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  Pain and the Dentist

The story begins in the late 1950s in the dentist's office. The mass screenings of the World Wars had revealed the failure of many Americans to seek regular dental care and the disastrous consequences that followed. The American Dental Association, the National Institute of Dental Research (NIDR; renamed the National Institute of Dental and Craniofacial Research (NIDCR) in 1999), and other authorities actively promoted regular dental visits, especially for children. But increased numbers of visits only pointed to the underlying problem: many Americans associated dentistry with pain and faced each appointment with dread.

A graph illustrating a cycle of fear and pain. Clinical pain leads to a painfuldental therapy, followed by postoperative pain and apprehension to avoidance of dental care, which leads to dental pathology and clinical pain

Diagram of Cycle of Fear and Pain.

Seeking to alleviate patient fears, dentists offered general anesthesia for many routine procedures.


It is estimated," NIDR researcher Edward Driscoll wrote in 1960, "that in many parts of the country...there are nearly as many general anesthetics administered in dental offices as there are in the local hospitals." 2

But this well-meant practice drew fire from anesthesiologists and health authorities, on several grounds. Dentists, even oral surgeons, rarely had formal training in anesthesiology or experience with many of the new agents introduced in the 1950s and 1960s. Even if they had, it was often impossible for one person both to perform the operative procedure and to monitor the patient's physiological status. The difficulty of monitoring was further complicated by the lack of information about the side effects of such new agents as sodium pentothal and sodium methohexital -- a particularly dangerous ignorance in light of the fact that patients generally left the dentist's office within an hour after the procedure. For all these reasons, dental anesthesia was condemned as unsafe, although there were few documented cases of patient injury.


Problems with general anesthesia in dentistry, 1960
  • Lack of training and experience
  • Lack of staff
  • Lack of data about agents used

Edward Driscoll of NIDR's Oral Medicine and Surgery Section began conducting studies of dental anesthesia in 1957. His aims were: to establish the necessary baseline physiological data; to evaluate the effects of stress on the dental patient; and to find the best methods of alleviation. With his associates, he performed full mouth extractions on more than 1200 patients, and collected readings for pulse, blood pressure, respiration, arterial oxygen levels, EEG, and EKG. Edward Driscoll. Photograph courtesy of NIDCR Public Information Office.

The results of Driscoll's studies in the late 1950s and early 1960s provided the first data on the efficacy and risks of dental anesthesia; unfortunately, much of the data were never written up for publication and the records were finally lost to the need for space when the Pain Branch expanded in the 1970s.

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References

1 The National Institute of Dental Research (NIDR) was renamed the National Institute of Dental and Craniofacial Research (NIDCR) on October 21, 1998.

2 NIDR Annual Report, 1960

 
Photograph of Edward Driscoll
Edward Driscoll
 
       
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