New endodontics study examines sedation use and dental anxiety

Dental anxiety can be so extreme for some patients that a simple cotton swab on the gums makes them flinch, and other patients, fearful of pain, simply avoid seeing the dentist, according to the authors of a new study in the Journal of Endodontics on when and how to use sedatives during dental procedures. Hence, dentistry is looking for sedation techniques to make patients more comfortable, noted the researchers from Case Western Reserve University.

For a master's thesis in endodontics, Madhavi Setty, DDS, MSD, wanted to understand how dental specialties such as endodontics for root canals, periodontics to treat gum disease, and oral surgery for extractions and corrective surgeries used moderate sedation.

In a retrospective study of 84 patients who received care and moderate sedation during a visit to Case Western Reserve's dental clinics in endodontics, periodontics, and oral surgery graduate programs between 2010 and 2012, Setty and co-authors examined each patient's age, sex, and existing medical conditions that would require consideration during treatment. Patients ranged from age 8 to 88, with an average age of 45, and 63% of the patients were women (J Endods, September 2014, Vol. 40:9, pp. 1327-1331).

Researchers found that moderate sedation was primarily used to calm anxiety in 54% of patients. The next most common anxieties were a fear of needles (15%), local anesthesia failures (15%), and a severe gag reflex and claustrophobia from the rubber dam (8% for both).

However, while moderate sedation helps to calm anxious patients, not all endodontists are qualified to administer sedation, and the procedure is not generally taught in most graduate endodontic programs, the authors noted. In response to that lack of training, the department of endodontics at Case Western Reserve University introduced training for moderate sedation into its curriculum last year. The ability to use moderate sedation may allow endodontists more options for patient care.