No one "likes" to go to the dentist. This sentiment, as a society, has spawned a whole new generation of available sedation. Take a few pills, a whiff of gas, maybe a little needle in the arm, and we can make all our fears and inhibitions disappear. It could also kill you. Death is bad. Really bad. It could ruin your whole day.
Nitrous oxide was invented in the very late 1700's with the intent to be used to relieve pain. It was immediately used as a recreational drug for the British upper class at "laughing gas parties," everyone would get all dressed up to sit in the parlor whiffing gas and giggling uncontrollably. It was fun. People died. There was little known about what the gas was or how to correctly administer it. Sometimes there was too much gas and not enough oxygen causing asphyxiation and death. It wasn't until the 1840's that doctors started using nitrous oxide as an anesthetic drug. It was first used to relieve a patient from pain during a dental extraction in 1844.
Then came the advent of anti-anxiety drugs in the 1940s and '50s. These were brought into dentistry around the 1980's to decrease anxiety in those with a fear of the dentist. Dentists also started teaming up with anesthesiologists to provide IV sedation. IV sedation is very safe, has a very low risk of death, but is also very expensive. It requires an anesthesiologist to be present as well as an extensive monitoring equipment.
In the late 90's a local dentist named Michael Silverman popularized an oral sedation technique called anxiolysis in which the patient is sedated with a concoction of pills. A handful of different pills such as Valium and Halcion are mixed together to put a patient under a "conscious sedation." This is cheaper than IV sedation because it doesn't require extensive monitoring equipment or an anesthesiologist, the dentist can administer the concoction himself. This is also very unsafe. It is non-reversible, in the event that a patient has a medical emergency or an unexpected reaction to the medication then there is nothing that can be done since the medication is already flowing through their system. It is also unpredictable- it's impossible to know how the medicine is going to take effect from one individual to the other. Dentists are required to be licensed to administer oral sedation and although many dentists feel uncomfortable with this technique it is still being used in some dental practices today. Michael Silverman has written many articles about this technique but no longer practices dentistry.
Our office uses nitrous oxide, also known as "inhalation sedation," for patients with anxiety. We can also administer Valium in a liquid form that relaxes a patient. I discovered liquid Valium in a pediatric practice where we used it very successfully on children. It was only a short thought process to begin using the same medication for our adult patients, with even greater success. Many of our patients liken the sedation to having a glass of red wine. There are few medical problems that prohibit the use of these materials, unlike the other forms of sedation, and it can be reversed if needed. Patients can come take a short nap in our chair while we work on their teeth with no risk of death!
A Family Dental Care Center: Dr. Seth Rosen
2030 West Main St. Norristown, PA 19403