Barbara Scott's dental phobia dates back to her early childhood days. She's never responded well to medications used to numb the mouth before a dental procedure, so she'd endure drilling and filling without the benefit of full pain relief. "I can remember sitting there with tears running down my face," she says.
Those experiences were the stuff of nightmares. Throughout her adult life, Scott, an executive secretary in Southern California, would suffer panic attacks at the thought of going to the dentist. So she'd postpone visits and the dental problems would only get worse. "It's a vicious cycle," she says.
When she would finally muster up the courage to get help, dentists would spend up to two hours giving her Novocain shots to try to get her mouth numb, with mixed results. A bad gag reflex only compounded the problem.
Now in her early 50s, Scott is still terrified of the dental chair but her fears are finally easing up thanks to an anxiety-relieving approach called oral conscious sedation that's gaining steam in dental offices around the country.
'Answer to a prayer'
Earlier this year, Scott badly needed some dental work, including a root canal and several crowns for cracked and decaying teeth that were at risk of soon being beyond repair. "I'd put off going to the dentist for as long as possible," she says.
She had no choice but to get her teeth taken care of and was planning to take a rather drastic step — general anesthesia, in which she'd be completely knocked out — to do so.
Then she heard about oral conscious sedation, commonly referred to as sedation dentistry. With this approach, anxious patients take a sedative pill such as Halcion about an hour before their dental appointment to help them relax. When the patient gets to the office, the dentist may give more pills, depending on how well the first one worked.
Though this technique has been promoted as a way to "sleep through your dental appointment," patients are not actually asleep. They can still respond to a dentist's questions and commands but aren't likely to remember any of it, says Scott's dentist, Leon Roisman of the Dental Plus Dental Group in Pasadena, Calif. Roisman has used the approach on an estimated 500 patients in the last year and a half.
Being oblivious to what's transpired in the dental chair is the beauty of the approach, according to Scott. "The next thing I knew, I was home," she says. "It was totally an answer to a prayer."
Safety concerns
But not everyone thinks oral conscious sedation is a gift from heaven. And the problems may go beyond the difficulties an escort could face in getting the drugged patient to the office willingly and injury-free, some say.
The American Dental Association doesn't take issue with dentists administering a single dose of Halcion or similar drugs like Valium. However, the group is concerned about multiple doses that could potentially give patients too much of a drug, causing them to be overly sedated -- possibly even unconscious.
Patients metabolize pills differently, so some may not become adequately sedated right away. "It may take 20 minutes, it may take an hour, it may take two hours," says ADA spokesperson Joel Weaver, a professor of clinical anesthesiology at Ohio State University.
That's in sharp contrast to inhaled or intravenous sedation, where the effects are almost instantaneous.
Weaver says a dentist who gives multiple pills may cause an overdose if all the medicine kicks in at once.
"Because there is such a wide variability in how rapidly or how slowly patients absorb drugs by the oral route, the ADA believes there is increasing potential for sedating patients to a level that is deeper than the dentist intended," he says.
Compounding the problem, most dentists aren’t trained in the use of intravenous sedation, so they don’t have the appropriate equipment and skills to quickly and effectively reverse an overdose of pills in an unconscious patient, he says.
But Roisman maintains that oral conscious sedation does not pose such danger, and he's given as many as five Halcion pills to patients during dental sessions that may last as long as six or seven hours — allowing for multiple procedures that otherwise might require several office visits.
"It is a very, very safe drug," he says, and patients are carefully monitored during procedures to make sure their heart rate is healthy and enough oxygen is pumping through their bodies.
Roisman was trained in sedation dentistry through a program known as the Dental Organization for Conscious Sedation, or DOCS. Since being launched in 2000, DOCS has trained about 3,500 dentists who have used the technique on 750,000 patients, according to the group's founder, Michael Silverman, a dentist in Lafayette Hill, Pa.
"It's growing every day," he says.
Yet safety has not been an issue with the technique as it's taught by DOCS, according to Silverman. "There has never been an adverse event in an adult with oral conscious sedation," he says. And despite the ADA's concerns about overdosing, he says, "it hasn't happened." (However, children have died from oral sedation, which is why the approach is only recommended for adults, Silverman says.)
Mark Donald, a dentist in Louisville, Miss., and a spokesperson for the Academy of General Dentistry, says his group is still working to formulate its stance on the use of pills for sedation dentistry. While the practice can be done safely, he says, he agrees with Weaver that multiple dosing could potentially be a hazard.
That's why patients considering sedation dentistry should seek a dentist who has received training in the practice and has plenty of experience with it, Donald says. He also cautions that patients should never drive to or from appointments while under the influence of the medications.
No bad aftertaste
While early DOCS promotional materials billed oral conscious sedation as "sleep dentistry," that language has been dropped because patients could misperceive the procedure as involving general anesthesia, according to Silverman.
"They don't physically sleep through the appointment but they think they did because they have no memory of it," he says.
Typically, patients who undergo oral conscious sedation are still given pain medication, such as local lidocaine injections. But they're unlikely to remember the shots.
That mind-erasing doesn't come cheap. Roisman says charges may run $300 to $600, depending on how much dental work is needed, and insurance generally doesn't cover it.
But his dental-phobic patients seem to think it's worth the investment.
"Of those who try it," he says, "almost 100 percent are thrilled."