For This Midcoastal Maine Dentist, Sedation Gives Patients Hope

By Genni Burkhart

In our ongoing series of interviews with DOCS Education members about how sedation dentistry has impacted their careers, we interviewed David H. Pier, DMD, a dentist of nearly 30 years in Midcoastal Maine.

Dr. Pier spent the first 19 years of his dental career in a group practice before opening his solo practice in 2003. The practice grew to such an extent that he built a second practice in 2020 during the COVID-19 pandemic.

Currently, Dr. Pier has two busy practices with 31 employees. Those practices not only survived the pandemic but continue to thrive. Dr. Pier's success is a testament to his hard work and dedication to providing high-quality sedation dental care to his patients.

All Roads Lead to Sedation Dentistry

Dr. Pier received his undergraduate degree in chemistry from Bates College in Lewiston, Maine, and his DMD from Fairleigh Dickenson University College of Dental Medicine in Hackensack, NJ.

He's a member of the American Dental Association (ADA), Maine Dental Association, Midcoast Dental Society, Academy of General Dentistry (AGD), DOCS Education, Christian Medical and Dental Association, Christian Dental Society, and a fellow of the Pierre Fauchard Academy and International College of Dentists.

In addition to his formal education and training, Dr. Pier acquired several skills through Dental Boot Kamp with the late Walter Hailey (along with DOCS Education's president, Dr. Michael Silverman, DMD). 

In the following years, Dr. Pier became increasingly popular with high fear patients, leading him to learn sedation dentistry in one of Dr. Silverman's first courses in the early 2000s.

It's hard for Dr. Pier to keep track of how many sedation cases he's completed throughout his career, but he can confirm it's been immensely rewarding.

What Matters Most

During the winter, Dr. Pier and his wife spend most of their weekends at their second home at the Sugarloaf Ski Resort, where they are active members of the Rockland Congregational Church and associate members of the Sugarloaf Area Christian Ministry in Carrabassett Valley, Maine. 

Karen Pier, Dr. Pier's wife, is the treasurer and on the board of the Knox County Homeless Coalition, an organization they both strongly support. They also assist at the Knox Clinic, a low-cost clinic for people who cannot afford routine dental and medical care, as well as many local, state, national, and international charities.

The Piers realize how incredibly blessed they are and have found giving back to others as one of their greatest joys in life.

Outside of work, Dr. Pier and his family's passion is skiing. A ski racer in his youth and college, he also coached ski racing for many years. Dr. Pier and Karen have three sons who were all strong ski racers and remain avid skiers.

Now into their family's third generation of skiing, the Piers have four granddaughters, seven, three, and two, and a fourth granddaughter born this May. She's sure to follow their love of skiing, as all their granddaughters have caught the bug, and continue their family tradition of being on skis as much as possible.

Besides skiing, the Piers enjoy the outdoor activities Maine is known for, such as sailing and hiking. They've also reached the phase in life where travel is a more frequent and welcome adventure.

The Incisor: How long have you been a sedation dentist?

Dr. David Pier (DDP): I was in one of Dr. Michael Silverman's first courses in early 2000 and have been doing sedation dentistry ever since. I have no idea how many cases I have completed, but it has been one of the most rewarding experiences of my career.

“Sedation dentistry has been one of the most rewarding experiences of my almost 40-year career. I encourage every dentist to incorporate some level of sedation and to encourage their patients to give anxiolysis or sedation a try.”

The Incisor: What impact has sedation training had on your practice?

DDP: While sedation has certainly been highly successful in our practice and a prime factor in our practice growth, the gratification we receive from serving patients no one else has been able to help gives the most incredible feeling of success. The added production and profitability are just a byproduct of our service. I now have three other dentists in my practice; they're all DOCS Education grads and have their sedation licenses.

Interestingly, not just the "high fear" patients benefit from sedation. We use sedation frequently for long appointments to make it easier for our patients to handle the long hours in the dental chair. We find they have less anxiety and far less muscle ache from staying in one position with their mouths open with a bite rest and rubber dam in place.

