The fear and anxiety that most patients experience when going to the dentist are uncomfortable, sometimes even paralyzing, but the emotions aren’t, in and of themselves, dangerous.
That’s not true of patients who are already medically compromised, battling life-threating illnesses such as coronary disease and cancer, where the stress of a dental visit alone poses an additional health risk.
Other fearful patients, those with disorders of the nervous system or severe psychological conditions, not only may pose a threat to themselves during dental visits, but on occasion, they also become disruptive and threaten the well-being of the dental team trying to care for them.
Historically, there were few options for patients such as these other than to be seen in a hospital setting where they would be treated under general anesthesia. Such procedures – especially for more-or-less routine dental care – were very expensive for the patient, difficult to schedule, and required patients to accept the ever-present risks associated with general anesthesia for non-life-threatening treatments, including fillings and cleanings.
Advanced oral sedation dentistry has changed the dynamics of caring for medically-complex patients, allowing large numbers of those suffering from chronic medical and psychological problems to be seen and safely treated in-office by a qualified general dentist.
Advanced Oral Sedation Pioneers
The result: millions of men and women with an ASA III+ classification can now join with the tens of millions of other fearful and anxious adults who’ve benefited from seeing a dentist trained to provide oral sedation.
Drs. Leslie Shu-Tung Fang and Anthony S. Feck
Although many dedicated dentists deserve a share of the credit for advancing the state of oral sedation training to include patients classified by the American Society of Anesthesiologists as ASA III+, two educators, in particular, have been instrumental in establishing the necessary screening and treatment protocols.
Anthony S. Feck, DMD, and Leslie Shu-Tung Fang, MD, PhD, have pioneered the advanced clinical training of general dentists in the pharmacology, physiology, psychology, and clinical techniques necessary to incorporate the complete care of medically complex patients into mainstream dentistry.
Dr. Feck is an internationally renowned clinician, author, and educator, who co-founded DOCS Education in 1999, and serves as its Dean of Faculty. Dr. Fang, who maintains an active international practice in Internal Medicine and Nephrology, is the John R. Gallagher III and Katherine A. Gallagher Endowed Chair in Clinical Excellence at Massachusetts General Hospital and Harvard Medical School.
Along with other distinguished faculty members, Drs. Feck and Fang lead the two-day Master Series: Advanced Sedation didactic and hands-on course on behalf of DOCS Education. Hundreds of general dentists, along with members of their teams, have completed advanced sedation training and in turn, have successfully and safely treated thousands of patients with serious medical and psychological problems.
Prerequisites and Careful Screening
Before taking Advanced Sedation, DOCS Education requires dentists to hold a current sedation permit (if their state requires one) and to have completed a minimum of 50 standard sedation cases.
Upon completion of the weekend course, dentists can care for most patients with congestive heart failure; pacemakers; cardiac stents; type 1 diabetes mellitus; complicated type 2 diabetes mellitus; hepatitis B and C; various bleeding disorders, and asthma, among other illnesses. (Patients, of course, must be screened and evaluated on a case-by-case basis to ensure their suitability for in-office oral sedation treatment.)
Drs. Feck and Fang have also played a leading role in training general dentists and specialists in the use of IV Sedation, which allows them to treat even more complex cases – both medical and psychological – without requiring the patients to be seen in a hospital setting.
According to Dr. Fang, these include patients with COPD; patients with automated implantable cardioverter defibrillators; and patients with Class III congestive heart failure.
To obtain an IV permit requires a much larger commitment of training time; typically, 60 hours of classroom education coupled with at least 20 live-patient experiences.
Yet the demand by general dentists to obtain their IV permits is growing, in part, so that the dentists may include even more patients among those they are qualified to treat, and in part because regulators in some states now require an IV permit even for general dentists who only use moderate enteral sedation (and in some instances, any sedative other than nitrous oxide).
[Be sure to read more on this topic on Thursday, March 22, 2018, when the Sedation Safety Week essay of the day will be “The Shaky Regulatory Landscape and What It Means for Dentists.”]
Despite all the advances, some patients are still too medically fragile to be treated in-office using oral or IV sedatives. These include patients with complicated arrhythmias, patients with advanced COPD; patients with severe congestive heart failure, and patients with hepatic decompensation, according to Dr. Fang.
Spread the Word
Because the advances in oral sedation dentistry have come gradually, and sometimes in subtle increments, it’s not surprising that many patients – and even dentists – remain unaware of the great strides that the profession has made over time in expanding the circle of adults who are now able to avail themselves of safe, in-office, oral sedation.
We’ve known for almost 20 years that healthy patients who fear the dentist have the option of being seen by a qualified sedation dentist, without fear, pain, or discomfort. Word is still spreading that many patients with chronic medical or psychological problems can also receive similar, compassionate, safe dental care.
(EDITOR’S NOTE: This article originally was posted online as part of the 10th Annual Sedation Safety Week program, which was held March 19th to March 23rd.
The theme of this year’s 10th Annual Sedation Safety Week was “Awareness.” Many dental patients remain unaware of the safe, in-office sedation options available to them, and as a result, let go of their oral health when faced with a major illness.
Both patients and physicians can benefit from speaking with a qualified advanced oral sedation dentist about the opportunity for medically-complex individuals to receive in-office oral sedation.)
Related Links:
- To register for an upcoming Master Series: Advanced Sedation course led by Drs. Feck and Fang, or to learn more, click here.
- To register to obtain your IV Sedation Certification, learn more, or join a wait list, click here.
- Incisor Profile: Sedation dentist David Kurtzman caters to special-needs patients, including those with developmental disabilities, physical handicaps, significant mental and medical problems, and severe dental phobias.
- Oral Sedation and Related Continuing Education Courses
- State-of-the-Art Dental Safety Equipment and Supplies
- The We Believe in Smiles™ Campaign: Photos To Remind Us of the Magic of a Healthy Smile
