LG DENTIST TAKES AIM AT PHOBIA

vital signs: Dr. Russell Kilpatrick demonstrates the machine he uses to monitor a sedation dentistry patient's heart rate, blood pressure and oxygen saturation. (The Observer/BILL RAUTENSTRAUCH).

- Bill Rautenstrauch

The Observer

The dentist flicks on his drill and zing! comes the high-pitched whine, an attention-getting sound in anybody's book.

Every muscle in the body of the patient in the chair tenses as the man in the mask and the rubber gloves bends to his work. The patient's eyes go wide and his fists clench as the screaming handpiece nears his mouth.

"Omigod," he thinks. "Here it comes! The drill! The drill! The drill!"

It doesn't matter that his jaw is dead and numb as an old hunk of barn wood. The patient who says he isn't at least a little afraid of the dentist likely isn't telling the truth.

But for some, the feeling's more than garden-variety anxiety. It's stark terror, a phobia that can't be overcome with a pep talk, or a prayer, maybe not even with a fifth of good whiskey.

It's a fear that clearly dictates the dentist is a person to be avoided like the plague, or at least the measles.

Sad but true, dental phobia keeps many people from achieving good oral health.

"For 40 percent of the people who don't get treated, it's because they're afraid of the dentist," said Dr. Russell Kilpatrick of La Grande.

In his office on Cove Avenue, Kilpatrick practices sedation dentistry, a therapy that helps people overcome that terror and even forget the moments they spend in the chair.

The treatment, involving a class of drugs known as benzodiazepines, is not new, but Kilpatrick says he's the only one currently using it in Northeast Oregon.

"I don't think there's another dentist in the three-county area practicing it," he said.

Benzodiazepines are psychoactive drugs considered mild tranquilizers. The class includes Valium, Xanax, Lexomil, Ativan, Klonopin and others.

Kilpatrick said Valium is frequently used for sedation dentistry purposes, though it's not the only option.

"It depends on several factors, including the patient's medical history," he said.

During an initial consultation called a "welcoming visit" the staff gathers gathers health information, takes x-rays and does an oral exam.

It's then that the dentist determines whether the patient is a good candidate for sedation.

"The patient must be physically healthy, have no debilitating diseases, and not be pregnant," Kilpatrick said. He added that the treatment is not for children under 14.

On the night before the first appointment, the dental-phobic patient is given a sedative to guarantee a good night's sleep.

A companion drives the patient to the office for the appointment, and back home again.

At the dentist's office, an additional sedative is given to create relaxation. The medicine is used in tandem with the usual numbing agent.

"The patient can be relaxed and is not under general anaesthesia," Kilpatrick said. "It's nice for the patient and the dentist, too. It makes it easier for him to do the job."

Some of the sedatives used not only help a person relax, but also have a hypnotic effect. It's a clear benefit, Kilpatrick said.

"You don't remember what happened. It's really handy for dental-phobic patients," he said.

In order to add sedation dentistry to the practice, Kilpatrick and dental assistants Sue Schnell and Renee Abram attended training offered in Seattle by the Dental Organization for Conscious Sedation.

Much of the training involved equipment used to monitor vital signs including blood pressure, heart rate and levels of oxygen in the blood.

Chairside, Kilpatrick and his staff keep an eye on that equipment, tracking the signs throughout the dental procedure. For the rare chance that something might go wrong, they have training in basic life support.

When the dental treatment is done, the effects of the drug quickly wear off, said Kilpatrick.

"It keeps a patient at a sedated level for just the right amount of time," Kilpatrick said.