But in August of this year, Chris Cook of Bakersfield, CA, pushed negative online reviews to a new level.

It was reported in dental news site DrBicuspid.com that Mr.  Cook took his 5-year-old son to see Bakersfield pediatric dentist Edward Dove, DDS, for a tooth extraction. Mr. Cook claims Dr. Dove mistreated his son during that visit by extracting a tooth before the child was adequately sedated.

According to DrBiCuspid.com, Cook stated that his son vomited up most of the sedative, screamed, and urinated on himself while allegedly being held down by three dental assistants during the procedure.  Allegations Dr. Dove vehemently denies.

Chris Cook decided to take matters into his own hands and created the “I Hate Dr. Dove of Bakersfield” page on Facebook, attracting more than 200 members in its first 48 hours.

Luckily for Dr. Dove, Facebook does have a policy for pages with the word “hate” and considers them in strict violation of their terms of service.  They swiftly moved to shut down the dental hate page.

Cook was undaunted by the Facebook boot, turned around and created a second Facebook group page, “Bakersfield dentist DOES NOT ROCK!!!!!!!!!” which is still up and active.

Dr. Dove has handled the situation by defending his treatment in the press and pointing to his 23 years in practice without a single disciplinary action. He has chosen not to engage with Chris Cook on his Facebook page, and was quoted in Dr Bicuspid as saying, “I think my reputation will be hurt a little bit, but right now I just want to calm down,” Dr. Dove said, “This guy is going ballistic, he’s trying to smear me, and I’m getting bullied.”

But should Dr. Dove be more concerned?

Just how significant are bad reviews for the future of your dental practice?

A new survey by market analysis firm Cone, Inc., found that four out of five consumers have reversed purchase decisions based on negative reviews found on the Internet. Another survey by Ratepoint found that 40 percent of consumers indicated they are more likely to consider a local business when they respond to a negative online review.

In the case of a Facebook page being dedicated to hating a dental practice, a dentist has little recourse since the unhappy page creator would have to allow the dentist to join the group page in order to issue a response.

Dentists have had little luck in defamation lawsuits when it comes to negative online reviews since the courts tend to look upon unhappy reviews as free speech. In a recent defamation case in California, a dentist has been ordered to pay $80,000 in attorney fees to the parents who posted a negative online review.

So how do you combat something like a negative Facebook page?

By making sure your dental practice has more than one website that appears on the top pages of Google when your business (and personal) name is searched online. Also have your own Facebook page, or pages for each type of treatment you offer. Have a Twitter page and make sure your practice is listed in as many dental directories as you can find. The idea is to control what appears on the first page of Google about your dental practice. Regular press releases help with this too.

For solutions to multiple name search and directory listing go to: www.InternetDentalAlliance.com.

For more on this story see: Facebook Pulls Plug on Angry Dad’s Antidentist Page

One example, is the following sketch where Tim Conway and Harvey Korman are at the dentist office, and Conway is the dentist.

Conway sticks his hand with Novocaine and realizes his hand has gone completely numb. He then attempts to hang forceps from his fingers, which causes Korman to begin to break character.

From this point on all Harvey Korman is trying to do is stop his own laughter.

Such incidents were so prevalent on the show that whenever Tim Conway did a sketch with Harvey Korman, the rest of the cast members would place bets on how long it would take for Korman to start laughing uncontrollably.

Enjoy our Friday random video -

The cost of sedation dentistry varies widely among dentists. Of course, if you are a dental patient spending thousands for cosmetic dentistry, then sedation fees are just a drop in the bucket.

The average fee for oral conscious sedation is about $300. Some dentists don’t charge, whereas others ask as much as $650.

A third offer IV sedation, charging about $500. But intravenous sedation fees ranged from $250-$800. Only 6% have general anesthesia capabilities. Ranging from $320 to $1200, anesthesia costs around $700.

“My IV sedation fee is based on the amount of time needed to complete dental procedures,” said a Florida pediatric dentist.

“Most of the time I don’t charge for the sedation as these are usually very large (20K plus) cases,” reported a Texas dentist.

To hear more of what dentists had to say about sedation dentistry, please click play and watch the following survey video -

Conscious sedation dentistry helps lower patients’ anxiety and marketing sedation dentistry to the anxious dental patient is a smart way to bring in new dental patients.

What do you charge for oral conscious sedation at your dental practice?

For more on this survey see: Sedation Dentistry: Cost of Peace of Mind

The average dentist often refers out braces, sedation dentistry, and root canals, while keeping cosmetic dentistry, and denture patients.

Related Story: Specialists Usually Refer Patients Back, Report Dentists

When it comes to pediatric dentistry and gum disease, dentists refer some patients out and treat others in house. 

Related Story: How Dentists Refer Wisdom Teeth Cases to Oral Surgeons

Overall, the average dentist refers out less than 20% of patients.

