Management of Dental Fear and Anxiety (Painless Dentistry)

Management of Dental Fear and Anxiety (Painless Dentistry)

Dental treatment is often associated with fear and anxiety. Such feelings may be related to the pain from injection, post-treatment pain and discomfort, the sight and taste of blood, the sound and sensation from dental drills, the idea of dental treatment being surgical, and/or simply the fear of extraction.

While painless dentistry is almost impossible as pain perception is largely subjective with individual pain threshold variation, pain perception may be dampened (less pain) using several pain and anxiety management methods. In NDCS, we have a suite of pharmacological management methods to deliver pain“less” dentistry.

Computerised local anaesthesia delivery system

Local anaesthesia is an essential drug to facilitate dental treatment. It provides numbness (loss of sensation) to teeth and surrounding soft tissues (for example, cheek and lips) such that surgical procedures and invasive dental treatment can be performed. These treatment procedures may include extractions, wisdom teeth surgery, root canal, deep fillings, deep gum cleaning and others. 

Traditionally, local anaesthesia is delivered using a syringe with needle. The thought of having an injection at the gums may be daunting for some, resulting in dental fear and anxiety.

Controlled delivery of local anaesthesia via a computerised delivery system allows the local anaesthesia to slowly numb the region in a way that applies less pressure to surrounding tissues. This can reduce pain and improve patient experience. In addition, the delivery system looks like a mechanical pencil attached to a tube, it is packaged in a non-intimidating way to reduce fear related to the sight of injection.

Together with topical anaesthesia and various ways of anxiety management, controlled delivery of local anaesthesia may be painless for some patients. The absence of pain cannot be guaranteed due to the subjective nature of pain. In addition, local anasthesia does not remove pressure applied to teeth during extractions.

Inhalation sedation using Nitrous Oxide

Sedation is the process of administering various medications to induce/produce a state of relaxation, drowsiness, and reduced perception of pain or discomfort, without the total loss of consciousness.

Nitrous oxide, more commonly known as "laughing gas", is mixed with oxygen and breathed in through a rubber mask placed over a patient’s nose. Patients may feel more relaxed and the dental treatment process may be made more comfortable. During this time, the patient may be slightly drowsy but will remain awake. The patient will also be aware of the surroundings and the dental treatment being performed. The dentist will control the amount of nitrous oxide the patient will receive, and the gas effect usually wears off quickly after treatment.

Inhalation sedation can be used for adults or children. It is non-invasive, safe, has pain relief properties, and can help the patient cope better with dental treatment. This is especially helpful for patients with mild dental fear and anxiety, and if the treatment is longer, uncomfortable, and/or more complex.

Although nitrous oxide is a pain-relieving agent, local anaesthesia is still required for dental procedures that may cause discomfort and pain, such as deep fillings, crowns, fillings, deep scaling, and extractions.

The success of nitrous oxide sedation depends largely on patient selection. Patients who have moderate and severe dental fear and anxiety may not be suitable candidates for inhalational sedation as substantial cooperation is still required from patients to wear the nasal mask throughout the procedure.

Patients will be assessed for suitability at consultation and pre sedation assessment. Those who are unsuitable for nitrous oxide sedation will need to explore other options to manage their dental fear and anxiety.

Intra-venous (IV) sedation

For IV sedation, a small plastic tube will be inserted into a vein and the medication will be injected into the veins while the patient is lying down. Usually, the patient will feel sleepy but should still be able to respond to instructions within a minute. Once a certain level of sedation is attained, the dental treatment will begin.

Throughout the treatment, pulse, blood pressure and oxygen levels will be monitored. Oxygen may be administered as well. The patient may remain conscious and may be instructed to follow the dentist’s instructions during the procedure. Once the treatment is completed, further administration of sedatives will be stopped and the patient will gradually become more awake. Occasionally, a reversal agent may be given to hasten the patient’s awakening.

Adults who have moderate to severe dental fear and anxiety may benefit from IV sedation. 

For patient’s safety, IV sedation in NDCS is administered by our anaesthesia team in the operating theatre, and this service is currently available for patients age 16 to 65 in NDCS.

Various dental procedures may be done under IV sedation. Patients will be assessed for suitability at consultation and pre sedation assessment. Those who are found unsuitable will need to explore other options to manage their dental fear and anxiety.

General Anaesthesia

A general anaesthetic is a mixture of drugs to keep the patient unconscious and pain free during a procedure or operation. Anaesthetic gas is breathed into the lungs and drugs are injected into a vein. A breathing tube is typically inserted into the patient’s windpipe to maintain proper breathing during surgery. This tube is removed as the patient wakes up after the surgery. 

The patient is fully unconscious during general anaesthesia. Pain management is required when the patient wakes up after surgery.

General anaesthesia is administered by our anaesthesia team. Patients will be assessed for suitability at consultation. Some patients may require pre-anaesthetic consultation with the anaesthesia team prior to surgery. Those who are found unsuitable will need to explore other options to manage their dental fear and anxiety.