Although the public's opinion of dentistry as a profession has always been mostly favorable, a visit to the dental office has remained a source of fear and anxiety for a substantial number of patients.1,4 It has been shown that the percentage of people with dental anxiety in western societies ranges from 4% to 20%.2-5 While the cause or source of dental anxiety may be influenced by cultural differences, the prevalence of anxiety seems to transcend countries and cultures.6,7
Depending on the severity of dental anxiety and/or phobia, it may lead to broken appointments, postponing treatment and in some severe cases, a complete avoidance of professional oral care.8 Ultimately, severely anxious and fearful patients have increased number of decayed and decreased number of restored or functional teeth.9 Such patients usually require more extensive and complicated treatment, which causes additional fear and anxiety to the patient and increased stress to the dental team.10-12
Regardless of the cause and level of anxiety which may vary among phobic patients, all patients expect and deserve treatment in a safe environment without fears and stress. In a successful practice, the management of patient anxiety is paramount for both the patient and the dental team. As in any other dental procedure, understanding the patient's needs, expectations, fears and apprehension is the first step in successfully managing the patient.
Malamed coined the term ‘the pain of fear’ to describe a circular relationship between pain and fear, where dental fear ultimately leads to more anxiety.13 This leads to poor oral health, and the negative effect of dental anxiety on oral health leads to reduced quality of life.10,14-19 The aim of this article is to provide an overview of conscious sedation in dentistry, and the various techniques available to the dental professional. It is by no means intended to be an instructional guide on the use of sedation in the office.