Dental Pain Management in Your Plymouth MN Dental Office
Over the years dentistry has gotten a bad rap as a place that is associated with pain. Our patient-focused dentistry makes the difference for our patients every day.
Some of this bad rap in dental pain management is deserved but a lot, especially in modern dentistry, it needs no longer to be a concern. For those of you who have anxiety over seeing the dentist or for those of you just curious about how family dentistry can be a pain free experience this may be a good article for you to review. It will talk about the anxieties and potential for discomfort in the dental chair and how it can be greatly mitigated through various options for pain management. Options can range from no pain management needed to full sedation dentistry.
If you are reading this article I’m going to guess that you have a certain anxiety about dental visits or you probably would not be so concerned about researching the topic. We are very gentle and skilled with our emergency dental care. With that in mind, I want to start with a personal story of my most recent dental visit. You will probably be surprised to hear that after almost 30 years in the dental business I never had my wisdom teeth removed. This was partly due to the stories I heard from my friends when they had their wisdom teeth out in high school. The anxiety those stories gave me coupled with the fact that there was never a pressing need to have them removed guided my decision process to never have my wisdom teeth removed. At my last regular dental visit, my doctor told me that an infection had developed around one of the wisdom teeth and it needed to come out. It was my turn to face my anxieties and get it done.
Now I wouldn’t consider myself an overly anxious patient but my friends’ stories from 30 years ago still rang in my head. My oral surgeon told me that my wisdom tooth was impacted and perpendicular to my other teeth. Not an easy extraction, even for an experienced oral surgeon. I had options for pain management and I chose “conscious sedation”. This sedation made me very groggy but I was awake for the whole procedure, could hear the doctor and assistants talking and could hear the dental tools running. My tooth needed to be sectioned out (I know, sectioning sounds horrible!) but do you know what?…. I never felt one bit of discomfort!! That is exactly how dental procedures are today. I’m hoping that sharing my own personal story, coupled with reading about the different pain management techniques available, that you can alleviate some of your own personal dental anxieties.
As I stated above, there are options available to you if you are concerned about discomfort for an upcoming dental procedure. Below are various dental pain management and sedation options the dentist may offer you.
Dental Pain Management and Sedation Options
- Sometimes the dentist will provide the option of no pain management for a dental procedure. This is when the doctor knows that the procedure will indeed not cause pain through the contact of any nerves. He or she will also take into consideration the anxiety level of a patient. If the patient is usually not anxious, then no pain management is a viable option. If the patient carries a high level of anxiety about visits, the reassurance that (delete and) anesthetic will be done for those people may be necessary.
- Topical anesthetic. This is a numbing gel that can be applied to the gums for minor procedures where the dentist feels there may be a chance of minimal discomfort during a procedure. As the name implies it is a gel applied to the gums that provide some numbing.
- Local anesthetic (Novocain, Lidocaine) is the pain management system most people are familiar with. It is the injection of anesthetic close to the area of treatment. It makes the area numb for a period of time so there is no feeling or pain from the teeth being treated.
Some people have an anxiety towards needles so dentists have learned a few tricks to help their patient get over the hump of the fear of needles prior to the procedure. They will often distract a patient with conversation to keep the focus off the needle. When the needle is put into the patient’s mouth the dentist can use a free finger to massage the gums close to the injection site to again, distract you while the anesthetic is being delivered. Last, the dentist may apply a topical anesthetic to the injection site to create numbness in the area where the needle is to be inserted.
Is Adult Oral Anxiolysis & Sedation Best for You?
For the patient who wants or needs to be sedated for their dental visits there are various options for sedation dentistry to help them. According to the University of Minnesota, “Research suggests nearly 30% of adults would benefit from some form of anxiolysis or sedation to receive dental care. Only 60% of these patients do well with nitrous oxide sedation alone, meaning 34 million fearful individuals are avoiding routine and necessary dental visits.”
