Who’s Afraid of a Little Dentistry?


It turns out that quite a few people are afraid of the dentist; up to 75 percent of adults report that they experience some form of dental anxiety. For the vast majority of dental anxiety sufferers, it’s the more invasive procedures – such as oral surgery – that really sets them off, while more routine procedures are much easier to deal with and provoke only a mild sense of anxiety.


Up to 10 percent of those same adults lean towards phobic on the fear scale, to the point that they avoid dental work until it’s too late. This, of course can lead to more severe dental issues resulting in the necessity of more time in the dentist’s chair, which then results in … more fear of the dentist. A vicious cycle for anyone trying to avoid the dentist. What’s the alternative for someone who experiences anxiety when it comes to dentistry? One answer is; sedation dentistry.


What is sedation dentistry?


Sedation dentistry describes the use of medication to induce a sense of relaxation in patients during dental procedures. Most patients choose the mildest form of sedative, making it possible for them to be awake yet still very relaxed (Conscious Sedation Dentistry). The opposite end of that spectrum is general anesthesia which induces complete unconsciousness. The full range of options runs from minimal – awake and relaxed, moderate – more deeply relaxed (may not remember procedure), deep – still aware but on the edge of consciousness and can be easily awoken, to deep sleep under general anesthesia. Sedation dentistry may also be appropriate for people who:


  • Have a low pain tolerance or very sensitive teeth
  • Require extensive dental work
  • Have anxiety associated with needles


Patients who chose to remain fully to somewhat conscious during the procedure are undergoing what is generally called ‘Conscious Sedation’. Although patients are not completely unconscious while undergoing Conscious Sedation Dentistry, many patients are so relaxed that they may nap through the dental appointment and very few associate any unpleasant memory following the experience. Some added benefits of sedation dentistry may include;


  • A shorter treatment time
  • Less jaw pain following procedure (particularly in people who suffer from TMJ)
  • More dental work can be done in a session
  • Less back/neck/shoulder strain (sometimes associated with sitting in a dental chair)


For sedation dentistry, a prescription medication is administered which induces a drowsy, relaxed feeling. This medication can be administered orally or intravenously (IV), depending on the desired results. The use of any sedation medication – with the exception of nitrous oxide – requires the patient to have someone available to drive them to and from the dental office, due to the relaxing effects of the medication that tend to linger after the procedure.  The patient’s vital signs are monitored throughout any procedure involving sedation.


Most Common Sedatives Used in Dentistry


Inhaled minimal sedation. This form of sedation uses nitrous oxide (laughing gas) mixed with oxygen which is inhaled through a mask over the nose. The dental practitioner is able to control the amount of sedation, and the effects of the gas usually wears off quickly.


Oral sedation. The level of sedation achieved using oral sedation can range from minimal to moderate. This involves the ingestion of a pill called Halcion, (related to Valium). This pill is usually taken about an hour before the procedure resulting in a drowsy wakefulness. A slightly larger dose produces a moderate level of sedation – the level most commonly associated with sedation dentistry.


IV moderate sedation. This requires the use of a sedative applied intravenously. It works quite rapidly and is readily adjustable by the dentist making it possible to regulate the dosage to a patients’ comfort level easier than some other sedation medications


Deep sedation and general anesthesia. Using the above method of application, medications are administered that result in near-to-total unconsciousness during the procedure. While under general anesthesia the patient cannot be easily awakened until the effects of the anesthesia wear off, or until they are reversed with medication.


Who Should Avoid Sedation Dentistry?


As with any medication there is a risk in taking anesthesia. When administered by an experienced dentist who has pre-screened the patient for any potential complication, sedation dentistry is quite safe. Some high risk groups should talk to a doctor before undergoing any type of anesthesia, including those who have a known heart condition, are obese or who suffer from obstructive sleep apnea. Other known risk factors include;


  • High blood pressure
  • Recent heart health incident
  • Uncontrolled hyperthyroidism
  • Angina pectoris
  • People taking antidepressants, beta blockers or cocaine



Armfield JM, Stewart JF, Spencer AJ (2007). “The vicious cycle of dental fear: exploring the interplay between oral health, service utilization and dental fear”. BMC Oral Health 7: 1. doi:10.1186/1472-6831-7-1. PMC 1784087. PMID 17222356.


