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Issue Date: March 23, 2003
My dream dentist trip
In short: Sedate me. Getting me into a dental office is usually like, well, pulling teeth. But this treatment option may work for you, too.
Fear of needles and bad experiences with Novocain kept John Shalf, 35, a research scientist from Oakland, Calif., out of the dentist's chair for 10 years -- until an aching tooth and the prospect that he could be fully sedated for his treatment lured him back. Shalf's anxiety about dentistry is a common one: 25 million Americans avoid the dentist because they are anxious or afraid. But other proponents of "sedation dentistry" are simply busy people who don't have the time to schedule multiple appointments and opt instead to be sedated just one time. Shalf tells USA WEEKEND how sedation dentistry helped him:
I have been avoiding dentists for most of my life. My general distaste for dentists goes back to when I was 4. My molars came in with incomplete crowns. The first thing they had to do when my teeth arrived was fill them. They strapped me down and gave me shots. The shots didn't work very well, but they didn't seem to believe a 4-year-old. Novocain isn't very effective on me. My mother and her mother have the same issue: We can still feel everything.
I had a great dentist 10 years ago who understood this and dealt with it. He was patient enough to wait for me to actually get numb before working on me. He also looked over my X-rays and did some experiments to determine that the nerve usually targeted with Novocain actually went in a different location through my jawbone than is typically the case. So from then on he would inject in a different location to numb me effectively with a single shot. But after I moved away from that area, I couldn't find anyone who would take me seriously. They'd say, "Oh, you'll be fine," so I stopped going in for dental treatments.
About a year ago, I had some severe tooth pain and decided I needed to get over this hump. A dentist recommended by one of my wife's friends took a look at my mouth. After he tried several times to inject me with Novocain, he said, "They have special dentists for people like you," and referred me to David Blende of San Francisco.
I felt comfortable going to Blende's group, because they were one of the few that offer general anesthesia during dental work. The staff was very attentive and had me fill out a survey that went over all the things I might have issues with. It even had a section that covered my fleeing instinct: "Do you postpone dental appointments continually?" Yes, I did.
To do all the work that was needed on my teeth in one visit, they put me under general anesthesia in the office.
Most people can't afford general anesthesia every time they visit. I paid a little more than $1,000 just for the anesthesia; the procedures cost extra. In my case, they had to do a deep cleaning, and they also had to prep one side of my mouth so they could put on a crown. They shaved down one tooth because the surface was damaged and prepped another tooth for root canal work. I don't remember how long it all took.
If I hadn't gone under general anesthesia, it would have taken four separate appointments, which didn't sound like a lot of fun. When you compare the cost of having local anesthesia four times and taking off work four times with going in for one appointment and getting general anesthesia, the decision is easy.
I didn't get sick from the general anesthesia, but I had to sleep the whole day afterward. (My wife once had four wisdom teeth cut out in one procedure under general anesthesia, and she was as sick as a dog for three days.)
My insurance doesn't pay for the sedation, but they did pay for all of the other work up to approximately $1,000. However, one of the teeth required root canal surgery (performed by a different dentist, with sedation by Blende), which alone cost $1,200. So I easily maxed out my insurance that year.
If my mouth were that messed up again, I might do it all again. I don't think I would have managed to go through with all those procedures just by doing local anesthesia -- I probably would have avoided that appointment.
Since I had my major work done, I've just been going in for teeth cleaning, which doesn't involve needles. But I still have kind of a dread of dental procedures that I'll probably never get over.
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HOW MUCH IS ENOUGH?
Full anesthesia, which renders the patient unconscious, is the most extreme of the sedation options available in dentistry, says L. Don Shumaker of Cleveland, a spokesman for the Academy of General Dentistry. (He sometimes supplements sedation with hypnosis.) As you go from one end of the scale of options to the other, the risk increases.
The first level is local anesthesia, used to numb the area being worked on, usually given by Novocain injection (although sometimes a patch is used). The numbing effects last from five minutes to three hours after treatment.
Next is inhalation anesthesia, often nitrous oxide or "laughing gas." (It also can be injected.) It works immediately, and the effects don't linger after the gas mask comes off.
Anti-anxiety drugs (such as Valium or Ativan), which can be used in addition to sedation, may stay in the system for up to eight hours.
Full anesthesia can either be "conscious sedation," where the patient thinks he's asleep and has no memory of the procedure but can respond to the dentist; or general anesthesia, where the patient is fully unconscious. It often is a combination of injected and inhaled sedation. Commonly, sodium pentathol is injected. The effects last for hours.
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