Building Momentum

I took care of a patient a few months ago who was sweating bullets in my conference room when she saw me for the first time. She couldn't imaging treatment without being "put under."  Now, I don't put anybody to sleep in my clinic, because I simply don't want to assume responsibility for their breathing. But I provided moderate sedation for her, and I have seen her twice for surgeries to replace a tooth with an implant.  Last week, she asked me if I would discuss how to improve her facial esthetics with Botox and Juvederm. WITHOUT sedation.

I thought her progress was interesting, because I have seen a similar pattern in fearful patients. I truly believe that past experiences of traumatic dentistry never fade; those events are hard-wired into the patients' processes of fear and/or anxiety, kind of like a deeply rutted road that is traveled thousands of times. But when I can create a visit that is free of the triggers for that psychological cascade of behaviors, I could swear that a new pathway is created for patients to travel that has a totally different context for them as they sit in my office for consecutive visits.

It's pretty fascinating and rewarding to talk with this patient about how I am going to stick her with a needle, and she is significantly more relaxed. And I proceeded to inject her without anesthesia!!!! Yes, I engineered some trust between us. But that is quite a positive trend she has displayed.  I anticipate she will see me for dental care in the future without the need for sedation, because I see that evolution in other patients too. I like not having to sedate patients. And I like it even more when I know that they can build momentum in a positive way to eliminate that need for sedation care.

Anxious Patients Who Self-Sedate!?!?!

The following is definitely a scenario that many dentists experience: An anxious patient takes a prescribed sedative medication to "settle down" prior to coming to a dental visit. The dentist has not been previously informed about this decision. The patient has decided that "there is enough" medication to effectively relax to begin treatment. Some dentists would treat this patient with no additional attention paid to the sedative medication, and the visit would appear to be successful with no difficulties of any kind.

Even though the above scenario may be commonplace, there is a significant amount of risk that is created for the patient, the doctor, and the team. There are a number of medical, ethical and legal issues with this situation.

1)  Even if a physician or dentist has prescribed a sedative medication for anxiety control, and the patient had self-administered the recommended dose, it is always implied that the drug can impair ability to drive or operate machinery. It is no different than being under the influence of alcohol. The drugs should not be used unless the patient has consulted with the doctor about the safest, most effective dose to reduce anxiety and complete the treatment successfully. The patient needs an advocate and/or escort present. The safety of the patient is at risk. The safety of the public at large is at risk if the patient was to drive away from that appointment under the influence.

2) Sedative medications can impair the ability to make sound decisions. If treatment had to change, or an unforeseen event demanded a change in treatment, it would be difficult for the patient under the influence of the medication to offer clear-minded consent to change their treatment. The best ethical and legal choice is to have the patient's advocate (who had been designated prior to sedation) make the choice in the best interest of the patient.

3) Without proper and continual monitoring, there is no way that the dentist or any healthcare provider can assess the real-time safety and physical status of any patient under the influence of sedation medication. The medical implications are too numerous to get into. Let's just briefly summarize the potential consequences: Injury, disability, or death are possible outcomes without proper attention to sedated patients.

4) Consultation and planning prior to treatment is essential in order to safely administer the least amount of medication to produce the best sedation effect for the anxious patient, while successfully and comfortably completing their treatment. This falls under the ethical category of non-maleficence: do no harm.

5) It takes time, effort, and expense for a healthcare team to manage a sedated patient to ensure their safety and success with any treatment while under the influence of sedation medication. So you should be aware: whenever our team treats you, and you have self-administered medications or substances to eliminate dental anxiety, you can expect us to deliver the safest and most successful outcome for you. But it will come at a nominal price to ensure that happens.

How We Decided to Offer Sedation Dentistry

Before I started practicing in 1998, I had the unique privilege to learn oral surgical procedures at a local hospital. The differences between hospital-based dentistry and general dentistry were numerous. The biggest difference was how patients were cared for comfortably with respect to their level of anxiety and their medical conditions. In many cases, comfortable treatment meant sedation or general anesthesia was used. From that point on, I knew I should position our practice to offer sedation dentistry.

Before we offered sedation to patients, there were a number of steps we had to take. First, I wanted my team well-educated and trained to administer safe sedation to patients. We took an extensive amount of time at several continuing education facilities. And I make sure that they receive regular reviews of all sedation procedures and emergency protocols. Being a part of the Dental Organization for Conscious Sedation (DOCS) keeps me and my team up-to-date about all aspects of sedation dentistry.

Next, I made sure that we were prepared with the right equipment and medications to monitor patients, and manage their needs. And I made sure that we arranged to focus on one patient's care at a time while they were under sedation.

I know many patients who want sedation are also in need of high-level rehabilitation--in a lot of cases, that means significant amounts of dentistry. So I prepared my practice to provide comprehensive care. That means we are trained to perform the standard of care not only for fillings, crowns, and cleanings, but also for oral surgery, root canals, dentures, gum surgery, and implants.

Finally, offering a comfortable environment that provides "TLC" and high-level customer service is necessary to work out details for people who require sedation or comprehensive care. This means we spend the time it takes to listen to a patient's specific needs and desires. We discuss how we can realistically and reasonably offer sedation dentistry to get them what they want.

It has been really rewarding for me to know that we have treated so many patients with sedation dentistry that would otherwise never be able to improve their dental health. The preparations to offer sedation have really paid off, because we know we are providing safe and effective ways to keep them comfortable during care.

Inaugural Blog!

Welcome to the first post on our new blog feature!

Our primary website is http://www.cascadiadentistry.com/.

I'll be dedicated to adding pages and links to information about high-quality dentistry, health, and general wellness on a regular basis. It's important to discuss not only the services we provide , but also let you into our personal lives every now and then. You can go directly to each of our main pages here:

Patients are saying great things about our office! Read testimonials about our care.
Our Services. We are proud to offer 6 Month Braces, implant dentistry, peridontal surgery, root canals, and sedation dentistry for our patients, as well as routine fillings and cleanings.
Our Team. We have set the standard for customer service. Contact us today to set up an appointment online!
Patient Resources. Book your visit online, access patient information and forms, find easy financing for dentistry, and be a part of our referral rewards program.
Contact Us. We love to meet new patients! Book your appointment online, leave us an email, or give us a call. Access directions and maps for your convenience.

It would mean a lot to me if you would leave comments on the blog posts, or drop me an email at chris@cascadiadentistry.com.