Dr. Gesker
Dr. Gesker experienced dental ACE as a child

Editor’s Note: In Part One of our series on adverse childhood experiences (ACE), Incisor explored how trauma experienced in childhood can have far-reaching effects on long-term physical and mental health, including oral health and dental care utilization.

In Part Two of this series, we discussed general ways to prevent traumatic experiences in the dental office.


We now turn our focus sharing real-life methods used by practicing sedation dentists, including both tried-and-true tips and promising new technologies.

Dr. Richard Gesker knows about Adverse Childhood Experiences (ACE). As a child he had extensive tooth decay and ultimately required extensive dental care. The emotional and physical pain he endured inspired his career as a DOCS-trained Sedation Dentist.

“I’ve devoted my career to give adults and children access to dental care preventing the oral deterioration that I experienced,” he says. “I try to get higher-risk cases into treatment and enforce care with increased education and awareness."

Incisor asked Dr. Gesker to share specific methods he employs to help his patients feel safe and comfortable.

“To prevent ACE,” he replied, “we ease the patient into the chair with simpler experiences—initial check-up appointments, cleanings and so on. We focus on prevention first. We allow the patient to become familiar with the office and having a good first experience. Avoiding dental trauma in the first place prevents the creation of the fear cycle and spares the patient from having fear of future traumatic experiences decades down the road.”

Along with targeting high-risk groups, this approach helps avert the need for extensive treatments.

Dr. Gesker in 1987

“We need to assign children and high-risk teens to specific dental offices using dental outreach workers,” according to Dr. Rich Gesker. “And the provider also needs to take accountability for managing their patient base, ensuring continuity-of-care of everyone under their direct care.”

“Children can sometimes be more reactive being more difficult to manage in the chair,” he says. “We stay away from clinical terms like 'nitrous' in favor of ‘calming gas,’ or ‘sweet air.’”

Dr. Gesker says that initial visits for a child usually start with the mother as early as 6-months of age. “We work on changing the habits of the parent, not just the child, educating them to be aware of preventative dental care; we familiarize the child and the parent to the dental office."

"Much of the expensive, painful and time-consuming dental care required by those in high-risk communities can largely be prevented; and this is why 'dental homes' are essential in addressing gaps-of-care and to increase access to dental care for everyone.”

Dr. Gesker
Dr. Gesker

Richard W. Gesker, DMD, MBA is currently the Chief Dental Officer for UnitedHealthcare Dental. He has enjoyed being a DOCS trained Sedation Dentist since 2007, and has dedicated his entire career in assisting apprehensive and anxious patients. He is always looking to remove barriers to care, especially for those patients with the most difficult health disparities.

Dr. Gesker had the pleasure of developing his clinical skills with business training prior to service in the Navy after dental school, private practice, community health, and in various other leadership roles. At UnitedHealthcare, his dedication is to change the lives of others by improving their overall health through dentistry. He has the tremendous opportunity to make a profound and meaningful healthy impact on millions of dental patients. Through education, prevention, and innovative programs, he is closing the gaps and shortcomings limiting access to care, thereby increasing the quality of care outcomes.


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