Rai, K, Hegde, A, and Goel, K. Journal of Clinical Pediatric Dentistry, 2007; vol 32: pp 1-4.


American Dental Association: “Policy Statement: The Use of Sedation and General Anesthesia by Dentists.”


Joel M. Weaver, DDS, PhD, dentist anesthesiologist; emeritus professor, College of Dentistry, The Ohio State University; spokesman, American Dental Association.


American Dental Association: “Guidelines for the Use of Sedation and Anesthesia by Dentists.”

Reviewed by Michael Friedman, DDS on November 29, 2015

© 2015 WebMD, LLC. All rights reserved.


Kleinknecht RA, Thorndike RM, McGlynn FD, Harkavy J (January 1984). “Factor analysis of the dental fear survey with cross-validation”. J Am Dent Assoc 108 (1): 59–61. PMID 6582116.


Armfield JM, Stewart JF, Spencer AJ (2007). “The vicious cycle of dental fear: exploring the interplay between oral health, service utilization and dental fear”. BMC Oral Health 7: 1. doi:10.1186/1472-6831-7-1. PMC 1784087. PMID 17222356.


Armfield JM, Spencer AJ, Stewart JF (March 2006). “Dental fear in Australia: who’s afraid of the dentist?”. Aust Dent J 51 (1): 78–85. doi:10.1111/j.1834-7819.2006.tb00405.x. PMID 16669482.



Those ‘Silver’ Fillings Are Actually Quicksilver

For years now, groups like the Environmental Protection Agency and The National Institute of Standards and Technology have been working to curtail the use and proliferation of mercury thermometers1 because of the dangers that they pose to both consumers and the environment.  Wikipedia says, “Mercury is used primarily for the manufacture of industrial chemicals or for electrical and electronic applications,” but did you know the EPA estimates that over half the mercury used in the U.S. today is currently resting in the mouths of dental patients2?  “Silver” dental amalgams are actually comprised of about 50% pure mercury.

Use of mercury amalgam fillings is still allowed and surprisingly widespread in the U.S., though an increasing number of patients and doctors are choosing to avoid them.  Some countries in Europe have started banning them3, as the dangers of mercury amalgam dental fillings are becoming more and more well known.

The Dangers

Even at room temperature, mercury evaporates.  This being the case, silver fillings will continuously secrete mercury vapor over their entire lifetime.  Chewing, consuming hot foods, and grinding teeth are among the activities that will increase the rate at which this vapor is released.  This is significant, because mercury vapor can easily invade your body through the respiratory system or even be absorbed through your skin into the bloodstream.  From there, the toxic metal can spread throughout the body or accumulate in more concentrated pockets, most commonly in the liver4, kidneys5, and brain6.

Mercury vapor inhalation produces a molecular lesion in brain protein that is similar to those found in 80% of alzheimer’s patients’ brains7.  The damage to neuronal cells can be evident in behavioral symptoms such as depression, anxiety and irritability, or physical symptoms such as tremors, headaches, and fatigue.  Mercury also damages the blood brain barrier making the brain more susceptible to damage from other heavy metals to which we all have environmental exposure.

Studies suggest a correlation between mercury exposure and fatty liver disease.  Oxidation of cells in the liver along with inflammation of the lymph nodes caused by mercury toxicity can lead to allergies and other complications of the immune system.

While the most common effect of acute mercury toxicity is kidney damage and renal failure, mercury exposure also leads to gastrointestinal complications and circulatory problems.  It is especially detrimental to early childhood and fetal development.  In essence, mercury can and will wreak havoc on almost any biological system with which it comes into contact, and there is no safe level of mercury exposure.

