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According to Columbia University's College of Dental Medicine, between 9% and 15% of people living in the U.S. avoid getting dental care because of anxiety and fear. That comes as no surprise to Rene Piedra, DMD (www.afraidofthedentist.net), whose dental practice in Coral Gables, Fla., welcomes patients who are reluctant to go to the dentist. "Every day, we see patients who have dental anxieties, fears, and phobias," says Dr. Piedra. "These fears can have a devastating effect, since procrastination in receiving dental care can impact a person's self-confidence, appearance, and well-being. Left untreated, dental problems can have far-reaching consequences, seriously affecting patient health." People with dental fear are increasingly opting for "sedation dentistry," and dentists around the country are changing their methods in response to patient demand. These newer kinds of sedation dentistry are much more than a shot of Novocain. Instead, nitrous oxide gas, oral medication, and intravenous drugs may be employed to put the patient in a relaxed, conscious state while the dentist performs the procedures. While Dr. Piedra is considered an expert in sedation dentistry, he believes that sedation is over-prescribed. "Sedation should be the last resort - not the first course of action," he says. "It's a quick remedy that may address the symptoms of anxiety, but not the underlying cause." Dr. Piedra differentiates between dental anxiety, dental fear, and dental phobia, and uses a range of techniques to mitigate apprehension at its roots. "Dental anxiety is basically the fear of the unknown, and can usually be handled by taking the time to familiarize a patient with the office, the equipment, and the procedures," he says. "Dental fear elicits more of a 'fight or flight' response, and typically can be eradicated by giving patients more control over their experience. Dental phobia can be more difficult to overcome, but the same desensitization techniques used to treat other phobias also work nicely with dental phobia." As a case in point, Dr. Piedra cites the experience of a person who had visited another dentist and received general anesthesia, only to awaken in the middle of the procedure with a tooth caught in her throat. Terrified, the patient doubted she could overcome her fear long enough for Dr. Piedra to complete the procedures she so desperately needed. "I started by showing her all of the instruments we would be using and honestly explaining every step of the procedure," he says. "Then she went back in the waiting room until her anxiety level subsided. She then came back in and allowed me to do an examination, and then went back out to the waiting room. We repeated the process over the course of several hours, but ultimately she received treatment that same day with no sedation." Several visits later, both the patient and her husband shed tears of relief because she was able to conclude the course of treatment with no sedation whatsoever. Dr. Piedra maintains that taking the time to understand the basis of dental fear and anxiety can pave the way for sedation-free treatment. "Unfortunately, many people have had humiliating or negative experiences with other dentists, or have picked up on a parent's dental anxiety," he says. "Uncovering the cause of the problem enables us to develop helpful strategies that will lead to successful treatment." By recognizing that the needs of patients differ, Dr. Piedra's team can personalize treatment to fit the individual. "For some people, headphones and a soft blanket will do the trick, while others might need to touch the instruments," he says. While Dr. Piedra is quick to note that sedation should always be an available option, his first goal is to increase a patient's comfort level. "If we can eliminate the anxiety, fear, or phobia, it will not only improve a person's dental health, but their general well-being," he concludes.
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Dr. Rene Piedra has trained in the field of Sedation Dentistry and is a member of the American Dental Association. He can assist people who have neglected their oral health and whose health continues to deteriorate because of fear or gagging. Visit www.afraidofthedentist.net
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