Ever since I started working as a Dentist I have had to deal with nervous and anxious Patients. Managing the psychological aspect of Patient care as well as getting some decent dental treatment done can prove a bit of a challenge especially if you are a freshly graduated dentist. Working in Berlin / Germany my weekly routine was to carry out dental treatments under general anaesthetic, often on children with severely neglected teeth. While that can be an effective way of getting someone out of his misery and sorting out things quickly I am glad that these days are over! After all a general anaesthetic has risks and working on an unconscious patient is somehow unsettling. So when I opened my practice and did more and more implant treatments I decided to attend a sedation course. To be able to cater for the few nervous patients in my practice. That was 3 years ago and I haven’t carried out one single sedation. But I have had Patients falling asleep during an Implant Operation… and snoring! I am quite convinced that all Patients can be treated pain free in a dental practice. Local Anaesthetics are effective enough for to eliminate nearly all pain. Of course there are exemptions: a drug addict or alcoholic patient quite often needs more anaesthetic and can be a challenge. Also an acutely infected tooth can be a bit difficult to ‘numb’ and will need certain techniques of injecting the anaesthetic in the right ‘spot’.
There are exemptions where I refer Patients for treatment under general anaesthesia: lower wisdom teeth are sometimes better removed under sedation or general anaesthetic.
All my Implant Treatments including Bone Graft Procedures are carried out under local anaesthetic and with adequate pain control and post operative care. It is always astonishing for me how little pain or swelling patients show when they come for their postoperative check.
One of the reasons for the relatively easy pain control in implant surgery is the fact that the bone itself has very few nerve endings compared to a pulp chamber of a tooth.
Conclusion: Dental Implant Treatment can be carried out pain free and safely under local anaesthesia. In cases where a psychological barrier exists (phobia) a ‘one off’ treatment under general anaesthesia or sedation can be helpful. Quite often subsequent treatments can be then carried out under local anaesthetic.