What to do with nervous patients

There is not one dental practice anywhere in the world that doesn't have to manage apprehensive patients who suffer from dental anxiety.

In fact, according to an article in the Australian Dental Journal,¹ 49% of Australians suffer from dental anxiety!² Just think about that for a minute - one in two of your patients have some degree of fear visiting you!

This article will speak to a technique that is growing in demand and increasing in popularity - with both dentists and patients. That technique is IV Sedation (also known as conscious sedation, twilight sedation, sedation dentistry and sleep dentistry).

Of course, allaying fear and apprehension begins with giving a patient your time. Time is essential to building trust and trust is key in the management of anxiety. You also have to be empathetic. Remember, patients don't care how much you know until they know how much you care! Offering sedation, in all its forms, is a clear message to your patients that you do care.

It's important to note that IV Sedation is just one of many sedation techniques available and falls in a spectrum. Within a dental setting, there are really only four modes of sedation available - inhalation, oral, intramuscular and intravenous. Each has its own advantages and disadvantages.

Modes of sedation

Inhalation Sedation (nitrous oxide/oxygen aka "laughing gas") is relatively safe, short-acting and patients typically recover within minutes. It can be titrated and reversed. However, it is not a potent sedative and it also requires a degree of patient cooperation with respect to wearing of a mask and breathing. Nausea and vomiting are not uncommon either.

Oral Sedation is easy to administer, but oral medications are absorbed slowly and take some time to have an effect. Furthermore, its efficiency varies greatly and it is not possible to titrate or reverse should it be necessary.

Intramuscular (IM) Sedation is useful in patients who refuse to swallow oral medications or are unable to do so and is faster acting than oral sedation. Nevertheless, it too has its drawbacks. It needs a fairly large muscle mass for administration of the injection, has a short duration, cannot be titrated or reversed and IM injections are painful!

Intravenous (IV) Sedation has a rapid onset of action and effectiveness and is easily titrated and reversed (a huge safety consideration). It is especially useful for uncomfortable, invasive or lengthy procedures. Sedation administered in a dental surgery can be more cost-effective than that performed in a hospital setting. On the other hand, it requires intravenous access which can be difficult on occasion and requires extensive additional training and mandatory annual reaccreditation.

So why is IV Sedation so popular?

Well, it has some distinct advantages.

Reason 1

First and foremost, it is safe. Modern anaesthesia is very safe and IV Sedation is one of the safest forms of anaesthesia. Sedation given in dental surgeries by qualified dentists has an excellent safety record.

Reason 2

It is comfortable and pain free. IV Sedation eliminates all fear, anxiety and stress associated with dental treatment. Patients are drowsy and blissfully unaware of their surroundings.

Reason 3

It's amnesic. Patients remember little or nothing about the procedure (this is arguably the greatest advantage).

Reason 4

The recovery is typically smooth and rapid. Patients are usually ready to go home 30 minutes after their procedure.

Reason 5

It is convenient, avoiding the use of a general anaesthetic and the inconvenience of going to hospital.

Reason 6

It is time efficient and highly productive, allowing for treatment that would normally take multiple visits to be done in one comfortable appointment (patients love this).

Reason 7

Finally, and probably most importantly, IV Sedation is customisable for each individual patient.

Locating dental practitioners trained in the use of IV Sedation and prepared to travel, is not always easy. If, however, you find one that you are comfortable working with, they are worth their weight in gold!

As a visiting dental sedationist I travel to practices along the eastern seaboard of Australia. When I first started visiting practices, I often wondered what benefits they saw from IV Sedation. After more than a decade in this space, I'm now used to hearing the same reasons over and over and over:

"Our patients love it!"

(As a result of the increased efficiency and productivity, dentists love it too!)

"The whole team enjoys the more relaxed treatment environment where procedures are completed more quickly without the need for patient interaction."

"We feel we are serving the community better as it's opened up the practice to a whole new group of patients who, without this type of sedation, would simply not be treated."

"We no longer have the hassle of going to a hospital."

"We are now able to keep more procedures in-house, preventing the need for external referral."

"It has boosted the bottom line of our practice by 30-40%!"

Typically practices are pleasantly surprised to see how easily IV Sedation is incorporated into their workflow and are amazed at the feedback that they receive from their patients. Patients who have avoided dentistry for years (in some cases decades), are particularly appreciative of the service. Dentists, especially the more experienced, often remark that if they could, they would do all work under IV! At the end of the day, it's an enjoyable and efficient way to practice. Period.

A practice builder

The icing on the cake is that if marketed correctly, IV Sedation is a practice builder - it increases market share, opens up new markets and improves the turnover of the practice. I have witnessed this in diverse locations and across all demographics. Frankly, it doesn't get better than that!

I'll end where I began... 49% of Australians suffer from dental anxiety. Instead of having our own uneasiness in dealing with these patients, embrace them, by offering in-house IV Sedation. I'm confident you'll be pleasantly surprised. I know your patients certainly will be! In a highly competitive world, think of it as another feather in your cap and a point of differentiation between you and other dentists.

About the author

Dr Minoo Vellani BDS; Grad.Dip.Clin.Dent (Conscious Sedation and Pain Control) has more than a decade's experience as a Dental Sedationist. He worked as a dentist for 20 years before becoming registered with the Dental Board as an approved Dental Sedationist in 2006.

References

1. Armfield, J (2010) "The extent and nature of dental fear and phobia in Australia", Australian Dental Journal, Vol 55 (4), pp 187-196.
2. "Dental Anxiety" is defined as having a low to extreme fear associated with visiting the Dentist.