Dr. Darren McKeever understands that patients may be nervous and somewhat fearful of dental procedures so he gets to know his patients and builds trust to ensure their comfort while in the dental chair. Local anesthetic, topical anesthetic, IV sedation and other medications can be used for a pain free experience.
Is dental anxiety a common problem?
Dr. Darren McKeever: I hate to say it but yeah, dental anxiety is actually a big issue in the dental world. I’m not saying that everyone comes in feeling so anxious that they need help but usually people do feel some sense of anxiety over being in the dental chair. It’s not uncommon. It’s not I think the majority of people but it is an issue that we have to deal with. Sometimes dentists will think, “Well, I’ve done this procedure 5,200 times in my career,” but they may forget it’s the first time for the person you’re working with at that moment.
I think that leads to a sense of who really has control over the procedure and I mean patients. If patients feel they have control over the procedure, it lowers that anxiety level. Unfortunately, I think sometimes we as dentists get into this mode of, “Well, I got to keep moving forward on my schedule,” and they forget that the patient needs to be in control of the process. In my experiences, that helps get rid of a lot of what is a common problem for people, which is the anxiety over what the heck is going to happen to me now.
If people don’t take care of their teeth and gums, can a cleaning actually be uncomfortable?
Dr. Darren McKeever: The longer people go in between routine maintenance, the more likely something pathological is going to become involved with their teeth. Gingivitis will make the teeth much more sensitive. The amount of tartar that builds up between cleanings will make the amount of effort necessary to remove the tartar be at a higher level. The more often people actually maintain themselves, the more comfortable we can keep procedures so that people aren’t dreading the fact that they may have to go. More often than not, what we see is people get busy in their lives and things get pushed back a little bit, pushed back a little bit, pushed back a little bit. All along they’re thinking, “Well, I really don’t have pain. Maybe I can push it back even further.” That’s usually the worst thing to do.
That’s like waiting until your car finally won’t start in the morning and that’s when you call the mechanic, when you were told six months ago maybe you have a leaky oil valve or something like that. Really, it can be uncomfortable but more often than not, it’s because people tend to push it off much longer than we would recommend for that individual.
What are some ways dentists can reduce discomfort during dental procedures?
Dr. Darren McKeever: I think the most important thing to reduce discomfort is reduce the mental discomfort of being in the chair. I always tell people there is a difference between being worked on and being worked with. If you’re being worked with, you’re in charge and you can handle some of the little bumps that may come along in a procedure because you feel like you have control. If that doesn’t work, there are a whole host of other things that we can do to reduce potential discomfort. Obviously, anesthetizing an area with local anesthesia is going to keep people from feeling it.
Some people need even more than that because they have higher levels of anxiety. Nitrous oxide can be a big help with some people, and some people it doesn’t work very well. We also have oral medications that will help people relax rather quickly and they wear off rather quickly. Then we have some people where we literally, in my office we bring in an anesthesiologist from the University in Newark. He will literally with an IV get people so relaxed that they don’t care what dental procedure they’re having. They’re just happy that they’re really not feeling anything and they’re calm, they’re collected and nothing is going to bother them. There is always a difference that people can choose from depending on what their level is of anxiety and potential discomfort.
Could a patient choose IV sedation for any dental procedure or is it just reserved for some?
Dr. Darren McKeever: It’s really recommended for some but I’ve literally had patients who will not get their teeth cleaned unless we bring in our anesthesiologist and use the IV. That is patient dependent. If they really need that level because their anxiety level is so high, there’s nothing that says we can’t do it because the IV sedation methods we use today are extremely safe. More often than not, the hassle of having to have that, someone has got to drive you, there’s a cost for the anesthesiologist. These are things that you really have to factor in so that if you really, really, really need it, it’s there for you. I tend to recommend that for people who are having things that are much more anxiety provoking. It could be a major surgery or an implant, or we have some people where just fillings is enough that they need to have their anxiety reduced with the IV. Really, the answer is anybody can have it, but practically it’s not something that we would recommend for everyone.
What is the process like for getting IV sedation? Is advanced notice required?
Dr. Darren McKeever: Advanced notice is always required because the physician who does the IV sedation will have to take a history from the patient and make sure that they are in good health. It would really be not prudent for us to just bring somebody in and tap a vein and go to town with the IV sedation. In fact, in my practice one time, even with the history and the physical that was taken on the patient, when the anesthesiologist hooked the patient up to the EKG monitor, he found an anomaly in the patient’s heart that the patient didn’t even know he had. Within six months, the man was being treated for having a stroke. We saved his life because he had been treated previously which made the stroke a lot less damaging and dangerous. You can see how just bringing somebody in without advanced notice would really be dangerous.
The process overall though is once the patient is cleared by our anesthesiologist, we set the time aside for the IV sedation procedure. In that, people when they are getting IV, they tend to want to get a lot more work done because they’re going to be knocked out. We need larger blocks of time so we have to find those blocks of time for them. Once they come in, they’re very relaxed. Sometimes they’ve already had an oral pre-medication that reduces their anxiety. Then really the IV just has to be inserted into the vein, more often than not in the back of the hand, very straightforward, not very uncomfortable at all. Within minutes, they’re falling asleep. Then when we’re done and the little machine is turned off that helps pump the IV solution into the patient, they start waking up within moments.
It’s very safe, very convenient for people but you can’t drive, you’re not allowed to go out and lease a car that night. There are some ramifications to it. It is a bit of a process but for people who need it, in my opinion, it’s a godsend.
If you are interested in speaking with Dr. Darren McKeever, visit www.mckeeverdentalcare.com or call 973-839-8180 to schedule an appointment.