| Afraid of the dentist?|
This pill may soothe your fears
By Steven Rosen
DONNA BRONSON HAS suffered from dental anxiety since childhood. Yet the 39-year-old Pasadena art director is completely unperturbed as she reclines in the chair of Northridge dentist Steve Maron. With a red blanket draped across her lap, she has that faraway smile of someone who is very happy.
And with good reason.
Just before being driven here by her husband, she took a prescription sedative -- a 0.25-milligram-strength triazolam pill, better known as Halcyon and commonly used as a prescription sleeping aid.
At the office, Maron gives her a second, equal dosage -- he has chopped it up and pours it into her mouth via a small envelope. A pulse oximeter attached to a finger monitors her pulse, blood pressure and oxygen saturation rate.
"I" m going to turn the lights down now and let you relax,'' he says. "I" m right here. I'll go and talk to your husband. You're OK.''
What Maron is practicing is known variously as sedation dentistry, oral sedation or conscious sedation, and dentists in the Southland and across the nation have, in recent years, taken it up to appeal to otherwise-fearful patients who need extensive work. There's even a national group promoting its use, the Philadelphia-based Dental Organization for Conscious Sedation. Maron is a member.
The champion of sedation dentistry is Michael Silverman, who founded the 2,600-member, for-profit Dental Organization for Conscious Sedation in 2000. Members pay $389 a year and receive such services as networking on sedationcare.com. Silverman also teaches three-day workshops around the country. So far, he says, his group's dentists have performed 850,000 sedations with no problems. He is not affiliated with any pharmaceutical company.
"Most dentists understand the science behind how sedation works," ' he says. "They have to understand the protocol -- what the medication is and what dose is right. They have to know how to assess the medical condition of a patient to tell if he" s healthy to have the procedure done. A patient who is healthy gets a green light. There's no risk.''
But the practice has raised concern in some quarters as to whether it constitutes a form of anesthesia without proper training. A national organization of oral surgeons, the American Association of Oral Maxillofacial Surgeons, considers it just like anesthetic injections, and which, "when applied in a manner of multiple dosing, may not provide an adequate margin of safety for dental patients," ' according to a position statement. It calls for strict licensing.
A special panel of the California Dental Board has recommended a moderate set of regulations for the practice that recognizes a difference between such sedation and use of anesthetics. It wants to require interested dentists to obtain a permit by taking a three-day course -- perhaps one like Silverman's -- approved by the California Dental Association.
In it, they would learn about the administration and monitoring of pill sedatives that exceed FDA guidelines for home self-administration by a patient. One crucial element of such a class would be learning to watch for signs of an overdose. By taking such a class, dentists would be permitted to practice sedation dentistry on teens and adults. (The state already requires a permit to practice on children.) A bill incorporating these recommendations has passed the California Assembly and is now before the state Senate.
There was a need for this panel, proponents say.
"It is a fairly recent phenomenon that at first was called by its proponents 'sleep dentistry," '' says John Yagiela, the UCLA School of Dentistry professor of anesthesiology who chaired that panel. "If so, you need an anesthesiology permit in California. And if that wasn" t correct, then they were misleading patients about what to expect.''
Proponents of sedation dentistry point to a 1998 article in Journal of the American Dental Association finding that 30 percent of Americans are "somewhat nervous, very nervous or terrified about going to the dentist." '
Bronson certainly fits that bill.
"When I was very young, I had a fever, and my molars didn" t close completely,'' she explains, several days before her dental appointment. "So decay was inevitable. At a young age, my molars had to have fillings. And when I had braces, they had to pull four teeth to make room for my wisdom teeth. And I had to have a root canal. This was all before age 13. So it seemed to me my teeth would always be my Achilles heel." '
After college, she just stopped going. But last year, after her husband read an article about sedation dentistry in Popular Science, she looked into it and discovered Maron's Web site. So far, she's glad she did. (He charges extra for the service -- between $250 and $300.) Before this latest work, she had made it through a previous four-hour appointment.
"My biggest fear is having to sit through hell," ' she says. "But this way I" m not completely out, yet I'm relaxed and not concerned and had no sense of time. And afterward, I slept very hard.''
Silverman says what he's advocating isn't a new idea -- just a new tool.
"For a long, long time, we" ve been trying to take the fear and anxiety and pain out of dentistry,'' he says. "The original oral conscious sedation was alcohol. You remember the old Westerns where a guy has a bottle of whiskey and rye and goes to a dentist to get a tooth pulled?
"Next were some liquids that were powerful narcotics, then barbiturates, then benzodiazepines. They" re the one with the least amount of side effects and the most advantages in dentistry to reduce anxiety and fear and relieve postoperative pain.
"The first benzodiazepine was Valium. Over the next 40 years, the drug companies have been developing sisters, cousins and second cousins, such as Halcyon," ' Silverman says.
While such sedation looks to become more popular, it's not for everyone who gets nervous in a dentist's chair. Because patients must be driven by someone else and then must sleep off the effects of the sedation, it's most appropriate for those needing significant dental work. But, Maron says, those are exactly the ones most in need of help.
"There" s always been a sense that there are certain patients we can't reach,'' he says. "This minimizes that. And once we get them over the hump, they" re pretty well-motivated afterward to take care of themselves.''