Management of patient anxiety must be a major consideration in oral surgical procedures. Anxiety Is a more important factor in oral surgical procedures than in other areas of dentistry.Patients are frequently already in pain and may be agitated and fatigued, both of which lower the patient’s ability to deal with pain or pain-producing situations.Patients who are to have extractions may have predetermined concepts of how painful such a procedure will be they have seen other patients, including family members,
who have reported how painful it is to have a tooth extraction. They are thus convinced that the procedure they are about to undergo will be uncomfortable. In addition patients may experience certain psychologic complications when surgical procedures are being performed. The removal of teeth causes a variety of reactions a patient may mourn for lost body parts or perceive the extraction is a confirmation that youth has passed. In such situations, patients would like to avoid the extraction because they
cannot avoid it they become doubly agitated.
Finally, anxiety is likely to be higher because the procedure is truly uncomfortable. As noted previously although the sharp pain is eliminated by local anesthetic a considerable amount of pressure sensation still exists. Other noxious stimuli are present during an extraction procedure, such as the cracking of bone and clicking of instruments. For these reasons prudent dentists use a prospective planned method of anxiety control to prepare themselves and their patients for the anxiety associated with tooth extraction.
Anxiety control may sometimes consist of a proper explanation of the planned procedure; including assurance that there will be no sharp pain and an expression of concern, caring and empathy from the dentist. For the mildly anxious patient with a caring dentist no pharmacologic assistance is necessary.
As patient anxiety increases, it becomes necessary to employ pharmacologic assistance. Fundamental to all anxiety control techniques are a thorough explanation of the procedure and an expression of concern. These are augmented with drugs given in a variety of ways. Preoperative orally administered drugs such as diazepam, may provide a patient with rest the night before the surgery and some relief of anxiety in the morning. However, orally administered drugs are usually not profound enough to control moderate to severe anxiety once the patient enters the operative suite.
Sedation by inhalation of nitrous oxide and oxygen is frequently the technique of choice and may be the sole technique required for many patients who have mild to moderate anxiety. If the dentist is skilled in the use of nitrous oxide and the patient requires a routine uncomplicated surgical procedure, nitrous oxide sedation is frequently sufficient.
An extremely anxious patient who is to have several uncomplicated extractions may require parenteral sedation, usually by the intravenous (IV) route. IV sedation with anxiolytic drugs, such as diazepam or midazolam with or without a narcotic, allows patients with moderate anxiety to undergo surgical procedures with minimal psychologic stress. If the dentist is not skilled at using this modality, the patient should be referred to a dentist or oral maxillofacial surgeon who can provide it.
further discussion of the techniques of oral, inhalation,or IV sedation is beyond the scope of this text.