More than Numb: Pain and Anxiety Control in Dentistry

Alex Frisbie, DMD

Pain is a powerful motivator. Considering that one of the most common chief complaints from patients is “I’m in pain,” preventing and alleviating discomfort is perhaps the fundamental service dentists provide as a profession. We’re typically an empathetic group; we ourselves feel stress when a child is crying from fear or when we miss a block. Frankly, if we aren’t managing a patient’s anxiety and physical pain to the best of our ability, we are coming up short.

In school, an anesthesia resident I shadowed said the most powerful drug he used was “vocal anesthesia.” What I dismissed as a joke back then I have found to be true over and over again. I have gained the trust of many patients who were previously referred for sedation by simply being calm, listening, and talking them confidently through an appointment. The concept that the subjective experience of pain entails more than just nociception and includes anxiety, sights, sounds, and physiologic stress should be ever-present in our minds. The experience of pain is highly individualized. Forming a meaningful relationship with each patient is the best way to determine what he or she needs to be comfortable.

Knowing the limitations of your training, licensure, and preparedness is a responsibility all of us have when offering services to our patients. From local anesthesia to moderate sedation, we need to balance anxiolysis and pain relief with safety. Every medical emergency arising from improper administration of anesthesia is a blight on our profession. Having a clear goal for anesthesia and working towards that goal within the parameters of our ability is what has made dentists stand out as leaders in pain management from the days of Horace Wells. Let us all make safe patient comfort our specialty.