Since sedation is used to relax the patient, it would normally be used in conjunction with local, or maybe even general anesthesia to help provide a stress-free, pain-free dental visit. We also consider urgent dental care requests and the timelines involved. Which option is the right one for you will depend on a few factors.
Criteria Considered When Select Your Dental Pain Medication
- Your age
- our general health (and whether or not you are facing gum disease)
- The type of dentistry you are being treated for
- How much dentistry or how many teeth will be treated
- Your anxiety level
Additional Sedation Dentistry / Anxiolysis Options
Nitrous Oxide (Laughing Gas)
Nitrous oxide sedation, also called Relative Analgesia (RA), happy gas or laughing gas, is a form of conscious sedation, according to the AAPD. This is a really great option for patients with mild anxiety or especially children to keep them calm. (Kids love to wriggle around!) It will help to make you feel relaxed during your appointment. You will be completely conscious and may actually laugh at the “bad jokes” your dentist tells you during the appointment Hence the nickname “laughing gas”. Since Nitrous Oxide does not make a person numb the only time it would be used without another numbing agent is when the dentist has an anxious patient where the procedure is done will not cause pain.
Minimal Conscious Sedation
Minimal sedation which was previously known as anxiolysis is a minimal conscious sedation. It is a drug-induced state that is normally delivered by taking a small pill. When under this form of sedation patients will respond normally to verbal commands. Although cognitive function and physical coordination may be impaired for a period of time, airway reflexes, and ventilatory and cardiovascular functions are unaffected. Because of the anxiety-reducing benefits, dentists will prescribe it be taken prior to an appointment for the highly anxious patient. But since it does impair physical coordination the patient needs a driver with them as they will not be able to drive home on their own afterward.
Conscious IV Sedation
Moderate Sedation or Conscious IV sedation is a deeper state of sedation. As the name implies it is normally administered through an IV. The patient will still respond to verbal commands but may lightly nap through the procedure. Same as minimal sedation, motor skills will be impaired but breathing and cardiovascular functions are maintained on their own by the patient. Your dentist and possibly a sedation nurse perform close monitoring of patient throughout the procedure.
Drug-Induced Deep Sedation
Deep sedation is a drug-induced depression of consciousness. Usually, the drug is administered through IV. At this point, the patient will not be able to be easily aroused but will respond to repeated to repeated commands. During a state of deep sedation, the patient may need help breathing but the cardiovascular function is maintained. As you may expect motor skills are impaired so you will not be able to drive after your appointment. As with mild sedation close monitoring of the patient is performed throughout the procedure by your dentist and possibly a sedation nurse.
Simple general anesthesia is a commonly used in sedation dentistry. This where a patient will actually lose consciousness and is not arousable. The ability to breath on your own is often impaired and quite often assistance will be needed to maintain your airway. Cardiovascular function may also be impaired at this time. Close supervision of the patient by a team of caregivers is needed during an oral surgery or dental procedure. As stated above you will not be able to drive and need a period of recovery time when being taken out of general anesthesia.
Hospitalization for Severe Dental Anxiety
If your dentist has hospital privileges patients with the highest anxiety levels can choose to be seen in a hospital setting. I had one patient whose anxiety was so extreme that they requested hospital care for their routine cleanings. While the dentist was happy to be able to care for the patient by their preferred method the out of pocket cost to the patient for this option was significant as you might imagine would be the case with hospital care.
Each level of sedation dentistry listed above will put the patient into a deeper state of sedation, along with increased complications and risks. As you discuss the options with your dentist it is important for you to fully understand how your sedation choice will affect you and your care. I feel confident that after you have had this conversation with your dentist that you can rest assured that your visit will be safe, appropriate for you and get the care you need to be accomplished with a minimal amount of pain and anxiety!
The Doctors at Smile Design Dentistry are skilled at your feelings of stress, fear or pain at the dental office. Call 763-537-1238