Sedation dentistry is helping to coax terrified patients back into the dental chair.
It was supposed to be a routine teeth cleaning.
But for Daniel Rourke, it felt more like torture. By the end of his dental appointment, he had sweat through his shirt and tie, necessitating a trip to a clothing store before he returned to work.
“I don’t know if he was a sadist or what,” Rourke says of the dentist, “but I had never experienced pain like that in my life.”
So for a quarter of a century, Rourke, now 72, never went back to a dentist. He brushed and flossed regularly but ignored the recommended twice-a-year professional cleanings. Finally, a toothache last summer drove him back to a dental office. “It hurt too much to ignore,” says Rourke, who lives in Rockville and works as a statistical consultant for law firms.
He happened to have heard a radio commercial for Bethesda Sedation Dentistry and decided to make an appointment. The word “sedation” caught his attention, as did a patient’s testimonial that Dr. Robert Schlossberg and his wife, Dr. Deborah Klotz, who run the practice, don’t judge patients for postponing their dental care.
Rourke met with Schlossberg and learned that the pain stemmed from an infected wisdom tooth that needed to be pulled. Schlossberg explained that his practice offers several sedation methods, including oral sedation, IV sedation, and nitrous oxide, also known as laughing gas, which can be combined with one of the other methods. Rourke opted for IV sedation.
Klotz says she and her husband tend to use oral sedation with less fearful patients because the effects might begin to wear off before the procedure is complete. An IV gives the dentist better control over the level of sedation. “I can make sure that no matter what I’m doing, I can always add more or perfectly tweak it so you’re comfortable,” she says.
Unlike general anesthesia, IV sedation doesn’t render patients unconscious, Klotz says, although sometimes it relaxes them so much that they fall asleep. If they feel pain, they’ll wake up, or the dentist will notice an increase in their heart rate. Klotz and Schlossberg use oral or IV sedation hundreds of times a year, they say, often just to put nervous patients at ease during routine cleanings. Because Rourke has an irregular heartbeat, Schlossberg consulted with his patient’s cardiologist to make sure it was safe for him to be sedated.
A few days after his initial evaluation, Rourke was hooked up to an IV and a heart monitor while Schlossberg pulled the infected tooth. Rourke wore a device that monitored his blood oxygen level. He says he doesn’t remember the procedure, a welcome effect of the drug.
MANY PEOPLE FEEL ANXIOUS about getting their teeth cleaned or cavities filled, but they force themselves to go to the dentist. Others, like Rourke, are phobic about visiting a dental office, a condition called “odontophobia.” According to scientific literature, 4 percent to 20 percent of people in industrialized countries avoid dental care because they are scared. To coax fearful patients back into the chair, some dentists offer sedation dentistry, also called “sleep dentistry,” which includes a number of methods to help patients relax. Sedation dentistry also enables patients with busy schedules to cram more treatments into a single appointment.
“When we look at sedation, we’re looking at a continuum from minimum to moderate to deep sedation to general anesthesia,” says Dr. Guy Shampaine, an American Dental Association (ADA) spokesperson who helped write that organization’s guidelines on anesthesiology and sedation.
Dentists safely sedate millions of patients every year, according to the ADA. The first public demonstration of general anesthesia in dentistry took place in 1846, when a dentist named William Morton administered ether to a young male patient in what is now called the “Ether Dome” at Massachusetts General Hospital in Boston. While the patient was unconscious, Morton removed a jaw tumor.
More than a century passed before Dr. Niels Bjorn Jorgensen, a dental faculty member at Loma Linda University in California, pioneered the use of IV sedation for dentistry in the 1960s. “Being the kindest and gentlest of men, Niels started worrying, from his first entry into dentistry, as to how the pain and discomfort which seemed inseparable from many procedures could best be overcome,” Dr. S.L. Drummond-Jackson, regarded as another sedation dentistry pioneer, said at a 1969 tribute to Jorgensen.
Most dentists who offer sedation dentistry provide inhaled nitrous oxide or tranquilizers by mouth, not general anesthesia, Shampaine says.