I'm Worried About Dentistry, So I Took A Pill!

Every now and then a patient will come in and explain they had to "take a pill" to be less anxious. I totally understand the rationale. Millions of people avoid coming to see guys like me, and have to take measures to relax. I'm a big fan of how effective that choice is for patients.

But self-medicating comes with significant risks. Take, for example the aforementioned patient. She drove herself to the visit while under the influence of the drug. I don't care if it's a time-release capsule or there is a late onset of effect from the drugs. That's a black-and-white no-no without a driver or an escort. It's a recipe for impaired judgement, a motor vehicle accident, or an accidental injury.

May people are surprised when I tell them it is a serious medical risk without close monitoring and controlled prescribing and dosing efforts. "But I feel perfect!"  some say. Most every common sedative will create respiratory depression, or mess with the brain's ability to regulate stable and consistent breathing. Then there's the physical changes to balance and communicating. The ability to reason starts to diminish. And most patients I see are using at least one other medication. Some patients metabolize or process the drugs differently; some get quick effects, some get little effect. That needs close management. There are countless drug interactions with sedatives. And those interactions need to be studied and managed for patients prior to taking the drugs.

So back to the question: why do patients self-medicate with sedatives instead of letting us administer them? It's mostly due to cost avoidance, in my experience. I get that. But I can't take on the liability of  patients using sedatives unless I can closely monitor administer, and control the drugs. And there's the point: risk management and monitoring patients while using sedatives will cost money. But ultimately the costs are lower given the numerous risks every patient faces.

Canine Eminence

I'm not a dog guy. I mean, I like dogs. I had dogs in my family as I was growing up, and my grandfather used to raise several different pure breeds. I don't own a dog these days. But seeing this example of behavioral therapy in the dental office with a loving, peaceful golden retriever may be enough for me to get back in the canine saddle.

I started drilling down in to a history of therapy dogs and dentistry.  I found a lot of commentary, but no particular white paper or American Dental Association policy on use of therapy dogs in dentistry. It appears that quite a few people or clinicians are against the thought of dogs in the treatment rooms because it's a messy, germy business. But I think we have to understand the purpose of therapy animals before we can really write off their use in dental visits.

Therapy dogs are used specifically to aid their owners or patients in managing their emotional or behavioral challenges. While it is true that the animals need to be accredited and specifically trained for medical use, there has been no published mandate about stringent gowning or disease precautions in the dental operating theater. Human contact is required for therapy dogs to fulfill their purpose.

In dentistry, it has been estimated that 30% of all patients have disabling anxiety, preventing them from seeking proper dental care. Sedation and general anesthesia has been successful options for those patients. But for numerous reasons, sedation procedures may not be appropriate. I interview and sedate a lot of dental patients, and some people simply can't have the medications

I think it's a great idea. It stands to reason that if a therapy dog with its excellent temperament could consistently not lick my patients on their mouths, and I didn't fulfill the urge to scratch it behind the ears every 2 minutes, that we could have a pretty great situation for anxious patients.


Thanks to Scott Clampett for the aforementioned link.