Sedation dentistry has to do with the desire and the need for dentists to treat the needs of patients without intense pain. Many important dental procedures are available. It is up to the dentist to choose the one which will satisfy the need and match the expected level of discomfort with the fewest risks, side effects, and cost.
Sedation dentistry (which used to be called "painless dentistry") is important not only because it makes dentistry safer and faster but because it is a way of reducing the negative prejudices about dentists that keep many from getting good dental care,
Sedation New and Old
The quest for comfortable dentistry is as old as human efforts to treat problems with teeth.
Clay tablets dated 2250 BC show that people working with dental caries (cavities) used a cement made from mixing henbane with gum mastic. Henbane (also called fetid nightshade) is now often used to treat digestive spasms or to apply to the skin for treating scar tissue. In 1,000 BC in India, wine was used--given to patients to the point that it produced insensibility.
Synthesized sweet vitriol, now commonly known as ether, was introduced by Valerius Cordus in Germany in about 1540 AD. In 1564 France, local pain relief was obtained by compressing nerves.
Laughing gas was invented in England by Humphrey Davy in 1779. Use of ether by English dentists became commonplace by 1842. The hollow point syringe for administering pain-killing medications was invented in 1853. Cocaine was expounded as a local anesthesia in 1884--around the time when heroin was being used as a cough medicine.
Modern anesthetics began to appear in the early 1900s: ethyl chloride, novocaine, "carbon dioxide absorber." Curare, the arrow poison appeared as a local anesthetic in 1942.
Lidocaine and halothane appeared in the late 1950s and early 1960s. Then there were pavulon, forane, protopfol sedative, and desflurane in the 1980s and 1990s.
Each new anti-pain preparation licensed for use has its own special properties and modes of administration that have to be studied and carefully applied.
Looking at it From the Patients' Perspectives
Most dentists understand that patients only know three things.
Most patients don't understand that the dentist put them through the most stable occlusion possible and that their teeth line up perfectly. If the dentist gives an injection that makes them jump, patients sure remember that. Use of needles is one of the trickiest things about dentistry, alongside the use of drills.
Even the Reduction of Pain Might Hurt.
Dentists develop skills in the administration of painkillers with needles. Timing is everything. Before administering the needle that can hurt, they administer powerful topical (surface) painkillers to numb the site of the injection.
By examining the surface of the gum and tissue they can tell when it is ready for the needle. The dentist may actually give the tissue a little jiggle when inserting the needle. It distracts the patients and helps stimulate the nerves so they don't register the needle poke.
The anesthetics administered to patients are generally very acidic. It's like putting lemon juice under the skin. That is what causes any pain in the injection. It is not the needle prick itself. Often dentists will add an anti-acid buffer like sodium bicarbonate to reduce the discomfort from the acid.
Sometimes injections have to be given in the upper palate of the mouth where there is no soft tissue to use a topical anesthetic on. Dentists care about that and will often use a little ice to numb the site of an injection.
William Linger, DDS, MAGD has been a dentist for 22 years. As a second generation dentist, Dr. Linger feels a calling and has a true passion for what he does. Please contact us to learn more.
