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I have avoided the dentist for years because I’m a total coward. My husband suggested that I see someone who uses sedation. Our dentist does not. When I talked to him about possibly using sedation himself, he told me it was too risky. Then, he told me about a woman in Iowa whose dentist gave her twice the dose that she was supposed to get and she ended up unconscious and then dying. Now I am a bit afraid of the sedation procedure. Are there safeguards?
Carol
Dear Carol,
I’m going to tell you that your dentist is doing you a great disservice. I don’t know why he is giving you unreliable information. Maybe it is because he does not want you switching to a dentist who offers dental sedation. I am familiar with the case he is talking about. In fact, a colleague provided testimony in that case. Believe me when I tell you that it was not how your dentist made it sound.
A woman weighing 270 pounds went to get a procedure using dental sedation. Her weight is relevant to this case. She was given 1.0 mg of Triazolam. Yes, that is double the recommended does, which is 0.5. However, that is misleading. Here is what the dentist said who gave testimony about this case.
“To establish the safety of a medication, using the usual recommended dose is not very helpful because it gives no clue about the safety margin of the drug. Some drugs have a wide safety margin. Triazolam is such a drug. To determine the maximum safe dose, we need to turn to clinical data establishing what is called the LD-50. The LD-50 of a drug is the dose at which 50% of the animals in a clinical trial die. This dose is extremely high for triazolam. Tested on mice, its LD-50 is greater than 1,000 mg/kg (see Halcion data from the FDA). For a 270-pound woman (a little over 120 kg), that would work out to a dose of 120,000 mg. While mice data can’t be extrapolated accurately to humans, it does give us a rough idea of the safety.
Not only was the dose not an overdose, in my report I indicated that I didn’t find the dose to be unusual and even suggested that it was an under-dose. While a dose of 0.5 mg would be appropriate for a typical patient, Ms. Mazurenko weighed about double what a typical female patient might weigh, and, besides, she was extremely anxious and had a history of drug abuse. In those circumstances, given the extremely high safety margins with triazolam, it would seem reasonable to me to have given her even much more. Her behavior at the appointment seems to indicate that she was inadequately sedated. She walked into the operatory and for some time conversed with the staff and, by the clinical record, showed no sign of even being sedated.”
You can read a post he wrote about it here, but I’ve summed up the important part.
Let me say first, that you are not a coward. Having dental anxiety is a real thing. In fact there are dentists who cater to patients with severe dental anxiety using sedation.
Dental sedation has been proven over and over again to be extremely safe. In fact, anxious patients find their life is changed for the better and they are finally able to catch up on all of their neglected dental work without any fear. If you’re still concerned, there is an organization that trains dentists in sedation safety, the DOCS Organization (Dental Organization for Conscious Sedation). Make sure you are using a dentist who has received extensive training.
This blog is brought to you by Lafayette, LA Dentist Dr. John Theriot.