A thorough pre-treatment medical and dental evaluation of patients can help in determination of their ability to tolerate the physiologic and psychological stress associated with their treatment, and hence, prevention of syncope.
- A proper medical history and examination of the patient, may uncover medical or psychological conditions that might predispose the patient toward syncope.
- Once dental fear and anxiety are confirmed, the doctor has an option to use minimal or moderate sedation techniques or modify the dental treatment accordingly.
Stress Reduction Protocols
- Minimize the waiting time at the reception or in the dental surgery.
- Keep the surgical instruments out of sight.
- Let the patient talk, listen to them and respond with empathy.
- Give frequent verbal reassurances and use distracting conversation.
- No unnecessary noise and use relaxing background music.
- No surprises: Warn the patient before doing anything that could cause anxiety.
Short Anxiety Questionnaire
- It includes a series of questions regarding the patient's attitude toward various aspects of dental treatment.
Based on the questionnaire by Corah et al.
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If you had to go the dentist tomorrow, how would you feel about it ?
- I would look forward to it as a reasonably enjoyable experience.
- I would not care one way or the other.
- I would be very uneasy about it.
- I would be afraid that it would be unpleasant and painful.
- I would be very frightened of what the dentist might do.
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When you are waiting in the dentist's office for your turn in the chair, how do you feel ?
- Relaxed
- A little uneasy
- Tense
- Anxious
- So anxious that I almost break out in a sweat or almost feel physically sick.
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When you are in the dentist's chair waiting for him or her to get the drill ready and begin working on your teeth, how do you feel ?
- Relaxed
- A little uneasy
- Tense
- Anxious
- So anxious that I almost break out in a sweat or almost feel physically sick.
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You are in the dentist's chair to have your teeth cleaned. While you are waiting and the dentist is getting out the instruments with which to scrape your teeth around the gums, how do you feel ?
- Relaxed
- A little uneasy
- Tense
- Anxious
- So anxious that I almost break out in a sweat or almost feel physically sick.
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In general, do you feel uncomfortable or nervous about receiving dental treatment ?
- Yes
- No
*From Corah NL: Development of a dental anxiety scale, J Dent Res 48:596, 1969.
Sedation
Sedation is the act of making calm. It can be achieved through non-drug techniques (iatrosedation and hypnosis) and pharmacosedation (oral, intravenous or inhalation sedation).
Iatrosedation
Developed by Dr Nathan Friedman, it is the process of relieving anxiety by the doctor's behaviour (verbal and non-verbal communication).
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It is an interpersonal-cognitive technique by which fearful patients are calmed by the behavior, attitude, and communicative stance of the dentist.
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The process consists of an iatrosedative interview and a clinical encounter.
Pharmacosedation
It is defined as the act of making calm with the use of drugs.
- Although intravenous sedation may achieve a more predictable level of sedation, phobic patients may also faint at sight of a needle. Hence, oral sedation is the preferred method for prevention of anxiety.
- Oral sedation produces only a minimally depressed level of consciousness that can be monitored by asking the patient to respond to verbal commands.
- The appropriate level of consciousness is when the individual is able to control his or her own airway and take deep breaths when requested to do so.
- For adult and teenage patients, Triazolam and Diazepam are effective oral agents, but Triazolam is the preferred agent.
- Triazolam is a benzodiazepine derivative drug that have anterograde amnesia, anxiolytic, sedative and anticonvulsant properties. Its rapid onset of action and short half-life (approx 2-4 hrs) makes it useful agent for oral sedation.
Sit-Down Dentistry
- In sit-down dentistry, the patients are treated while they lie in a supine or slightly upright position.
- The supine position (ideally with the feet elevated about 10-15 degrees) prevents the decrease in cerebral blood pressure.
- The use of supine position during dental treatment has the potential to dramatically reduce the chances of syncope.
References
- Medical Emergencies in the Dental Practice (7th Edition), Stanley F. Malamed, Daniel L Orr II, Mosby Elsevier.
- Medical Emergencies in Dental Practice, Orrett E. Ogle, Harry Dym, Robert J. Weinstock, Quintessence Publishing Co, Inc.
- Medical Emergencies Essentials for the Dental Professional (2nd Edition), Ellen B. Grimes, Pearson Education Inc.
- Image Credit: Adobe Stock Images.
*This article is an excerpt from the above mentioned books and Medical Sutras does not make any ownership or affiliation claims.