Sedation Dentistry: From Nitrous Oxide to Oral Conscious Sedation and Beyond

Dentists Offer an Array of Dental Sedation Options

Dental Survey Results

When we asked dentists about the highest level of sedation dentistry they offer to their patients, responses were across the board. Some offer full anesthesia; others offer OCS; others offer no sedation services.

General dentists and specialists have markedly different patterns of sedation. Given the more intensive procedures often performed by specialists, it’s not surprising that they offer a higher level of sedation on their patients.

A number of dentists voiced their preference for IV sedation. “It’s the platinum of sedation without side effects,” wrote a prosthodontist. “I would lose over half my practice without dental sedation,” said another dentist. But one dentist worried, “With some of the practitioners I’ve seen, conscious sedation is a catastrophe waiting to happen.”

What else do dentists think about sedation dentistry?

  • “I would lose over half my practice without dental sedation.” (Arkansas dentist)
  • “It makes for really easy visits and incredibly appreciative patients.” (California dentist)
  • “Although sedation seems like a nice thing to have available for your patients, the reality is that it is a real pain to provide! My favorite method of sedation is someone who is able to take just local anesthesia!” (Nevada dentist)
  • “Nitrous sedation is my favorite because of total reversibility.” (California dentist)
  • “I don’t agree with the use of dental sedation.” (Florida dentist)
  • “I think the profession is missing the boat concerning IV sedation….I wouldn’t work without it. Three cases this morning. This is my 40th year using IV.” (General dentist)
  • “I feel too many dentists are treading in an area where they are not well trained.” (Pennsylvania dentist)
  • “I’d love to do more, and I feel hog-tied because of state laws. I spent a lot of time and money to learn about it only to learn that I couldn’t legally do what I was taught.” (Pennsylvania dentist)

Read the complete Sedation Denistry: From Nitrous Oxide to Conscious Sedation to Anesthesia survey results

Dentist Sues Over Negative Review on Consumer Website

Yelp is a free website where consumers can post reviews of restaurants and stores, places and professionals.

It’s caught on very well in the San Francisco Bay Area, where people use it to find everything from coffee shops and antique stores to doctors and lawyers.

A California pediatric dentist recently made headlines for suing a couple for defamation after they posted negative reviews about the dentist on Yelp.

After the dentist treated their son, the boy’s parents complained about the doctor’s treatment, upset that the boy was light-headed after receiving laughing gas and expressing outrage that the dentist placed a dental filling that contained mercury in their son’s mouth.

Misplaced Consumer Anger

It’s easy for an educated dentist to assume that most people realize that silver fillings are composed of an amalgam that includes mercury. But this case highlights how no one should assume that consumers know the facts. In this case, the dentist had the parents sign a consent form that disclosed the mercury content. The parents’ review said they had not been told of the mercury content.

The parents’ comments also indicated that their son was woozy after receiving “general anesthesia” from the dentist. The dentist’s suit states, “Plaintiff could lose her license to practice if she gave her patients general anesthesia. Dr. Wong only uses laughing gas (nitrous oxide) and oxygen.”

Yelp strives to maintain a “hands-off” policy, and did not take down the review as the dentist had requested. Actually, the dentist didn’t quite request so much as demand… Here’s the ineffective note she wrote to Yelp:

The review by T. J. on 9/10/2008 is full of lies and misinformation. When a disgruntled patient makes false accusations against me, I cannot refute these charges on your website because I must protect my patient’s privacy. I demand that you take this review down immediately.

The dentist’s attorney initially filed suit against Yelp as well, but later acknowledged that he had not been aware that websites offering third-party content are legally protected.

Everybody’s Doing It

In a recent survey of the Chicago Dental Society, 11% of responding dentists said they sometimes scan websites like Yelp and Angie’s List to see what patients are saying about their dental practice.

Yelp is particularly popular in the San Francisco Bay area. (Indeed, the aforementioned dentist filed suit in Silicon Valley’s San Mateo.) Angie’s List is a similar such site that is most popular in the Midwest. Though they are the top names, there are other similar websites that have caught on in various areas.

The Scandalous Review

Wondering what all the fuss is about? Though the poster has erased all but the final sentence, we tracked down the text of the original review. Would you, as a dentist, be upset with a review like this? You certainly should be – it’s terrible marketing. But would you sue?

1 star rating! Let me first say I wish there is “0” star in Yelp rating. Avoid her like a disease!

My son went there for two years. She treated two cavities plus the usual cleaning. She was fast, I mean really fast. I won’t necessarily say that is a bad thing, but my son was light headed for several hours after the filling. So we decided to try another dentist after half a year.

