Sedation Success: Case Study in Dental Trauma

The effectiveness of sedation dentistry allows people to overcome even the most extreme dental fear to receive necessary care. The results of this case study are remarkable, with significant progress being made in just four sessions.

Dentist: Gretchen Galvin, DDS

Patient: 52 years, Male

Reason for Dental Visit: Worn, chipped teeth, unesthetic teeth, and pain on lower right molar

Reason for Sedation Care: Decades ago, a traumatic dental experience led to a fear of dentists and avoidance of dental care. The patient experiences severe anxiety and cannot sit in the dental chair without sedation. Their fear is rooted in needle injections, the sound of the drill, and the anticipation of pain during procedures.

Medical history: Acid reflux, anxiety, heart murmur

Medications: Omeprazole, Paroxetine

ASA Classification, physical evaluation with tonsil classification: ASA II

Physical Eval: Vitals recorded and all WNL. No abnormal findings. Physical all WNL. Tonsil Classification: MP 1

Treatment Results

Dental History:

The patient has not been to the dentist in decades due to past traumatic experiences related to dental visits. The patient was afraid because he knew he needed extensive dental work as his teeth were breaking down. Still, he was highly fearful of experiencing pain from injections and dental procedures. The patient was also diagnosed with anxiety and severe anxiety-induced bruxism.

Initial Treatment Provided:

  • X-rays including panorex, BW, and PAs
  • Clinical EO/IO exam performed
  • Sedation consultation performed

Diagnosis:

  1. Bruxism: Severe, generalized, anxiety-induced, nocturnal
  2. #30: Irreversible pulpitis with SAP, restorable decay
  3. Heavily worn dentition, generalized breakdown/wear into dentin
  4. Collapsed VDO, severe
  5. Dental anxiety, severe
  6. Gingivitis: Moderate, generalized
  7. #31: Necrotic with chronic apical abscess, non-restorable decay

The treatment plan was devised to address all the patient’s needs, including:

  1. #30 root canal.
  2. Zirconia (bruxir) crowns on teeth #3-14 and #19-30 to open VDO and for full coverage due to wear.
  3. Extraction of non-restorable tooth #31.
  4. Due to the patient’s high level of anxiety, all treatment was planned under oral sedation.

The patient agreed to the treatment, and medical consultations were obtained along with a pre-sedation assessment, which included checking the patient’s medications against the sedative drugs. The patient's preoperative blood pressure, heart rate, and oxyhemoglobin saturation were measured using a pulse oximeter. Preoperative and postoperative instructions were reviewed, and written consent was obtained for dental and sedation care.

Sedation Appointment

Drug protocol and level of sedation achieved: Triazolam 0.5 mg was given 60 minutes before the dental procedure, along with 50 mg of Hydroxyzine for each appointment. Moderate conscious sedation was achieved for each 2-3 hour appointment, for a total of four appointments.

The patient responded very well to sedation. He was relaxed, moderately sedate, and able to follow commands. The patient showed no fear or apprehension and tolerated all injections and dental work during the appointment without requesting to stop or expressing any fear. The patient was able to complete all planned treatments for each appointment.

Post-Treatment Follow-up and Results

The final follow-up occurred during the patient’s prophy appointment, approximately one month after completing all the necessary work. The patient was delighted with the sedation treatment and the progress made in just four appointments.

The effectiveness of sedation dentistry is evidenced by the successful treatment outcome and exceptional progress achieved in just four appointments. This approach emphasizes meeting patients at their comfort level while effectively addressing all their oral healthcare needs.

 

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