Related Story: Root Canal Referrals: Dentists vs. Endodontists

Here are some dentist comments on referring patients:

• “Impacted wisdom teeth and molar endodontics are referred out 100%. Everything else is decided case by case.” (North Carolina dentist)
• “Some patients have such poor dental insurance for certain procedures, I’d rather let a specialist do the treatment.” (Nevada dentist)
• “I think most dental implants should be placed by either oral surgeons or periodontists because in my community, a lot of the dental implants placed by general dentists fail.” (Alabama dentist)
• “I refer out general anesthesia, but most anxious patients do well in office with oral sedation.” (New York dentist)

Read more: Dentist Specialist Referrals: What Dental Treatment Dentists Refer Out

In last week’s Britney/Brittany episode, the whole glee club has musical fantasies about pop star Britney Spears while under the influence of Dr. Carl’s hallucinogen-laced sedation dentistry.

Sedation Dentistry on Glee

The popular TV show chronicles the adventures of a high school glee club. One of the school’s teachers is dating Dr. Carl, a local dentist played by John Stamos.

The dentist visits the glee club for a dental outreach, where he discovers that some of the students have terrible teeth. Cheerleader Brittany’s are the worst of the bunch.

Brittany: “I don’t brush my teeth. I rinse my mouth out with soda after I eat. I was pretty sure Dr. Pepper was a dentist.“

Brittany goes to visit Dr. Carl for treatment.

Dr. Carl: “So, Brittany, you, uh… You have the worst teeth I’ve ever seen. You have cavities in every single tooth. That’s got to be some sort of record.“
Brittany: “Please don’t pull all my teeth. When I smile I’ll look like an adult baby…”
Dr. Carl: “All right, we’ll put you under a little general anesthesia – you won’t feel a thing.”
Brittany: “Like roofies?”
Dr. Carl: “Yeah, totally.”

While Brittany is sedated, she has vivid musical dreams of Britney Spears. When the cheerleader wakes up, Dr. Carl tells her that she’ll have to come back the next day, as he wasn’t able to fill all of her 68 cavities.

When cheerleader Santana accompanies her friend Brittany, Dr. Carl is reluctant to work on Santana, as she has perfect teeth. But the cheerleader is determined, telling the dentist, “Get up in my grill, ‘cuz Brits and I wants to get our anesthesia on!“

All of the students visit the dentist, and all have musical fantasies of Britney Spears. The reason for this is explained later in the episode:

Artie: “The nitrous oxide dentist uses a mild hallucinogen.”

“Studies have proven that it induces vivid dreams,” the student explains. “Often the last thing the patient thinks of, the subconscious moves to the forefront. Since we’ve all been thinking so much about Britney, you know, it stands to reason…”

Sedation Dentistry in Real Life

Of course, people who watch this episode will hopefully understand that it does not accurately represent sedation dentistry. The “hallucinogen” reference makes it clear that Dr. Carl is not your average sedation dentist.

Nonetheless, from a dental perspective, a few aspects of this episode are troubling.

Most bothersome is the ambiguity between general anesthesia and nitrous oxide sedation. Dr. Carl tells Brittany he’s giving her general anesthesia – and there’s no anesthesiologist, no oxygen monitors, no assistant. Later in the episode, we learn that Dr. Carl in fact uses nitrous oxide.

The difference between general anesthesia and nitrous oxide was at the heart of a dentist’s recent lawsuit against Yelp reviewers. The dentist sedated a child with nitrous oxide and put in an amalgam filling. The child’s parents later posted extremely negative comments about the dentist, saying she had used too much general anesthesia on the child. (The pediatric dentist does not offer general anesthesia.) The parents were also upset that the dentist used a filling that contained mercury, although they had signed a consent form saying as much prior to the child’s treatment.

The Consequences of Dr. Carl

The fact is, Dr. Carl is now the most visible dentist in today’s pop culture landscape.

As a profession, dentists could do a lot worse. John Stamos’s Dr. Carl is handsome, charming and funny. He’s not nerdy or awkward or cruel. Refreshingly, he doesn’t at all play into the ‘Marathon Man’ stereotype of dentists as pathological sadists.

Dr. Carl is giving sedation dentistry a lot more exposure than it normally gets. On the one hand, it’s great to let people know that sleeping through their dental work is a viable option. On the other hand, this is clearly not an accurate representation of sedation dentistry.

And What about You?

Do you think TV viewers are savvy enough to realize how Dr. Carl's "treatment" differs from real-life sedation dentistry?

Have any of your patients mentioned ‘Glee’ and Dr. Carl to you? Is Dr. Carl an asset when it comes to dental marketing?

"Sedation is not for everybody (the dentists)," advised one dentist.

The respondents to this survey tended to offer multiple types of sedation dentistry.

