Sedation Dentistry: How A New Jersey Doctor is Helping His Patients Face Their Fears

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About 30 to 40 million Americans don’t visit the dentist regularly. Not because they don’t have time, forget to make an appointment, or don’t have insurance, but because they have a condition called dental phobia: an intense, unreasonable fear of going to the dentist. Thankfully, Dr. Joel Singer in Fort Lee, New Jersey, offers a solution.

It’s called sedation dentistry, and although it is not covered by insurance, it is perhaps one of the only reasons phobic patients are willing to see a dentist. Because Dr. Singer has helped so many patients since the opening of his practice in 1988, he has accumulated a beautiful collection of gifts and thank you notes. I sat down with Dr. Singer, who explains more about his methods and why helping fearful patients is so rewarding.

Q: Why do people develop dental phobia?

A: Many patients relate back to a time as a child when they had dental treatment done that was uncomfortable or painful, and the dentist didn’t stop. Or they were treated without any local anesthetic and felt pain throughout the procedure. I also believe that there are a lot of people who have been physically or emotionally abused, having someone entering the oral cavity while lying down makes some people very uncomfortable.

Q: So dental phobia is often associated with a traumatic experience?

A: I saw a patient today that I did sedation for, a young adult, that remembers the sound of the drill and the smell of tooth structure being cut. He hasn’t seen a dentist in 12 or 15 years.

Q: What do you think people are most afraid of?

A: Dentistry is the probably the one branch of medicine where we do invasive procedures on someone’s head and face. They see you coming at them, they see the instruments, they see the tools, and they’re wide awake during the procedure. Some people are most afraid of needles, the injection, or the drilling. They’re afraid to hit a nerve. It’s all related to the experience they’ve had in the past.

Q: What makes people finally want to see a dentist?

A: The gentleman I saw today, he’s in his 30s, and he hasn’t been to the dentist since he was in his teens. He’s got several broken teeth that hurt but this one infected tooth hurt so much and finally got him in. When we did his full exam and x-rays, he had several really bad teeth and he had many many cavities. It’s quite common. Patients come in because something finally hurts, or it’s visible in the front so now they have no choice. One patient didn’t come in until her front tooth broke off and then she couldn’t go to social functions.

Q: How do you treat patients who are dental phobic?

A: I use oral medication, pills, called oral conscious sedations and we bring patients to a moderate conscious sedation. It’s not general sedation or general anesthetic, like they may use in an operating room. Patients are still in control of their own breathing, swallowing, and reflexes—they’re just very sedated, in and out of sleep. Some patients sit up and use the restroom and come back, but then they lay down and they basically fall right back asleep.

Q: Why don’t more doctors use oral sedation?

A: I think that dentists, like many other professions, are slow to change. One of the biggest remarks I hear on a daily basis is, “You gave me the injection already? I didn’t even feel that! Every time I go to the dentist it usually hurts so much.” And then I think to myself, well, it doesn’t have to if other dentists would take the time to learn to give an injection that doesn’t hurt. It’s really not that difficult to do.

Q: That’s very surprising. Have you ever had a painful dental experience yourself?

A: My own dentist, I cringe when he goes to give me injection, and he’s one of my best friends! But he doesn’t care to listen to what I have to offer. I guess he’s happy enough with the medicine he’s providing and with the population that he’s providing dentistry to.

Q: Do you sedate people who aren’t dental phobic?

A: Absolutely. One of the other reasons that patients come in is because dentistry is very time consuming. When you are sedated, you lose all sense of time and we can do a lot more for a patient in one appointment. Other patients come, not because they’re phobic, but because they have a gag reflex and they have a difficult time with instruments in the back of their mouth and having molds or impressions taken. The gag reflex when they’re sedated is basically gone.

Q: What is the worst case of dental phobia you’ve ever seen?

A: One of the saddest cases, I think very recently, was a young adult who came in and the majority of her teeth were decayed to the gum line. Broken, rotted, black and brown stuff right to the gum line. She said that another dentist that she went to embarrassed her and questioned if she was a drug addict. She was homebound for a couple of years with terrible depression and didn’t take care of her mouth. Now that she’s got her depression under control, she still can’t leave the house because she cant go back to school or get a job or do anything with her life because she’s embarrassed to be seen in public. We’re still corresponding and trying to work with her to get her to be able to commit to doing something so that I can help her.

Q: How much progress do your patients make after you’ve treated them?

A: On the one hand, I have a lot of life-long patients who will never see anybody else, people who have turned a corner and are now sticklers for keeping every scheduled appointment. Unfortunately, I have equally many who come to me to go under sedation and then disappear. That’s very frustrating for me to have helped someone and not be able to get them to stay healthy.

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