The Incisor: And from your patient's perspective?

DDP: It is interesting, as I have been offering sedation services for so long; I have become a stronger advocate for including sedation at some level for many of my patients. A patient does not need to "white knuckle" it to have their dental care completed. When patients are nervous, I encourage them to try light sedation or anxiolysis.

Many of these patients thank me for the encouragement and wish previous dentists had offered them this path. Additionally, for any appointment of four hours or more, I strongly suggest adding some level of sedation to make the time go faster and to relax the muscles.

Regarding the high fear patient, sedation enables them to have dental care for the first time in years. Many of these patients become comfortable in our office and no longer require sedation. Still, the combination of sedation and verbal skills enabled them to reach that point.

The Incisor: Do you have any specific patient stories about how sedation dentistry impacted your patient's oral health and overall wellness?

DDP: Jane Doe 1: Jane was the new wife of a friend of mine. Jane was in my reception room in tears because she had a toothache and knew she had to have dental work done. My friend kept saying to me, "I didn't know." Meaning he never knew she had this extreme fear. (Note: that is extremely common. People with severe dental phobia are embarrassed, so never tell others.)

To get Jane to sit in the chair, I promised I would not touch her teeth. I would only look with my eyes and take some X-rays. We reviewed Jane's needs which included restoring several areas of decay and one tooth needing endodontic treatment, which was the source of her pain.

I got to the source of Jane's fear – like so many patients, she had had dental treatments as a child with no anesthesia and was held down while the dentist "drilled" her teeth.

It's an amazing fact that once a patient can share the source of their fear with another person for the first time, they begin to have trust and hope. Since I did not break my promise by touching any of Jane's teeth, she could listen to me about sedation dentistry. She ultimately had all her restorative and periodontal treatment completed with oral sedation. She became both an advocate for our practice and a loyal and regular patient who could now have her preventive care without sedation.

Several years later, she needed another crown. I said that sometimes after it's been a long time since having dental treatment that some of the anxiety returns. She looked at me and said, "You don't scare me!"

That was music to my ears.

Jane Doe 2: This patient is more recent. As my wife and I are involved in serving the homeless population in our area, we have met and become supportive of a woman (also a patient of mine) who is a survivor of extreme abuse by her husband (a well-known international celebrity).

She has created a new organization called "Finding Our Voices," where she makes posters with photographs of survivors and their stories. These posters hang in the windows of many of our local businesses, helping to create awareness of this all-too-common problem.

Through this organization, the founder has met women whose dental health has been ruined by physical abuse or inability to access dental care. She decided she wanted to do something for them, which led to a new organization called "Finding Our Smiles."

"Jane 2" was the first patient treated through Finding Our Smiles. Jane's ex-husband would not allow Jane to brush her teeth because he said she was only trying to make herself look good for her boyfriend. (Note: There were no boyfriends.) Due to years of being unable to care for her teeth, she had primarily black teeth in the front and many bombed out, non-restorable teeth in the back.

Many of these women who are survivors of abuse have an extreme fear of dentistry – usually due to the fact that we invade their most personal space, and they are afraid of anyone getting too close. We treated Jane with sedation and gave her smile back to her.

The ability to smile for the first time in many years changed Jane's life. She became a different person with confidence and hope. My income from Jane's case was zero, but the gift I received from seeing her smile was priceless.

The Incisor: What made you decide sedation dentistry was the right choice for your practice?

DDP: I learned high-level communication and verbal skills from the late Walter Hailey through Dental Boot Kamps in the '90s. With these skills, I developed a reputation for being a dentist who can help people with dental phobias.

As I treated these anxious patients more, I became increasingly aware of the extremely phobic patients who would come in only when they had a toothache, only to return years later when they had another toothache. As I learned more about their stories, I realized that even the best verbal skills cannot help these patients commit to routine care.

