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If you are anxious about
dental treatment then you are not alone. Between 6-14% of the population
avoid attending the dentist because of anxiety about treatment. Between
45-55% of patients who attended the dentist are anxious in the dental
environment.
The reasons people fear attending the dentist are varied and include
pain, cost of treatment, lack of control while in the dental chair,
embarrassment and fear of the unknown. The cause of dental anxiety is
usually a previous bad experience, but can be caused indirectly through
horror stories about dental treatment from family, friends and even
the media.
The fear of treatment may appear to the patient to be irrational, uncontrollable
and without obvious cause. Such patients will only attend for treatment
when in extreme discomfort or never at all. As a result their dental
condition deteriorates to the point where their appearance is affected.
This can cause embarrassment and loss of self-confidence which in turn
can cause problems socially and at work.
For other patients, the fear
is not so deep seated. They can explain the cause of their anxiety and
can usually control it to some extent. However, they are still anxious
about dental treatment and will try and avoid it where possible.
Fear of dental treatment
can be overcome by a variety of treatment methods which are described
on this website.
When you make the appointment to see the dentist, tell the receptionist
you are nervous about treatment. This first appointment will usually
be to discuss your fears about treatment and to do an initial examination
of your teeth. From this appointment a provisional treatment plan can
be made. Depending on what you and the dentist decide, this plan can
include one or more of the the treatment methods outlined below.
Initially, you may wish to have treatment using one or more of these
described methods. However, the ultimate aim should be to reduce your
anxiety to a level that it is possible to have treatment without any
assistance. This is not possible in all cases, but where it can be achieved
it is very satisfying for both patient and dentist.
There are several methods
available to help you overcome your fears while dental treatment is
being done. These are:
BEHAVIOR MANAGEMENT
This is the simplest method of treatment for nervous patients. It involves
a careful and sympathetic approach from the dentist, with explanations
of what is being done and allowing the patient control over the procedure.
Some patients may want to
bring a friend along for support. It may also be possible to play relaxing
music or to watch a video while having treatment.
ORAL SEDATION
This involves the use of oral sedative drugs e.g. diazepam, midazolam,
which are taken before treatment. They can also be taken the night before
treatment to help you sleep.
The sedative effect of these
drugs is unpredictable and can vary between individuals. Because the
drugs are taken by mouth it is impossible to quickly increase or decrease
the amount sedation.
They are best used for sedation
the night before treatment to ensure restful sleep or to produce light
sedation during treatment where anxiety levels are low.
While under the effects of
the drug, the patient must be accompanied by a responsible adult and
refrain from driving and operating machinery.
INTRAVENOUS SEDATION
This involves administering a sedative drug in order to produce a very
relaxed state so that treatment can be carried out. The drug also causes
short term memory loss so that very little of the treatment can be remembered.
The drug is administered
through one of the veins in the arm or hand. The amount of drug given
varies between individuals but enough is injected to produce relaxed
state within five minutes. Because the drug acts very quickly, more
can be given if necessary to increase the feeling of relaxation.
The effects of the drug can
last up eight hours after and the patient must be accompanied by a responsible
adult and refrain from driving, operating machinery or other responsible
activities during this time.
It can be used on most healthy
adults but must be avoided in patients with severe lung disease, some
heart problems, obesity or in pregnancy. It is also not suitable for
children or the elderly.
This type of sedation is
very safe as the patient is not unconscious as in general anaesthesia.
It works for the vast majority of patients and it is a very effective
way of providing dental treatment. It is also very effective in treating
patients who gag easily.
INHALATION SEDATION
This involves giving a mixture of nitrous oxide ('laughing gas') and
oxygen which are inhaled through a rubber face mask. The nitrous oxide
reduces anxiety and improves co-operation, without causing unconsciousness.
The effects of the nitrous
oxide wears off very quickly and the patient can leave the surgery without
the need for an accompanying adult.
This technique can used for
most patients but must be avoided in those with colds and other respiratory
problems, psychiatric treatment, vitamin B12 deficiency and in pregnancy.
This form of sedation is particularly useful for treating anxious children.
GENERAL ANAESTHESIA
General anaesthesia (GA) involves being 'put to sleep' in order to provide
dental treatment. It is only available in hospitals and specialist centres,
and must be administered by a qualified anaesthetist. Because of the
slight risks involved with GA, it is only used where there is no other
option. The procedure is usually limited to adults who are undergoing
complex treatments (e.g. extraction of wisdom teeth) or are not suitable
for the other methods of treatment described. It is also used to treat
anxious children. Treatment provided under GA is usually limited to
extractions and simple fillings.
HYPNOSIS
This involves the use of hypnotherapy to reduce anxiety.
It is very effective in people
who are respond well to hypnosis. It may involve one or more preliminary
sessions before treatment is attempted. The hypnosis may be done by
a hypnotist working with a dentist or by the dentist if he is qualified
in hypnotherapy.
This type of treatment is
not widely available and can be time consuming and expensive.
PSYCHOTHERAPY
This form of treatment is used to treat a whole range of phobias and
anxiety disorders. The psychotherapist will initially try and locate
the origin of your fears. They will then follow a program of therapy
designed to overcome or control your anxiety sufficiently for you to
undergo dental treatment.
ACUPUNCTURE
Acupuncture is a medical treatment which can be used to relieve the
symptoms of a variety of physical and psychological conditions including
dental anxiety. Each patient's case is assessed by the practitioner
and treatment will be tailored to the individual.
Community Dental
Service?
A Community Dental Service (CDS) provides treatment for people
who may not otherwise seek or receive dental care, such as people with
learning disabilities, elderly housebound people, people with mental
or physical health problems or other disabling conditions which prevent
them from visiting a family dentist / General Dental Practitioner.
A Community Dental Service
often manages oral health promotion and oral screening for schools.
The CDS may provide treatment for children identified at screening,
who do not have a family dentist. Some CDSs only accept patients on
referral from GPs or from General Dental Practitioners. Your local CDS
will be able to give you information about the exact services it provides.
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