By DOCS Incisor Staff
Recently, Dr. Anthony Feck, the Dean of Faculty and Clinical Director for IV sedation at DOCS Education, received an email from Dr. Rosen Dimov, DMD regarding a concern he had while working on sedation patients.
At the Incisor, we see this as a welcome opportunity to highlight how sedation dentistry works in real-world situations, and for all of our members and readers to contribute their own questions, situations, and discussions related to sedation dentistry, patient care, and practice management.
Here in the first installment of our new Incisor series titled “A Word from Our Members,” Dr. Feck offers his advice on how to best adjust occlusions on sedation patients while working in all four quadrants.
Dr. Dimov: …I pay special attention to occlusion once I do either multiple fills or multiple crown bridge units.
Question: How can I provide the same quality of care to sedated patients, since if they are numb in all three or four quads, they’ll miss that perception for their real occlusion and feel sleepy? I don’t think they’d be able to follow my instructions for bite adjustments once just woken up in the chair. Probably, I would have to concentrate on working only in one quad, finish the work, do bite adjustments, then go to the second one. Will that process create an issue with anesthetizing the patient in the second quad once I am finishing the bite in the first one, leaving a time gap while waiting on the second quadrant to get numb? Could that time be better utilized to do some periodic exams in the hygiene column?
Possibly, once I see them for 24-hour post-op, I would need to check the bite and do some more adjustments, if the patient allows. My concern is that occlusion will be an issue, and we all know what kind of problem can ensue.
Dr. Anthony Feck:
What I've found, having a great deal of experience doing full mouth dentistry and working in all four quadrants, is that adjusting the occlusion on sedated patients is surprisingly straightforward. Even though numb and sedated, they are still conscious and can follow directions. With their muscles relaxed and when prompted, patients tend to bring their teeth together in a more centric muscle/joint-related position than a centric-occlusal-related position. This allows me to restore their occlusion in a more harmonious relationship. We do on occasion (15% of the time) need to make minor adjustments to the occlusion following the sedation appointment while they are not sedated. Even for the anxious patient, this is well-tolerated.
I hope this helps. Again, I speak from a lot of experience and if what I write doesn't convince you completely, I would ask you to trust the process. You are hardly a pioneer in building the occlusion in a patient who is sedated.
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Look for this new series, “A Word from Our Members,” in upcoming issues of the Incisor. And if you’re interested in submitting a question or sharing your story, please email us here.