According to Columbia University's College of Dental Medicine, between 9% and 15% of Americans avoid getting dental care because of nervousness 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 leery about going 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, tremendously affecting patient health."



People with dental anxieties are increasingly opting for "sedation dentistry," and dental practitioners 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 overused. "Sedation should be the last resort - not the first course of action," he says. "It's a quick fix that may address the symptoms of anxiety, but not the underlying cause."

Dr. Piedra distinguishes between dental anxiety, dental fear, and dental phobia, and uses a variety of techniques to mitigate apprehension at its roots. "Dental anxiety is basically the fear of the unknown, and can usually be dealt with 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 harder to overcome, but the same desensitization techniques used to treat other phobias also work great with dental phobia."

As an illustration, Dr. Piedra cites the experience of a patient who had visited another dentist and received general anesthesia, only to awaken in the middle of the procedure with a tooth lodged in her throat. Terrified, the patient doubted she could overcome her fear long enough for Dr. Piedra to perform the procedures she so desperately needed. "I started by showing her all of the instruments we would be using and honestly discussing every step of the procedure," he says. "Then she went back in the waiting room until her apprehension 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 in the end she received treatment that same day with no sedation." Several visits later, both the patient and her husband shed tears of happiness because she was able to complete the course of treatment with no sedation whatsoever.

Dr. Piedra says 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 source of the problem enables us to develop helpful strategies that will lead to successful treatment."

By accepting 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 primary goal is to increase a patient's comfort level. "If we can alleviate the anxiety, fear, or phobia, it will not only improve a person's dental health, but their general well-being," he concludes.