I wish I had gone there earlier. First, the new dentist discovered seven cavities. All right all of those appeared during the last half a year. Second, he would never use the laughing gas on kids, which was the cause of my son’s dizziness. To apply laughing gas is the easiest to the dentist. There’s no wailing, no needles. But it is general anesthetic, not local. And general anesthetic harms a kid’s nervous system. Heck, it harms mine too. Third, the filling Yvonne Wong used is metallic sliver color.

The new dentist would only use the newer, white color filling. Why does the color matter? Here is the part that made me really, really angry, The color tells the material being used. The metallic filling, called silver amalgams, have a small trace of mercury in it. The newer composite filling, while costing the dentist more, does not. In addition, it uses a newer technology to embed fluoride to clean the teeth for you, I regret ever going to her office.

P.S. Just want to add one more thing. Dr Chui, who shares the same office with Yvonne Wong, is actually decent.

Read the San Francisco Chronicle article or see the actual complaint.

Tell us what you think…

Dental Patients Will Travel To See Their Dentist (video)

Dental patients travel for dentist treatmentThe average dental patient travels about 5-10 miles to see their dentist for treatment, we found in this survey of dentists. Rural patients travel longer distances for dental care than do urban residents.

However, some patients keep their dentist even after moving hundreds – sometimes thousands – of miles away.

“I’m a specialist," said one periodontist, "so we have quite a few patients from the coast, which is 90 miles away."

Agreed a dental implant dentist, "Many of our patients travel up to 4 hours by car for their treatment." An orthodontist seconded this, saying, "I have had a few patients who have travelled 150 miles one way to come to my office." 

"Including the guy who comes from Palm Beach?" asked a New York oral surgeon. "Not enough patients come from far away!"

Maybe it's New York… “I have both an active local clientele and an international clientele,” boasted a prosthodontist from that state.

Read more about this dental management issue: Dental Patient Travel Distance: Dentist Survey Results

Dentists’ Greatest Fear – Raising Fees (video)

Dental feesMost dentists have been avoiding fee increases, this survey found, even though regular fee increases are a basic principle of effective dental management.

But in a recession, dentists fear they’ll alienate patients if they raise dental fees.

“Same fees, more dental marketing…” said one orthodontist.

Read more: Dentists and Dental Practices May Have To Raise Fees

Taxpayers Footing the Bill for Braces in Texas

the house that braces built WFAA-TVThe business of charging taxpayers for putting braces on kids’ teeth has exploded in Texas over the last three years according to a story by WFAA-TV in Dallas.

In 2010, Texas spent $184 million on Medicaid orthodonticsmore than the rest of the United States combined.

I want you to understand, right up front, that I’m tremendous proponent of just about any program that put dollars in dentist’s pocket for providing quality dental care. Time to be honest, this level of government pork could only have been arranged in a smoked filled back room in the dead of night.

While Texas struggles with its Medicaid budget, 34 dental organizations collected more than $1 million in Medicaid orthodontics last year.

Orthodontic treatment for children is generally an elective cosmetic procedure that many parents spend thousands of dollars on for their children. Very few dental insurance carriers cover orthodontics or elective procedures such as teeth whitening.

But in Texas, Medicaid pays dentists for orthodontics per procedure, instead of a lump sum for the “finished mouth” of straight teeth, according to WFAA-TV. This has made Medicaid orthodontia a lucrative dental business in Texas.

So much so that just three years ago, dentist Richard Malouf’s All Smiles Dental Centers of Texas collected $5.4 million from Medicaid orthodontics. Since that time, All Smiles’ Medicaid orthodontics billings nearly doubled to $10.2 million. This caught the interest of Chicago-based hedge fund Equity Partners who recently acquired All Smiles Dental for an undisclosed sum.

Now Texas dental clinics are being bought up by hedge funds, making Wall Street the ultimate destination for millions of taxpayer dollars as reported by WFAA.

The following is a video of WFAA’s investigative report –

Nowhere is the lucrative business of Medicaid braces more evident than with dentist Richard Malouf’s mansion in Dallas. It is a massive French chateau with a pool house, big enough for the average American family of four to live in. The Maloufs also own the mansion next door. According to tax records the combined value of the two properties is more than $14 million.

It is known as the house that braces built.

Dr. Malouf isn’t alone in offering Medicaid braces; there are five other dentists’ offices that provide Medicaid orthodontia on the same half-mile street in Dallas. Many of them advertise free braces under Medicaid. Jefferson Dental is one such dental operation and, according to WFAA, it is owned by hedge fund Black Canyon Capital of California.

During a struggling economy, many question whether this is the best use of taxpayer dollars. A Medicaid dollar that is spent on braces is a Medicaid dollar not being spent on fighting cavities and procedures most dentists feel are necessary.

It will be interesting to see how this story unfolds. I really want to see the which legislators initiated and signed off on this this piece of legislation and who the lobbyist where who pushed it through.

I not sure other state dental boards should hire them or hang them?

For more on this story see: Tax Money for Unneeded Braces Goes to Hedge Funds

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