One day, when a woman visited Dr. John Whittemore about some dental work, he asked about her level of anxiety. Her reply: "I'm pretty anxious." Later, when he gently placed the mirror inside her mouth and said, "Open wide," he saw two big tears rolling down her cheeks. "I sat her back straight in the chair, went knee to knee with her, and we talked about her fears." That experience prompted Whittemore to become certified in conscious sedation, which allows dentists to treat a more relaxed patient, perform more procedures in a single visit, and — perhaps most important — build trust with people who had neglected their teeth for years.
Dr. Todd Gruen, who works with Whittemore at Germantown Dental Group, explains that offering a patient Valium is nothing new. What's new is that, thanks to a national group known as D.O.C.S. (Dental Organization for Conscious Sedation), dentists can receive extensive training in how the benzodiazepam medications can benefit both patient and dentist.
"Our intention is not to let somebody fall asleep. I want the person awake and responsive the entire time," says Gruen. He and Whittemore are among several dentists in the Memphis area certified by the state to practice conscious sedation. Prior to the procedure, the dentist performs a thorough medical screening. "I want to emphasize," adds Gruen, "that this is not for everyone. We look for minimal-risk, healthy patients with no complex medical history."
Just as vital as medical history is under-standing patients' past dental ordeals. "It's like peeling an onion," Gruen explains. "There are so many layers of fear and we can't peel them away in five minutes. We have to build a relationship of trust."
He and his staff built that trust with Stacey Young, who recalls "multiple bad experiences," including having her teeth drilled without adequate anesthesia. Internet research led her to Gruen, who put her at ease. "It had been six years since I had seen a dentist and I needed a complete mouth restoration," says Young. At the pre-sedation visit, she was given two pills with detailed instructions. She took one pill the night before, and the other one an hour prior to the procedure. "I was aware of my surroundings but in a completely relaxed state," she says. Comforted by blankets and soothing music, she underwent replacement of all her back teeth with temporary crowns. During the second and final procedure, those 12 crowns were replaced with permanent porcelains. Although each procedure took the better part of a day, Young says, "It felt like I had only been there about an hour. Undergoing the conscious sedation was the best decision I have ever made concerning my dental health. I probably would not have fixed my teeth without that option."
Before the sedation protocol, patients are instructed to have a relative or friend drive them to and from the office. During the procedure, the person's blood pressure and oxygen saturation levels are monitored, and an employee is always in the room to assess the individual's status. Depending on how much the dentist and patient want to accomplish, more sedation may be administered. After the procedure, the dentist gives careful post-op instructions for the patient's safety.
A national study shows that out of 29,000 sedation administrations, 85 ad-verse reactions occurred, and 19 of those needed a reversal agent. Of the hundreds of protocols that Germantown Dental Group has administered since 2004, no ill effects have been reported.
In addition to fearful patients, conscious sedation helps those with an over-active gag reflex and with chronic jaw and neck pain. Often that pain comes from pure tension. "I've treated my father for 14 years. He clutches the armrests so hard he leaves fingerprints and always gets a severe headache," says Whittemore. "We tried conscious sedation and it was amazing, the difference in his relaxation."
