Taking "murder" out of the dentists

Ruapehu Bulletin, Volume 6, Issue 313, 14 November 1989, Page 11

Taking "murder" out of the dentists

Dentists and dental treatment have always been associated with pain. For the practising dentist the association is an unavoidable fact of professional life and an inherent handicap in providing effective dental services.

Because of this, dentists have been in the forefront of research into pain-relieving procedures. Over a hundred years ago dentists first used "laughing gas" to relieve the pain of surgery and it was dentists who pioneered the use of hypnosis as a pain-relieving medium. The highly successful use of local anaesthesia by dentists also led our medical colleagues to use it more widely in other parts of the body. Even though the dental procedure can usually be made almost painless with local injections, having an injection in a sensitive area like the mouth can be a very stressful experience. This, altogether with other discomforts like the clinical smell of dental surgeries and the noise of the equipment, or the feeling of being "captive" in the chair, can make a visit to the dentist very off-putting. Again, dentists have been innovative in developing safe and effective sedative routines to help overcome this obstacle to dental treatment. The dentist's training now has a greater emphasis on the 'human' side of dentist/patient relationships. Previously the technical aspects of dentistry were given top priority, producing excellent technicians but perhaps 'cold professionals'. The dentist's friendly

demeanour and concern has been found to be most important in establishing the trust vital for relaxing an anxious patient. First visit The sedation of a nervous patient ideally should begin at the initial visit. Many dentists use questionnaires to find out which areas of dental treatment have caused upsets in the past and by bringing things out in the open help to avoid a repetition of the problem as well as giving the opportunity to change attitudes or errors of fact. It has been clearly established that where there is trust in a dentist/patient relationship the treatment can often proceed without the use of drugs. Where sedatives need to be used, the patient usually has three choices: • Tablets taken orally (oral sedation). • Nitrous oxide and oxygen gases (called "happy gas") for relative analgesia, or nitrous oxide sedation. • Intravenous sedation - slowly giving the sedative through vein in the arm or hand. Before any of these methods are employed a thorough check of the patient's medical status is made and any concurrent medication ! may need to be investigated with the general medical adviser. Cairn for dentist Any one of these

sedatives can produce an environment in which the patient is cairn about the dental procedures, so allowing the dentist to work with quality, painlessly and skilfully. One of the desirable side-effects of the sedative is that the appointment seems to go very quickly and that there seems to be very little recall of the events that took place. However, because there has been some alteration in awareness and concentration, it is most important and that no responsible duties or work be undertaken for some time. And of course driving is strictly forbidden after the intravenous drugs have been given. Dentists today want to reach out to those who, because of harsh experiences in the past, now avoid dental treatment. Many patients who are prepared to give a visit to the dentist another try will find that their old fears will gradually fade and that they can have a healthy, comfortable mouth with teeth they can feel proud of.