A USA Today article quoted ADA figures detailing that "12 million Americans are dental phobics. Another estimated 12 to 24 million suffer dental anxiety." Over the years I have treated many apprehensive patients. I used intravenous sedation for 17 years. In 1987 the cost of liability insurance became so expensive that we would have had to charge$100 an appointment just to cover the insurance even though we had never had a problem. It was hard to stop providing this service because it was so needed and I hated to walk away from the year of anesthesia training I had taken after dental school but with this increased cost IV sedation was no longer practical.
In 1988, I heard about Halcion, a drug new to dental sedation. This drug was the tenth most prescribed drug in the U. S. as a sleep aid. It has some problems when used every night particularly with the elderly. However, several of the dentists on the staff at dental schools where I teach had mentioned that they were having good success using this orally, as a pill, to sedate dental patients. We have used this on over 130 patients and are very happy with the results. We have been particularly pleased with it when treating uncontrollable children.
To use Halcion, requires that a patient come to the office an hour before their appointment so we can have them take the Halcion. After 45 minutes most patients, 75%, have amnesia (do not remember any or very little) of the rest of the appointment. Although, they are awake, they are very relaxed.
It is important that the sedation patients are not pregnant, are not nursing mothers, do not have glaucoma (an eye disease), do not have myasthenia gravis (a nerve, muscle disease), are not taking other sedatives, tranquilizers, other mood altering drugs, Tagamet - Cimetadine (an anti acid drug) or Erythromycin (an antibiotic). It is important that no alcohol or street drugs be taken before or after treatment.
As with all sedatives, patients can not drive, operate machinery or undertake any activity that could be hazardous. This includes such activities as walking unaided, climbing stairs etc. They should not undertake positions of responsibility, care of children etc, and should not make important decisions, legal or monetary etc. for the rest of the day. They should not have alcohol or other sedatives for twenty four hours. It is necessary to have a responsible adult come with them, take them home and stay with them for the evening.
We have had such good success with this procedure we are now collecting data so that we can write a paper on it's use for a dental journal. We are being helped in this study by the University of Washington Dental School. It is important to realize that this drug has not been approved by the FDA for dental sedation. This does not mean it can not be used for this purpose it simply means that it has not been through a rather lengthy process of approval. It has been reported on as being used for oral surgery. It has many advantages over older sedatives. It does not affect the bodies systems as much as other drugs. It is not as hazardous or costly as general anesthesia. As it is in tablet form, it does not require to have a needle placed in a vein. The patient has the safety of being awake but they are well relaxed and probably will not have much memory of the dental appointment. Back to office page