ISSUE Is there an alternative to those painful visits to the dentist? Yes, says HEMA VIJAY, describing the advantages of sleep dentistry, especially for those who are afraid or have multiple health problems

“Had he sought dental intervention earlier, we could have saved more teeth,” says Dr. Elavazhagan, facio-maxillary anaesthesiologist. He has just overseen the sedation of 50-year-old R. Subramanian for the elaborate dental ‘flap surgery’ done on him. Subramanian had slept through the procedure without experiencing any pain, but curiously, all through the surgery, he was conscious enough to open and close his mouth as instructed by his dentist, and give coherent answers to his anaesthesiologist’s probing questions.

Apparently, it doesn’t have to be general anaesthesia where the patient is unconscious in order for him to undergo a dental procedure painlessly. There is a middle path — sleep dentistry. In fact, once the individual who has undergone sleep or sedative dentistry wakes up, he will have no memory of the procedure. “A short while later, he is in total control of himself and can even drive himself home, if he wishes. “That is the beauty of sleep dentistry,” says Dr. Elavazhagan.

Who is it for?

Fear of the dentist’s drill had held Subramanian back from seeking treatment for years. Hearing about sleep dentistry finally gave him the courage to visit the dentist. Sleep dentistry can be a good solution for people like Subramanian who are extremely anxious or dread dental procedures. It is also a solution for elaborate or multiple procedures that need to be done at one go. Subramanian’s upper and lower jaw bones had worn out leaving his teeth mobile, and the only solution was to replace the worn-out portions.

If this procedure were to be done under general anaesthesia, it would require hospitalisation, which is both expensive and time-consuming. If done without sedation, the procedure would have required many sessions, as a person who is awake cannot keep his mouth open for the long time it takes for flap surgery to be performed on both the jaws. Sleep dentistry is how Rajagopal had multiple dental procedures done on him at one go — two root canals and the extraction of his wisdom tooth.

So then, can anybody who is short of time or anxious about dental treatment opt for sedative dentistry? Not really. It is case specific, and the decision has to be arrived at by the dentist and the anaesthesiologist after evaluation of the patient. But generally, it can be a boon for people with acute anxiety, cardiac problems, blood pressure, diabetes, bronchial asthma or cerebral palsy. Dr. Elavazhagan explains, “The stress brought on by dread of a procedure can trigger an epileptic attack in those who have epilepsy, and raise blood sugar levels in some diabetic persons. In a cardiac patient, this stress can increase the heart rate and blood pressure which, in turn, can worsen myocardial ischemia. It can precipitate asthma in a patient with a history of the disease. Meanwhile, a person with cerebral palsy will have uncontrolled movements that could make the dental procedure very difficult without sedation.”

In the case of children, inhalational/intravenous sedation is not popular because all children cannot be treated effectively under sedation and because they show varied behavioural response to sedation. Likewise, sleep dentistry cannot be employed on people who are mentally challenged and who may not be very co-operative. General anaesthesia is a better option for them. “If it is indicated, sleep dentistry can be a good solution. As with all technology, however, it should be judiciously employed,” says Dr. M. B. Aswath Narayanan, Professor and Head, Public Health Dentistry, Government Dental College and Hospital, Chennai.

Leave it to the experts

Sometimes, a paradoxical situation could emerge, as some individuals are stimulated by sedation. Since control and evaluation of the sedation levels is tricky, it must be done only by someone who is trained and can expertly monitor pulse, blood pressure, etc., and rescue the person in case there is an emergency that’s a result of sedation. As with general anaesthesia, mistakes can be fatal. Meanwhile, intravenous sedation is the mode considered best for sleep dentistry.

“There is lack of awareness about sleep dentistry. But with proper evaluation and if executed by trained anaesthesiologists, it is perfectly safe,” says orthodontist and dental surgeon Prof. Dr. S. Venkateswaran, who performs sleep dentistry.

FACT FILE

The American Dental Association has established very clear guidelines for sedative dentistry:

* During sleep dentistry, the patient is in a sleep like state and doesn’t perceive the procedure, but is conscious enough to respond to instructions.

* It enables time-consuming/multiple dental procedures in a single session.

* It is a good option for people with acute anxiety, cardiac problems, blood pressure, diabetes, bronchial asthma, cerebral palsy, etc.

* Sleep dentistry is an individual-specific option, opted for as per the dentist and the anaesthesiologist’s evaluation of the individual.