Fear of pain is the main reason people avoid seeing the dentist. The good news is that there is a wide array of medications and techniques - used alone or in combination - that can reduce or eliminate pain and control anxiety during most procedures.
- Topical anesthetics. Topical anesthetics, applied with a swab, are routinely used to numb the area in the mouth or gums where the dental work will be done. The topical anesthetic is given prior to injection with a local anesthetic, such as Lidocaine.
- Laser drills. Some dentists are now using lasers to remove decay within a tooth and prepare the surrounding enamel for receipt of the filling. Lasers may cause less pain in some instances and result in a reduced need for anesthesia.
- Electronically delivered anesthesia (also called transcutaneous electrical nerve stimulation [TENS]). This is an alternative to the shot of anesthesia. Adhesive pads are placed on the face and a battery-powered device sends electrical impulses to the treatment area to numb it. The patient controls the level of stimulation through a hand-held unit. Another form of electronically delivered anesthesia is called cranial electrotherapy stimulation. Under this technique, electricity is passed into the brain, which causes relaxation. Again, the patient controls the intensity of the current, increasing or decreasing it to control the pain as needed. Advantages of these approaches are that as soon as the device is switched off, the effect is instantly reversed. The patient is able to drive and resume normal activities immediately following the dental visit.
- Nitrous oxide (also called laughing gas). This gas, which is inhaled by the patient through a rubber face mask, helps people feel relaxed and is one of the most common forms of sedation used in the dental office. Effects wear off quickly after the gas is turned off. This is the only form of sedation under which patients can drive after the procedure and can eat food within a 12-hour period of the procedure. With IV, oral and general anesthesia, the patient cannot drive following the procedure or eat after midnight the night before the procedure.
- Intravenous sedation. This form of pain and anxiety control involves injecting a sedative into a vein of a patient's arm or hand. This approach is usually reserved for patients undergoing extensive dental procedures or for the extremely anxious patient. Dentists need to monitor the oxygen level of patients receiving IV sedation and may need to give such patients additional oxygen during the procedure. With IV sedation, the patient is awake but very relaxed. If you think you may be interested in IV sedation, ask your dentist if he or she is licensed to administer intravenous sedatives.
- Oral sedation. An oral medication, such as Halcion, works on the central nervous system to help patients relax. Oral sedatives are often not prescribed because they take about 30 minutes before their effects are felt and can cause drowsiness that may last for hours.
- General anesthesia. With this technique, the patient is "put to sleep" for the duration of the procedure. Patients requiring general anesthesia can be treated in the dentist's office, but more likely are treated in a hospital setting. This is because this type of anesthesia has risks, which include a sudden drop in blood pressure and irregular heartbeats, so the patient needs to be closely monitored. For these reasons, general anesthesia is typically only used if extensive dental work is needed and when other forms of sedation or pain control are not sufficient to conquer fear. If you think you may be interested in general sedation, ask your dentist if he or she is licensed to administer this form of sedation.
It's important to discuss all of these options with your dentist. It is also important to tell your dentist about any illnesses or health conditions you may have, if you are taking any prescription or nonprescription medications, or if you ever experienced any problems or have any allergies to any medications. Using all of this information, your dentist will work with you to determine which anxiety- and pain-reducing approach may be the best option for you. Also know that your dentist may be licensed to administer some, but not necessarily all, of the pain- and anxiety-reducing strategies identified here. Finally, keep in mind that although some health care professionals may feel that the use of sedation might be inappropriate for routine dental procedures, many dentists believe that the benefits of good oral care for patients with high anxiety and/or dental phobia outweigh the risks of sedation.
Mind/Body Techniques to Control Anxiety or Pain
- Distraction strategies. One way to reduce stress and anxiety is to distract yourself with something pleasant. Bring a Walkman with your favorite music. Some dentists have Walkmans in their offices that can be borrowed, and others are beginning to offer virtual-reality goggles, which provide images and sounds to take your mind off of the work your dentist is performing in your mouth.
- Relaxation techniques.
Studies have shown that practicing relaxation techniques helps reduce pain and
anxiety levels in patients. There are many types of relaxation strategies.
Some of the more common include:
- Guided imagery. This is the technique of imaging a pleasant experience or a particularly soothing environment. By concentrating on creating as much detail as possible, your mind becomes absorbed in this task rather than focusing on what the dentist is doing.
- Deep breathing. This technique involves breathing deeply and slowly, which floods the body with oxygen and other chemicals that work on the central nervous system and improve your comfort.
- Progressive relaxation. Using this technique, you consciously concentrate on relaxing every muscle in your body beginning at your toes and working all the way up to your head. Reducing muscular tension helps reduce pain.
- Biofeedback. This technique involves learning how to relax and better cope with pain and stress by altering your behavior, thoughts and feelings. Specialists who provide biofeedback training range from psychiatrists and psychologists to dentists, internists, nurses, and physical therapists.
- Hypnosis. Hypnosis, whether self-induced or aided by a dentist or therapist, is another way to produce a relaxed state.
- Acupuncture. This technique involves the placement of very thin needles into certain locations on the body. The body responds by releasing numerous chemicals that have an analgesic (pain-killing) effect on the body. A related technique, acupressure, uses pressure applied to certain locations instead of needles.
- Support Groups. Most communities have support groups that offer practical tips and coping skills in addition to emotional support for those who suffer from anxiety or phobias. Ask your dentist if he or she can assist in finding a support group in your area.
- Mental health therapy. Working with mental health professionals, such
as psychologists and psychiatrists, is another worthwhile option to consider
for those with severe anxiety and phobias. The types of therapies that might
be tried in this setting include:
- Systematic desensitization. With this technique, patients are gradually exposed to the things they are afraid of - for instance, in this case, the dental office and dental instruments.
- Cognitive behavior therapy. This approach teaches patients how to calm their mind and body and change negative or harmful thinking patterns so that they can feel better, think more clearly, make better decisions and overcome fears.
- Psychotherapy. This is a process by which patients increase their personal awareness and come to an understanding of and make peace with the difficult events or fears from their past.
Reviewed by the doctors at The Cleveland Clinic Department of Dentistry.
Edited by Charlotte E. Grayson, MD, February 2003, WebMD.
Portions of this page © The Cleveland Clinic 2000-2003