hospital setting unless the dental office has a specialist come and administer the drug in house.
Conclusion
That wraps up this blog! We look forward to sharing our next blog with you where we will examine the process of IV sedation. From a historical perspective to practical considerations, we’ll talk about it all. Ok, not exactly. We will become educated though, so bring your pen and paper (or laptop) so you can learn what you need to feel less anxious about ongoing dental care with our Briar Pointe Dentistry team. We work hard to provide comfortable dental visits with our dedicated dentists, Dr. Neil Blavin and Dr. Rikki Blavin. Please call 248-347-0030 if you have any dental questions or concerns.