Drug Class: Benzodiazepine, sedative-hypnotic
Uses: Insomnia: unlabeled use: oral
sedation of anxious dental patients
“The most common side effects of benzodiazepine
sleeping pills are related to the ability of the medications
to make you sleepy; drowsiness, dizziness, light-headedness,
and difficulty with coordination. Users must be cautious
about engaging in hazardous activities requiring complete
mental alertness, eg, operating machinery or driving
a motor vehicle. Do not take alcohol while using triazolam.
Benzodiazepine sleeping pills should not be used with
other medications or substances that may cause drowsiness,
without discussing said use with your dentist/physician.
How sleepy you are the day after you use one of these
sleep medications depends on your individual response
and on how quickly the product is eliminated from your
body. The larger the dose, the more likely an individual
will experience next day residual effects such as drowsiness.
For this reason, it is important to use the lowest effective
dose for each individual patient. Benzodiazepines that
are eliminated rapidly, eg, triazolam, tend to cause
less next day drowsiness…” (Pharmacia &
Upjohn Company, April 2001).
Interactions With Other Meds:
“Triazolam tablets should not be taken with Ketoconazole,
Itraconazole, and Nefazodone” (first two are antifungals
and third drug is a antidepressant) (Pharmacia &
Upjohn Company, April 2001)
Increase effects of erythromycin (antibiotic)
Increased sedation: Alcohol, CNS depressants,
Opiod Analgesics, or anesthetics” (Mosby’s
Dental Drug Reference, fourth edition, 1999)
“CYP3A3/4 Inhibitors:" Serum
level and/or toxicity of some benzodiazepines may be
increased; inhibitors include amiodarone, cimetidine,
clarithromycin, erythromycin, delavirdine, diltiazem,
dirithromycin, disulfiram, fluoxetine, fluvoxamine,
grapefruit juice, indinavir, itraconazole, ketoconazole,
nefazodone, nevirapine, propoxyphene, quinupristin-dalfopristin,
ritonavir, saquinavir, verapamil, zafirlukast, zileuton…”
(Drug Information Handbook for Dentistry, 8th edition,
“…hepatic disease, renal disease, suicidal
individuals, drug abuse, elderly, psychosis, child e<15
yr old, acute narrow-angle glaucoma, seizure disorders.”
(Mosby’s Dental Drug Reference, 4th edition, 1999)
Effects on Pregnancy:
“Certain benzodiazepines have been linked to birth
defects when administered during the early months of
pregnancy. In addition, the administration of benzodiazepines
during the last weeks of pregnancy has been associated
with sedation of the fetus. Consequently, the use of
this drug should be avoided at any time during pregnancy.”
(Pharmacia & Upjohn Company, April 2001)
*Patients should be advised to note the differences
between drug names: generic vs. brand names. If you
have any questions about your current meds and interactions
of those meds with Triazolam, please consult your physician.
An educated patient is the safest patient.
Updates in Dental
Volume 1, Number 2, March 1997
Focusing in this issue on: Triazolam , EMLA, and Dental
Using Triazolam to Reduce Anxiety
for Dental Procedures
Triazolam is a benzodiazepine that is
chemically related to diazepam. Triazolam has a rapid
onset, short duration of action and no active metabolites.
These properties make it a near perfect anti-anxiety
medication for dental patients. Clinicians and patients
are sometimes reluctant to use triazolam because they
are unfamiliar with the medication and uncertain about
the drug’s effects. Triazolam is an excellent
preanesthetic medication on the morning of a dental
appointment, or the evening before. Doses as low as
0.25 mg of triazolam can relieve anxiety and induce
sedation and amnesia before procedures. Studies have
documented anxiety relief when 0.25 mg of triazolam
was given in combination with 40 percent nitrous oxide.
The effects were comparable to 19.3 mg of intravenous
diazepam but with faster postoperative recovery.
