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Is dental sedation worth the risk?

December 12, 2008 12:00:00 AM PST
About a third of Americans are afraid of the dentist and the drill. The idea of getting sedated or completely knocked out appeals to many of these people. But some dentists warn it's not without risks. Recently, Dustin Fuller has been calm while he waits to see his dentist. But it wasn't always that way.

"I was really deathly afraid of the dentist," said Fuller.

After avoiding the dentist for 30-years, he was forced to finally go when he broke a tooth.

"I had extreme fear. Even just sitting there filling out paperwork the first time, I forgot my address," said Fuller.

He easily handled his root canal with conscious oral sedation, a new trend in dentistry.

"They remember bits and pieces, but they really don't remember details," said Dr. Anna Belous, DDS.

Dr. Belous offers oral sedation to fearful patients. They get valium the night before and another sedative pill the day of the procedure.

"It's very well managed. It's very safe," said Dr. Belous.

Oral surgeon Lee Pollan says the trend is disturbing, and many dentists are not trained to deal with the complications.

"These drugs can depress respiration and depress cardiovascular activity," said Dr. Pollan.

If patients aren't sedated enough, dentists may give a second dose. It's not risk-free. Patients have died.

"It's very easy for a patient to slip from moderate to deep by adding additional medications, and before you know it, you have a patient that's over-sedated and in trouble," said Dr. Pollan.

Guidelines suggest dentists undergo a minimum of 24 hours of training in sedating patients and ten clinical experiences administering the medications. Dr. Belous says with the right training, it's safe and she's happy to offer it.

"I think more people are aware of it. More people are eager to do this," said Dr. Belous.

It costs up to $500, but patients like Dustin wouldn't be here without it.

"To sit in a dentist chair for five hours with a root canal and not realize you were there more than an hour, that's worth easily that much, if not more," said Fuller.

Dental sedation has been used for everything from routine cleanings and fillings to root canals. Some experts believe intravenous sedation is safer and more precise since it's easier to overdose when using pills. However, intravenous sedation usually requires more training than oral sedation.

Web Extra Information:

FORGET ABOUT YOUR DENTAL PROCEDURE?
About 30 percent of Americans are afraid of going to the dentist. These patients often let dental problems linger for years. Now, there's a way to treat fearful patients. It's called conscious oral sedation. Patients get valium the night before the dental procedure and a sedative pill the day of the procedure. "They remember pieces, bits and pieces, but they really don't remember details," Anna Belous, D.D.S., from Contemporary Dentistry in Rochester, N.Y., told Ivanhoe. Oral sedation has been used for everything from routine cleanings and fillings to root canals. In the last five years, thousands of dentists have been trained to administer these drugs to patients who are awake but not necessarily alert. Patients may forget the whole experience or have only vague recollections. It's a trend that has some patients reconsidering dental work after years of avoidance. "I think more people are aware of it," Dr. Belous said. "More people are eager to do this."

SAFETY CONCERNS:
Some experts like Lee Pollan, DMD, MS, from Strong Memorial Hospital in Rochester, N.Y., worry that many dentists are not trained to deal with the complications that may arise with conscious oral sedation. "These drugs can depress respiration and depress cardiovascular activity," Dr. Pollan told Ivanhoe. Some patients have even died from the sedation. Critics say intravenous sedations are much more precise and therefore safer because pills take longer to absorb into the bloodstream. However, intravenous sedation typically requires more training than oral sedation.

TRAINING GUIDELINES:
After warning that the rising use of oral sedation was not being adequately regulated, the American Dental Association published guidelines recommending that dentists:

  • Undergo a minimum of 24 hours of training in sedating patients
  • Have 10 clinical experiences administering the medication (including three actual cases and one that involves bringing a patient back from deep sedation)


WHAT YOU SHOULD LOOK FOR?
Dr. Pollan suggests that if you are considering oral sedation, you should find a doctor who:
  • Has at least 24 hours of training (although Dr. Pollan recommends more)
  • Will monitor your vital signs during the procedure
  • Is able to reverse the sedation if a problem should occur
  • Can manage any potential complications

COST: Conscious oral sedation can cost up to $500.


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