One of the most common fears in human beings is going to the dentist. The extraction of teeth, seeing an anesthesia needle, the use of local anesthetics, and the noises surrounding the clinic are the situations that produce more phobia and anxiety in most people; leading them to avoid regular visits to the dental office until the condition of the mouth has advanced to an ill state, and even creating psychological trauma in patients. In addition to this, the anxiety produced by the duration of the treatment and the relationship patients make between oral surgery and pain influences also in this fear of dentists.
It was the need and the concern for alleviating pain and suffering that motivated all the investigations and advances made throughout history and that has evolved into what Anesthesiologia is currently. Curiously, an American dentist is considered to be the first doctor to perform a general anesthesia. William T.G. Morton, on October 16th, 1846, using the diethylether in a public demonstration was able to produce surgical sedation on a 17 year old patient for painlessly removing a neck tumor.
The word anesthesia is derived from the Greek “aesthesis”, which means ¨insensitivity”, and it is a controlled medical act in which drugs are used to block the tactile and painful sensitivity of a patient, whether it is general or local and with or without consciousness compromise.
Nowadays, there is an increasing need to handle patients who are receiving dental treatment or oral surgery with the least amount of anxiety, tension, fear and pain possible. There are several alternatives for this:
Motivational therapy: psychological preparation, anxiety and self control techniques, either performed by the dentist himself or by a trained professional.
Oral sedation: performed by the prescription of oral medication taken the night before or even one hour before the treatment.
Nitrous oxide: commonly known as ¨laughing gas¨ and it is regularly used by dentists nowadays.
In some cases, either due to conditions by the patient, if they present high anxiety levels or psychological trauma, or due to the type of oral surgery that he/she will be submitted to, mostly if it is a prolonged duration treatment, is when the patient can benefit from intravenous sedation.
Intravenous sedation is the type of sedation that needs to be applied by an anesthesiologist, whom administers diverse hypnotic or sleep inducing drugs and sedatives through a vein directly to the bloodstream, with the purpose of taking the patient to a semi-unconscious state to reduce or eliminate psychic and/or motion unrest, allowing diagnostic or surgical procedures to be performed, while an adequate cardio respiratory function and ability to respond to verbal and tactile stimulation are maintained.
The anesthesiologist is in charge of not only administering sedative agents, analgesics, and hypnotics, but also monitoring and controlling vital signs, in addition, it is his responsibility to provide the necessary medical care to guarantee the patient´s safety and comfort throughout the procedure.
Not all patients are suitable for intravenous sedation in a dentist office. Children, adults with poorly controlled or life threatening chronic illnesses, patients with mental illnesses or retardation are not ideal candidates for this type of procedure. For these cases it is recommended to use general anesthesia in a hospital. In order to find out if a patient is suitable for intravenous sedation, the person´s full medical history is needed, as well as a complete physical evaluation involving laboratory exams are also required according to each patient´s physical condition.
The use of intravenous sedation as a complementary mean to dentistry procedures to diminish anxiety and avoid psychological trauma has demonstrated to be highly beneficial. Being able to handle patients that are afraid, apprehensive, overly anxious, as well as being able to shorten therapeutic times makes it possible to provide a better treatment quality and a more positive response from the patient to future procedures.