I heard this interesting statement the other day –
“Ignoring a patient’s fear of dentistry will not make the fear go away, However, Ignoring a patient’s fear of dentistry may make the patient go away”
Stanley F. Malamed – Dentist and Dental Anesthesiologist
We’ve all experienced it, that look of fear from the patient in the waiting room when you introduce yourself, the “I hate being here” comment as you walk through the surgery door and the flinching and pulling away whilst you’re giving LA . Let’s be real, most of the people coming into our rooms don’t want to be there, but for some people going to the dentist can be an extremely anxiety provoking and traumatising experience. This results in many people avoiding the dentist until they’re in serious pain, and problems are often more complicated to fix.
Managing and treating anxious patients is one of the most challenging parts of the job, without getting these patients in the chair and comfortable with treatment we are unable to do the dentistry we need to help them. Communication is definitely the cornerstone of managing these patients, however in some instances we need to be able to offer our patients more to make their lives and ours a lot easier.
An option for these patients that is safe, painless and effective is Nitrous Oxide sedation (or in patients terms, Happy Gas!). Nitrous oxide has been used in surgical and dental settings since the mid-1800s. Anxiety control and sedation are something we might get a lecture or two on in dental school, however most of us do not get an opportunity to practice delivering relative anaesthesia or treating patents under sedation.
Having no experience with this at dental school, when I started working and my practice had the equipment, I was keen to provide the service for patients, however unsure as to whether I legally could?!
To clear things up the Dental Board of Australia states that “You do not need to be endorsed to administer relative analgesia using nitrous oxide/oxygen on its own or in combination with local anaesthesia as long as the stage of conscious sedation is not achieved.” So all registered graduates of Australian dental schools are qualified to deliver oral and nitrous oxide sedation.
Whilst we can technically use it, not many of us know how! Here is a quick infographic summary of the basics. If you have nitrous at your practice make sure you have someone experienced with using it show you how to use it, as every machine is different, or do a course like I did to make sure you are fully on top of it. I’ve also attached some further resources with some more indepth information.
Useful Links:
Australian Dental Board Sedation Guidelines – https://www.dentalboard.gov.au/Registration/Conscious-Sedation/FAQ-on-Conscious-Sedation.aspx
American Academy of Paediatric Dentistry – Nitrous Oxide Sedation Guidelines and How-to – https://www.aapd.org/media/Policies_Guidelines/BP_UseofNitrous.pdf