The History of Dental Pain Management: The Progress That Has Been Made

This is a guest article by Dr. Justin Clemens.

Within the past 30 – 40 years, it has become increasingly popular to sedate patients to have dental work completed. Although this seems like a long time, in the sense of medicine and dentistry, it really isn’t. This is where the true melding point of medicine and dentistry occurred.

Let’s take a little trip in time to see where we began in dentistry to help us better understand where we are now in terms of pain management. The most recent of what we would call “modern dentists” were more like “tooth mechanics”. They were simply drill and fill or just yank it out with no numbing at all. This was until the advent of cocaine in the late 1800s. It is from cocaine that we derive all of our synthetic local anesthetics with which you may be familiar. The big ones that might ring a bell would be Novacaine, Lidocaine and Septocaine, just to name a few. These essentially made dentistry painless.

Patients can still feel anxious about dentistry even with all those drugs available. This is because of the hundreds of years of barbaric dentistry before these drugs were invented. It is not so much about the pain that needs to be managed, but rather anxiety.

Nitrous oxide also known as laughing gas was initially used in 1844 by Horace Wells as an anesthetic. It produced an analgesic effect that did a wonderful job in getting us through the “dark years” until the advent of cocaine.

Sedation dentistry can occur via a variety of methods. One of the most common is the oral route. A patient simply takes a pill, most commonly Valium, Halcion or Ativan, approximately an hour or so before their procedure. Their vital signs will be monitored just like any other sedation procedure. This causes the patient to go into a twilight state to make them feel “at ease”. The dentist will then continue by administering the anesthetic or “be numbed”.

Keep in mind that it is always safer to go with conscious sedation regardless whether it is a light or deep sedation. Dr. Ahmed Ezze, with Easy Dental VA, recommends it whenever his patients ask about pain management. He says

“Many patients approach me about doing ‘sleep dentistry’, since they are really afraid of completing their dental work, even if they are completely numb and can’t feel any pain. Most of these patients are unaware of what they can achieve with oral conscious sedation. Nearly every patient, no matter how fearful, can have all of their dental care completed under conscious sedation without ever feeling afraid.  The advantages are numerous, but the most important advantages of conscious sedation are that it is way safer, and far more affordable than ‘going under’ for dental treatment.”

Another common method is IV conscious sedation. The procedure is the same, except the drugs for sedation are administered through an IV and usually performed by a dental specialist. With this method, you are monitored a little more closely, but the rest of the procedure is the same.

It seems that the dentist is not the one to fear. We have nothing to fear but the fear itself.