An oral surgeon's approach to the fearful patient. Intravenous sedation and general anesthesia.

: The oral surgeon's role in the management of the very apprehensive and/or phobic patient presents multiple challenges. It is important for the surgeon to recognize and even analyze some of the subtle changes that he and members of his staff feel when presented with these special patients. In general, they tend to disrupt the usual flow of practice and elicit behavior that may be defensive and threatening. Surgeons are temperamentally task oriented and may not be able to effectively manage such patients short of resorting to full general anesthesia. Appropriately administered and monitored, it may answer the acute surgical need while bypassing the underlying emotional situation. Referral of the patient to a special "dental phobia clinic" for follow-up care is definitely indicated, once the acute pain, swelling, or traumatic injury has been treated.