Experts debate sedation at dental offices

January 5, 2009 11:28:17 AM PST
About 30 percent of Americans are afraid of going to the dentist. Sometimes they let dental problems linger for years without being seen.

But what if you could forget you ever went to the dentist? Now it's possible, but some dentists warn it's not without risks.

Today, Dustin Fuller is calm while he waits to see his dentist. It wasn't always this way.

"I was really deathly afraid of the dentist," Fuller said.

After avoiding the dentist for 30 years, Fuller was forced there when he broke a tooth.

"Extreme fear, even just sitting there filling out paperwork the first time, I forgot my address," Fuller said.

He easily handled his root canal with conscious oral sedation, a new trend in dentistry.

"They remember bits and pieces, but they really don't remember details," said Anna Belous, DDS, general dentist, Contemporary Dentistry, Rochester, N.Y.

Belous offers oral sedation to fearful patients. They get valium the night before and another sedative pill the day of the procedure.

"It's very well managed. It's very safe," Belous said.

Oral surgeon Lee Pollan says the trend is disturbing, and many dentists are not trained to deal with the complications.

"These drugs can depress respiration and depress cardiovascular activity," said Pollan, DMD, MS, oral maxillofacial surgeon, Strong Memorial Hospital, Rochester, N.Y.

If patients aren't sedated enough, dentists may give a second dose. It's not risk-free. Patients have died.

"It's very easy for a patient to slip from moderate to deep by adding additional medications, and before you know it, you have a patient that's over-sedated and in trouble," Pollan said.

Guidelines suggest dentists undergo a minimum of 24 hours of training in sedating patients and 10 clinical experiences administering the medications. Doctor Belous says with the right training, it's safe, and she's happy to offer it.

"I think more people are aware of it. More people are eager to do this," she said.

It costs up to $500, but patients like Fuller wouldn't be there without it.

"To sit in a dentist chair for five hours with a root canal and not realize you were there more than an hour, that's worth easily that much, if not more," Fuller said.

Oral sedation has been used for everything from routine cleanings and fillings to root canals. Some experts believe intravenous sedation is safer and more precise since it's easier to overdose when using pills.

However, intravenous sedation usually requires more training.