Pharmacological Management of the Dentally Anxious Patient

Dental anxiety is a complex psychological problem in which patients associate negative feelings with the dental experience and is determined clinically through physiological and behavioral presentations. Self-reporting along with questionnaires and patient interviews can indicate the level of a patient's dental anxiety and guide the dentist in determining the appropriate management. Nonpharmacological methods of managing dental anxiety should be exhausted before pharmacological sedative techniques are considered. Nitrous oxide with oxygen is frequently used in the dental setting because of its relative safety, ease of use, and effectiveness for patients with mild to moderate dental anxiety. Oral sedation may be used for moderate to severely anxious patients and most typically consists of the administration of a single benzodiazepine drug prior to the dental appointment. Combination therapy of nitrous oxide with oxygen and oral sedation may be an option to increase the efficacy of both routes of sedation. Conscious intravenous sedation is a viable alternative for practitioners to use if they are adequately trained and certified to do so. Special considerations may apply for sedation of pediatric, elderly, and medically compromised patients and those with cognitive, physical, and/or behavioral disabilities. Sedation guidelines vary regionally, and dental professionals providing sedation must do so only with adequate training and certification as set by their local medical and dental regulatory governing bodies. This article provides a general review of the pharmacological management of dentally anxious patients as seen by a general dentist.