Dr. Michael Silverman was one of my mentors through Dental Boot Kamp, so I signed up to learn about sedation dentistry with him and never looked back!

The Incisor: What's the most important factor you look for concerning continuing education?

DDP: Living in Maine, we often travel for advanced CE programs, so I look to the programs with the best reputations and quality presenters. That has led me to complete all the Dawson Academy courses, the hotel courses taught by Frank Spear, becoming a Kois Center graduate, completing the Bioclear courses, and most of the courses offered by DOCS, among many others.

I complete over 100 hours every year and have found the more I learn, the more I realize there is to know! I guess I have been a CE junky. As I approach the end of my career, I aim to spread that CE passion to more of my colleagues. I am proud of my partners because they are already far ahead of where I was at their age.

The Incisor: Dental technology you can't live without? (Or look forward to getting)

DDP: Number one would be the Dental Cone-Beam Computed Tomography (CBCT). To that, I would add our scanner, intra-oral cameras, and 3D printers.

Beyond that, I plead to being a "boomer" and will leave the newest technology to the next generation. (We have not moved into CAD/CAM at this point because the quality of our lab is exceptionally high, but I expect CAD/CAM will be our next move.)

What's the most significant obstacle your practice (or dentistry in general) faces?

DDP: Staffing issues since COVID-19 have been a significant challenge. We doubled in size right after re-opening from the shutdown related to the pandemic. The prime reason for this explosive growth was due to being able to open our second practice at the same time as a local dentist in his seventies retired because he did not want to deal with the post-pandemic "new normal."

Since he was my patient, he told all his old patients to call us. With doubling in size, it took over two years to finally develop our larger team to embrace our culture and commitment to service above and beyond. We finally have a complete team in the admin and assistant departments, but we still need to hire one or two more hygienists, which are few and far between.

In terms of insurance, we are 100% fee-for-service, so other than ensuring the value we provide makes patients want to stay with us rather than go to cheaper in-network dentists, we are not as impacted by the whims of the insurance industry as many of our colleagues.

We have had a membership plan through DenVantage for over seven years and currently have over 1300 patients enrolled. The membership plan has been the best way to compete with insurance companies.

I would say every dentist needs to have a membership plan. I am a partner in DenVantage, which can help dentists incorporate membership plans in their practices. I am happy to help whether or not the dentist becomes a client of DenVantage because I believe membership plans are critical for the future of independent dentistry.

Final Thoughts

DDP: Regarding the high-fear patient, it's genuinely about access to care.

Most people would say that the number one thing that keeps fearful patients away from the dental office is fear, but I don't believe fear is the primary impediment. I think the real underlying reason is – EMBARRASSMENT! So many of these patients are so embarrassed that they cannot handle something as routine as going to the dentist, so they avoid it.

To make matters worse, when they finally work up the courage to go to the dentist, the dentist scolds them for their dental neglect! The common practice of "shame and blame." Once scolded like a child – added to their already feelings of shame – they become even more avoidant.

The second reason is not as much fear of the dentist as fear of what they will hear – how bad their dental condition is. If instead of scolding, dentists took the time to get to the bottom of the reason this patient is so anxious and told the patient that there is no need to be embarrassed – fear of the dentist is one of the most common fears in society – more high fear patients would become faithful patients.

"It's Important to Give Patients Hope"

DDP: I always let the patient know I am 100% supportive. I let them know how much I respect them for being able to come to my office despite their severe anxiety. I explain that I am not looking at the history or focused on the current problems – I am looking to the future and the solutions for how we can work together to bring you back to dental health and feeling good about your teeth.

It still amazes me after all these years how many patients come to me for oral sedation, but once they have been able to share the source of their fear and realize they will not be blamed or shamed, many patients no longer need sedation.

That said, there will always be plenty of patients who still need sedation, so the success of sedation dentistry will continue well into the future and long after I am gone.

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Author: With over 13 years as a published journalist, editor, and writer Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides in Northern Colorado, where she works as the Editor in Chief of the Incisor at DOCS Education.