For many people, going to the dentist’s office can be a nerve-wracking experience. In fact, dental anxiety has led to entirely new frontiers in dentistry, known as sedation dentistry. Sedation dentistry allows the patient to be awake but sedated during their dental procedures, but it comes at a cost- a cost many insurance plans won’t cover, and some patients cannot afford. In Texas, some dental practices have come up with another way to try and curb dental anxiety: by serving patients (and their guests) alcohol during their visit. But the gesture, which may seem like a brilliant idea to some, and a recipe for disaster to others, is coming under fire in the Texas Senate in the form of Senate Bill 404 (SB404) which seeks to abolish this trend in the Lone Star State. Dr. Stephen Hill, an Allen, Texas dentist, shares his thoughts about SB 404, and what is at stake if it passes or doesn’t pass.
Alcohol- it’s a popular way to take the edge off in social gatherings or other situations that make people feel uncomfortable. In fact, some psychologists see no problem with an occasional drink at social gatherings for just this purpose. But is having a glass of wine or two at the dentist’s office the same thing? Texas Senator Lois Kohlkorst doesn’t think so. The daughter of a dentist, Kohlkorst is sponsoring SB404, because she feels strongly that alcohol and medical procedures have no business together. And she’s not alone. The Texas Dental Association supports SB404, citing patient safety as its number one concern.
"Unlike using traditional sedatives like nitrous oxide, the effects of alcohol cannot be controlled," Hill said.
Indeed, with nitrous oxide, patients are delivered a controlled stream of laughing gas through tubes in their nose.
"When you take out the nitrous tubing, the effects are completely reversed within five minutes of the nitrous oxide being turned of," Hill said. "It allows you to resume your customary activities immediately after your appointment."
But this isn't the case with alcohol. It can often take hours for patients to be sober enough to drive themselves home, and that can depend on many factors, such as how much alcohol they’ve consumed, how much they weigh, if they’ve had any alcohol before coming into the office and if they are on any medication that might interact badly with alcohol. It then places the burden of determining if the patient is sober enough to drive on the dental practice, a responsibility many practices understandably do not want.
And then there’s the question of consent. If a patient needs a procedure such as a filling or another service that could be done during the same visit, they cannot consent to such a procedure if they are intoxicated.
"It is unethical to ask an intoxicated person to consent to a procedure," Hill said. "That patient would have to return at another time to give their consent."
But while returning seems like an easy enough solution, it could be putting the patient at greater risk. For example, for a patient who has a bad infection, such as an infected abscess, it is in their best interest to have the abscess drained before the infection worsens. However, if the patient is intoxicated, they cannot provide consent to this procedure, and would then need to return at a later date. In a procedure like this where time is of the essence, waiting even a day or two could enable the abscess to grow and the infection to spread.
So, what can patients do if they’re afraid of the dental chair? Hill suggests speaking with your dentist prior to your appointment and discussing your options. Many practices offer safe sedation options, such as nitrous oxide or prescription sedatives. This differs greatly from simply becoming intoxicated because it allows the dentist to prescribe an appropriate dosage of sedative for your body weight and the duration of your procedure as well as to verify that the sedative will not interact with any other medications you may be taking. As for driving yourself home, that’s a no.
"When using prescribed sedation, you'll need to have a driver to and from the office," Hill said.
Other stress-reduction options you can discuss with your dentist include playing relaxing music, deep breathing techniques, or frequent breaks between steps in your procedure.
"Your dentist wants you to feel comfortable, and we’re happy to work with you to find a safe way to put you at ease when you’re in our care," Hill said.