Earlier this week I saw a adult male patient with extreme anxiety, verging on a true phobia. I had seen him only once before when he attended with an abscess arising from a previously root-filled LL3 (#33) about 18 months ago. On that occasion we treated him under IV Midazolam and re-treated the tooth, which has been symptomless since. He arrived, perspiring profusely through fear, though he is otherwise an entirely pleasant chap, he has had a very adverse previous dental experience(s) as a child. His hair and shirt were soaked before he sat in the dental chair ! On this occasion, he was unaccompanied, had a mechanical # of the ML cusp of LR6 ( #46) and had gross supragingival calculus and staining anteriorly. Oh yes , and he was getting married in a few days time! Isn't it always the way ! After all the necessary explanations and duly signing a consent form, we were able to administer RA ( inhalational sedation) there and then, provide a temporary dressing and using an ultrasonic scaler, smarten him up for his wedding. He may well not permit more than this level of treatment without I.V. sedation. This remains to be seen in the future.
This case illustrates nicely, 3 key benefits of Relative Analgesia.
- It can be used "in an emergency" situation when an escort is unavailable.
- In some cases it can be used to allow simple palliative treatment in otherwise fearful patients, pending an IV session at a later date.
- That patients who get used to IV as a sedation method, never conquer their fear, since they have little recall of the fact that the dentistry could have been or was pain free. They may well become indefinately dependant on IV sedation.
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