The typical dose used in the dental office
is usually 0.25 mg. Triazolam should be given to reduce
anxiety when non-pharmacologic methods have not worked
or are not practical. Oral triazolam in doses of 0.125
to 0.25 mg provides a safe alternative to parenterally
administered drugs, especially for dentists not trained
in parenteral sedation. Triazolam works well to reduce
the emotional component of pain. It is beneficial for
long crown and bridge procedures, implant or periodontal
Topical Application of 5% Eutectic
Mixture of Lignocaine (xylocaine)and Prilocaine (EMLA)
Before Removal of Arch Bars.
British Journal of Oral & Maxillofacial Surgery.
30 (3) : 153-6 , 1992 Jun.
Abstract: The analgesic
effect of topical application of a 5% eutectic mixture
of lignocaine and prilocaine (EMLA) was studied in 45
patients undergoing removal of oral arch bars used for
the treatment of mandibular fractures . Employing a
double-blind technique, either 4g of the eutectic mixture
(EMLA group, n=15) or 4g of a similar emulsion containing
no local anesthetic (placebo group,( n=15 ) was applied
to the gingivae using a toothbrush with a standardized
technique. In the control group (n=15), infiltration
anesthesia with lignocaine was used only if requested
by the patient during the removal of the arch bars.
The patients in the EMLA group had significantly better
analgesia (P less than 0.005) of the gingivae just before
removal of the arch bars than patients in the control
group. The number of patients who found the procedure
pain-free with the placebo group was (2/15) (P less
than 0.005). The plasma concentrations of both lignocaine
and prilocaine were well below the toxic levels. Topical
application of EMLA can be recommended for short procedures
as an alternative to infiltration.
Assessing Abuse And Neglect And
Dental Fear In Women
Edward A. Walker, M.D.; Peter M. Milgrom, D.D.S.; Philip
Weinstein, Ph.D.; Tracy Getz, M.S.; Ralph Richardson,
Abstract: Little is known
about how specific life stressors, such as sexual, physical
and emotional abuse and neglect, might be factors in
the establishment or maintenance of dental fears or
might affect routine dental treatment. The authors collected
data from 462 female members of a large urban health
maintenance organization about their dental fear and
histories of childhood and adult traumas. According
to these data, a history of trauma appears to be significantly
associated with elevated dental fear, although multiple
factors play a major role in the establishment and maintenance
of these phobias. Such patients frequently describe
fundamental concerns for their safety. They report having
fears of being trapped in the dental chair, feeling
claustrophobic, being unable to breathe or experiencing
choking or severe gagging that interferes with treatment.
For these patients, a sense of helplessness and lack
of control appear to be underlying problems.
I have used EMLA with excellent results intra-orally
as a palatal topical anesthetic. The area must be dried
and isolated, and EMLA is applied for at least five
minutes. This provides for relatively comfortable palatal
injections. EMLA is useful for periodontal scaling.
It will provide gingival, but not pulpal anesthesia.
EMLA is well documented as a topical anesthetic for
intravenous access. The patient feels little or no pain
as the angiocath is placed. The skin is nicely softened
by the EMLA, which reduces the resistance to the passing
of the needle. EMLA makes starting IV’s easier
for doctors and patients. Triazolam (Halcion, Upjohn)
is a generically available short acting benzodiazepine.
Use of triazolam is an underused modality in dentistry.
Patients expect our best in all respects, particularly
in anesthesia, pain and anxiety control. This is an
easy to use addition to our repertoire that requires
minimal training and adjunctive equipment. Patients
are provided with a euphoric and comfortable association
with our procedures. This medication works well in combination
with nitrous oxide.
Patients with dental phobia do not feel
safe in the dental environment. Patients who have suffered
abuse or other traumatic experiences may not feel safe
anywhere. Victims of abuse may have problems with trust
in a professional relationship. Care must be taken to
provide a secure environment in the office. Time should
be given to develop a supportive rapport between the
patient, dentist and staff.