• 88% Nitrous Oxide
• 83% Oral Conscious Sedation
• 47% IV Sedation
• 31% Dental Fear / Phobic Counseling
• 22% Pediatric Sedation

Here are some comments from dentists:

• “Couldn't do without these two [nitrous oxide & conscious sedation].” (Texas dentist)
• “It's a wonderful option for dental phobic patients!” (Minnesota dentist)
• “In many cases it is the only safe way to practice dentistry for pediatric dentistry cases and special needs and phobics.” (Pennsylvania dentist)
• “It is wonderful that dentists are now addressing the issue of patient dental anxiety with sedation, but I hope we don't attempt to treat patients with a one-size-fits-all mentality.” (General Dentist)
• “It's not for everybody (the dentists).” (Kentucky dentist)
• “Sedation is very safe when used properly. Practice carefully and continue your training.” (Tennessee dentist)
• “The dental profession should offer more programs for dentists who want to be able to administer general anesthesia.” (Massachusetts dentist)
• “I.V Sedation is probably safer due to more direct route of administration.” (California dentist)

Read more: Dentists Offer Many Types of Sedation Dentistry

“Kids are a different breed from adults when it comes to sedation, and you REALLY have to have thorough training to sedate them,” said one dentist.

Among survey respondents, 54% say it's a great treatment modality that requires proper training; 11% are still am not certain of its safety; and 35% think general dentists should not be performing pediatric sedation.

Here's a sample of what dentists had to say about pediatric dental sedation:

• “It is a great way to treat children. However, weekend courses do not give one adequate training to sedate children; one needs to be formally trained.” (Arizona pediatric dentist)
• “Proper training and the use of modern equipment are the key.” (California dentist)
• “This is the most delicate group of all patients, and the one that GP’s should be very cautious when treated. This also is the group that has the most incidents when sedation is performed.”(Florida dentist)
• “It should be done more often.” (Orthodontist)
• “Just ask an anesthesiologist. They all say NO!!! No one should!!!” (Massachusetts pediatric dentist)
• “I am a pediatric dentist. I used to offer it in my practice. I have stopped since 2004. I recommend that it is used ONLY in a hospital setting.” (Massachusetts pediatric dentist)
• “There are a small number of general dentists who will obtain the necessary training to SAFELY provide sedation services for children, but I can't for the life of me understand why they would want to.” (California oral surgeon)
• “There is no excuse for inadequate training. You must be on top of your game and realize it is not successful all the time. Still will need a source where pedodontics can be done under a general anesthetic.” (Oklahoma dentist)
• “Pediatric sedation should be performed only in a hospital setting and only for special-needs children. The rest of children do great if you will only be patient with them and do 'show and tell.' The most difficult children always, and I mean always, do great and overcome their fear if you give them time and love and show them how trust works.” (California children’s dentist)

Read more: Pediatric Sedation Dentistry Causes Disagreement Among Dentists

Listen to what Dr. Michael Silverman has to say about DOCS Education’s evolving stance on the subject: Dental Continuing Education for Pediatric Sedation

It’s been 10 years since Dr. Michael Silverman and Jim Du Molin launched their first seminar for DOCS

Though Jim wasn’t able to make it to Dr. Silverman’s anniversary celebration for DOCS, he sent along a video greeting. (Watch the video)

DOCS began some years before that first seminar. Dr. Silverman was working to lessen dental fear and dental anxiety for dental implant patients.

Jim was the dental consultant; Michael was the sedation dentist. Together, the two men worked out how to pitch sedation dentistry to the public, how to market conscious sedation, and how to work with patients who have dental phobia.

Over a decade later, the DOCS program has been a smashing success. Hear what Jim has to say about the anniversary of sedation dentistry‘s DOCS:

Sedation Dentistry: DOCS 10-Year Anniversary Video from Jim Du Molin

In our survey, two-thirds of dentists reported that their practices offer sedation dentistry with OCS.

“It is an excellent tool for the patient with dental fear who has not been to the dentist in years," offered one sedation dentist. "It is a major part of my practice."

“The regulations are overly onerous," said a pediatric dentist. "More rules and regulations won’t prevent irresponsible behavior–it will only prevent many competent practitioners from utilizing this modality."

“I have a permit to do IV sedation in addition to oral sedation, which does not work for at least 50% of patients," said another dentist.

Read more about sleep dentistry: Dentists Love Oral Conscious Sedation

This is especially true of oral conscious sedation, but also holds true for IV sedation.

“There’s also been a decrease in demand for dental implants and cosmetic dentistry," said one dentist. “People are trying to save wherever they can,” agreed a periodontist.

Here are some further comments:

• "All of dentistry is elective excluding a simple extraction. When times are bad and money is tight, dentistry can be delayed, including broken fillings, cleanings, crowns, etc." (Indiana dentist)
• "If it costs more for sedation dentistry…or anything else…patients would rather not do it or delay treatment." (General dentist)
• “The recession is causing patients to defer anything except what they perceive to be critical care.” (Maine dentist)
• "Demand has stayed the same or slightly INCREASED!” (Indiana dentist)
• “Case sizes are smaller as dental financing is not as readily available.” (Tennessee dentist)
• This is the first time an economic slowdown/recession has ever affected our practice.” (California dentist)

Read more: Sedation Dentistry & the Recession: Less Work for the Sleep Dentist