Minimizing the Danger During Removal

While patients with mercury amalgam fillings are continuously exposed to mercury vapor, the concentration of said vapor and level of exposure is generally at its highest when the filling is being placed.  The removal of these fillings also releases exceptionally high levels of vapor, especially when certain methods are used.  Unfortunately, the standard of care for removing metal fillings is very inconsistent in the dental industry.  This makes it crucially important for patients seeking the safe removal of their mercury fillings to choose a dentist that has a carefully implemented mercury removal protocol.

Multiple precautions must be taken8 to ensure that the patient is not exposed to mercury through the skin or to vapors through the respiratory system.  There are environmental concerns with regard to the disposal of this toxic material.  Furthermore, protective measures are needed to ensure that other patients and staff are not subject to mercury vapor exposure in the office as a result of these procedures.

These precautions include keeping the temperature of the amalgam as low as possible during removal, so as not to release excess levels of vapor.  The office should have an effective suction system with proper discharge disposal.  Protective material should be strategically positioned to protect the soft tissue in and around the mouth as well as the airway.  The patient should have clean air piped in through the nose during the procedure, so as not to be breathing the air immediately surrounding the mercury removal site.  Ambient air evacuation or filtration are needed to protect others in the office from mercury vapor exposure.  All staff involved in the removal procedure should cover all of their skin and wear respirators to avoid the immediate and accumulative toxic effects of mercury exposure.

Dr. Sperbeck has long understood the importance of practicing mercury free dentistry.  Furthermore, he is one of the few dental practitioners in all of Los Angeles with both the knowledge and experience to free patients from ongoing exposure to mercury vapor without exacerbating the problem in the process.  If you would like to make your mouth a mercury-free zone, call today to schedule a consultation.



1  Peter Gwynne.  “Mercury Thermometers Face Final Phase Out.”  USNews.com.  Inside Science News Service.  25 Feb. 2011.  Web.  29 Feb 2016.
2  “A Comprehensive Review of the Toxic Effects of Mercury in Dental Amalgam Fillings on the Environment and Human Health.”  iaomt.org.  The International Academy of Oral Medicine and Toxicology.  2016.  Web.  29 Feb. 2016.
3  Andrew W. Saul, Ph.D.  “Mercury Dental Amalgams Banned in 3 Countries.”  Orthomolecular.org.  International Schizophrenia foundation.  11 Nov. 2008.  Web.  29 Feb. 2016.
4  Nicole Cutler.  “Update on Toxins Harming the Liver.”  LiverSupport.com.  Natural Wellness.  20 Apr. 2008.  Web.  29 Feb. 2016.
5  Boyd ND, Benediktsson H, Vimy MJ, Hooper DE, Lorscheider FL.  “Mercury from Dental ‘Silver’ Tooth Fillings Impairs Sheep Kidney Function.  iaomt.org.  Am J Physiol.  1991; 261(4 Pt 2):R1010-R1014.  PubMed ID: 1928419.  2016.  Web.  29 Feb. 2016
6  “Get the Mercury Out:  The Effects of Mercury on the Nervous System.”  Faculty.Washington.edu.  Washington University.  n.d.  Web.  29 Feb. 2016.
7  Russell Blaylock, M.D.  “How Mercury Causes Brain Degeneration.”  Online video.  YouTube.com.  University of Calgary.  13 Apr. 2013.  Web.  29 Feb. 2016.
8  “Safe Removal of Amalgam Fillings.”  iaomt.org.  International Academy of Oral Medicine and Toxicology.  n.d.  Web.  29 Feb. 2016.




Found this on The Internets and thought it’d be appropriate to share some dental humor. (I do not claim ownership of the photo.) But here’s your friendly holistic dentist PSA: take mercury seriously!

Dr. Sperbeck, West Los Angeles