According to Columbia University's College of Dental Medicine, between 9% and 15% of Americans avoid obtaining dental care because of nervousness and fear. That comes as no shock to Rene Piedra, DMD (www.afraidofthedentist.net), whose dental practice in Coral Gables, FL, 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 postponements in receiving dental care can impact a person's self-confidence, appearance, and well-being. Left untreated, dental problems can have far-reaching consequences, severely affecting patient health."



People with dental anxieties are increasingly seeking "sedation dentistry," and dental practices around the country are changing their approaches 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 used too often. "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 mixture of techniques to allay 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 stopped by giving patients more control over their experience. Dental phobia can be tougher to overcome, but the same desensitization techniques used to treat other phobias also work well with dental phobia."

As an illustration, 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 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 nuance 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 in the end she received treatment that same day with no sedation." A few visits later, both the patient and her husband shed tears of relief because she was able to complete the course of treatment with no sedation whatsoever.

Dr. Piedra maintains that taking the time to grasp 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 valuable strategies that will lead to successful treatment."

By acknowledging that the needs of patients differ, Dr. Piedra's team can tailor treatment to fit the individual. "For some people, headphones and a comforting 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 get rid of the anxiety, fear, or phobia, it will not only improve a person's dental health, but their general well-being," he concludes.