Case No 6.First visit referral from a colleague

A new patient was referred by a local practitioner. A nice enough lady of about 50- something. She was very anxious with fear "in her eyes" in the waiting room. There was much wringing of hands and perspiring. We began with an after hours chat about her fears, with a promise beforehand, that no treatment or even examinations would occur at this visit. Amongst other things we discussed the pros and cons of RA or IV options for her since she was a severe gagger.

She attended a few days ago for a second visit to give her a trial run (and titrate her) of RA and carry out a routine examination (though no intra-oral rads at this stage). I asked her during the early moments of induction, as I often do, how many gin and tonics (glasses of wine etc) it would take to get her "tiddly". This can be an important and revealing question. Teetotallers, tend to sedate at lower levels of Nitrous Oxide.

She told me that she drunk beer and would down 12 pints at a sitting!! Well to me this sounded preciously close to alcoholism, however at that stage I just took it on board and continued, as expected to a relatively higher proportion of Nitrous than Mr and Mrs average, achieving a good level of relaxation. Her demeanour visibly changed, she stopped sweating and shaking and allowed a full examination, charting, BPE scores etc. She commented during the session how different she felt, how much better. At the end of the session, she returned to her shaky self but could not get over the difference the RA had made to her.

She subsequently became a regular patient of the practice accepting routine dental care.