Ethics & Law · patient case with 3 questions
Anxious adult with a traumatic dental history
Patient: Male, 44 years old
Chief Complaint: Needs restorative treatment but is visibly frightened.
Background: He describes a previous dentist who treated him without adequate anaesthesia and, when he complained of pain, told him to stop crying like a baby. He has avoided dental care for eleven years.
Current Findings: Tense, tearful, hyperventilating slightly on sitting in the chair. Multiple untreated carious lesions.
Question 1
Which response is most likely to build this patient's trust?
Show answer and explanation
Correct answer: A. “That must have been a very frightening experience. I will make sure you are completely numb before I start anything.”
- A. CORRECT. This does two things at once. It VALIDATES the experience, which tells the patient he has been heard rather than judged, and it makes a specific, verifiable commitment addressing the exact source of the fear — pain without anaesthesia. Empathy plus a concrete promise of control is the foundation of trust with a dentally anxious patient.
- B. Jumping to sedation bypasses the relationship entirely. It may have a place later, but offered first it signals that his fear is a problem to be chemically removed rather than understood.
- C. Criticising a colleague is unprofessional, and it does nothing to reassure the patient about what will happen NOW. It may even heighten anxiety by implying dentists are unpredictable.
- D. This minimises the experience. Being told that the thing that frightened you is old news is dismissive, however factually true it may be.
Note: Then back the words with actions: agree a stop signal he controls, tell-show-do, topical before every injection, slow deposition of warmed anaesthetic, short first appointments that end on a success.
Question 2
A different patient arrives for a scheduled intravenous sedation appointment smelling strongly of marijuana. What should the dentist do?
Show answer and explanation
Correct answer: D. Reschedule the appointment
- A. Dose reduction does not resolve the unpredictability of the interaction, and it does not address the consent problem at all.
- B. Marijuana emphatically does interact with sedatives — additive CNS depression and cardiovascular effects are both well documented.
- C. Abandoning the sedation but proceeding with treatment still leaves an intoxicated patient who cannot consent, and elective care under those circumstances is not defensible.
- D. CORRECT. Recent cannabis use interacts unpredictably with intravenous sedatives — it potentiates CNS depression, alters the dose response, and raises the risk of tachycardia and dysrhythmia when combined with anaesthetic agents. Beyond the pharmacology, an intoxicated patient cannot give valid informed consent. Reschedule, and explain clearly why.
Question 3
Which agent is most commonly used for ORAL conscious sedation in dentistry?
Show answer and explanation
Correct answer: A. Triazolam
- A. CORRECT. Triazolam is the benzodiazepine of choice for oral conscious sedation in dentistry. Its rapid onset (roughly 30–60 minutes), short half-life of about 1.5 to 5 hours, and reliable anterograde amnesia match the length of a dental appointment closely, and recovery is quick.
- B. Diazepam has a very long half-life with active metabolites, producing prolonged sedation and a hangover effect that far outlasts the appointment.
- C. Alprazolam is used for anxiety disorders. Its onset and duration profile is less suited to procedural sedation than triazolam's.
- D. Midazolam is the standard agent for INTRAVENOUS sedation. Its oral bioavailability is poor and unpredictable, and its oral use in dentistry is largely confined to pediatric practice.
Note: Typical oral triazolam protocol: 0.125–0.25 mg given roughly one hour before the appointment, with an escort arranged and driving prohibited for the rest of the day.