Your Local Area - Reconstructive Dentistry

Four Ways To Be Understood by Your Dentist

What do you want from your relationship with your dentist? Oftentimes, this question is answered when there is a dental problem or emergency requiring immediate attention. There is a different approach to your relationship with your dentist that relates to your own needs and dental health.

This approach is designed to help you create the kind of experiences you want with your dentist. You have a choice about this relationship and how it can support and assist you in your life. It begins with the simple question stated at the beginning of this article: What do you want from your relationship with your dentist?

The answer to this question can take many forms. For some people it may mean having a lot of information about their dental health and future. They seek facts to know they are making good, informed decisions. Others may want a friendly relationship in which openness and communication are valued.

They want information but, more importantly, they want to know they are important to the dentist and the dental team. Some individuals want minimal information and discussion -- just the facts and the solutions to take care of any problem.

We all have different wants in our relationships with health professionals such as dentists. Here are four tips to assist you in deciding what you want in your relationship with your dentist:

1. Do you want a lot of detailed information about actual problems or potential problems or do you prefer a quick summary of data with recommendations about what to do?
2. Do you like to make quick decisions or do you prefer to think about things before you act?
3. Do you like to talk about what is happening or do you prefer to have your dentist just tell you what is going on?
4. Do you want the dentist to describe a problem situation and solution with pictures so you can see what it happening or do you prefer to go on gut feeling?

Each person looks for different things in their relationships. It is your responsibility to determine what you want and look for that in the relationship with your dentist. The answers to the questions above will tell you something about this.

The next step is communicating what you want so that you are understood. Only you know when someone else understands you. Here are four tips to assist you in this communication process:

1. Tell your dentist that you have some ideas about how he or she can assist you with your dental health.
2. Ask when it would be a good time to discuss your needs and desires for your dental care and relationship with your dentist.
3. Communicate what you want and how that will help you.
4. If you had a negative experience in the past with another dental professional or are dealing with dental anxiety, always discuss what happened. Past hurts or disappointments have a way of negatively influencing present situations that are similar in nature.

Communicating what you want is important to your dentist for it is the best way for him or her to plan for the optimal dental health for you.

By Brian DesRoches, PhD

The Role of the Sedation Dentist In Dental Care for Children

Conscious Sedation Dentistry

While many younger patients in the dental care office are cooperative and manageable without the need for sedative drugs, there are a significant number of children who cannot tolerate dental care without the use of these techniques.

For older, mildly apprehensive children, the use of oral conscious sedation may prove effective during dental care. Drugs such as chloral hydrate, Vistaril, Phenergan and Versed are frequently used either alone or in combinations selected by the sedation dentist for dental care.

Inhalation conscious sedation, using nitrous oxide, or laughing gas, is also highly effective in a mildly apprehensive older child who is older than six years.

In some instances, the use of a physical restraint (known as a Papoose Board or PediWrap) may be necessary to minimize excessive movement (which could be dangerous) during dental care treatment.

Naturally, many younger children are not mature enough to understand the need for their cooperation during dental care treatment. In this situation, the techniques described above have little chance for success. Deep sedation or general anesthesia may be required for dental care treatment to be successfully provided.

When this is necessary, the sedation dentist will employ a highly trained and certified dentist anesthesiologist, medical anesthesiologist, or, in some cases, nurse anesthetist, whose sole responsibility is to ensure the safety of the child while the dental care is being done.

Dentists trained to administer general anesthesia have received a minimum of two years of specialized advanced training and have been certified by their state Board of Dental Examiners.

Monitoring devices, some of which evaluate breathing, blood pressure and heart rate, will be employed by the sedation dentist to help ensure the safety of the procedure.

All aspects of the child's medical history, including any drugs he/she may be taking, should be disclosed to the dentist before any dental care.

It is suggested that the parent ask the following questions of their dentist prior to signing an informed consent granting permission for the administration of conscious sedation, deep sedation or general anesthesia to a child:

• Will the child require sedation or general anesthesia for his/her dental care treatment?
• Who will monitor the child while the sedation dentist works on his/her teeth?
• What kind of monitoring equipment do you use?
• Are you and your assistants trained in resuscitation?
• Will you continue to monitor the child after the procedure, until the drug has completely worn off?

Children's Dental Care Treatment

The administration of local anesthetics (commonly known as Novocain) is needed whenever potentially painful dental care procedures are performed (even during conscious sedation dentistry and general anesthesia).

The administration of local anesthetics to children by a trained sedation dentist is extremely safe and represents the ideal means of providing comfortable dental care treatment.

The following are some of the procedures the doctor might use to make this procedure more comfortable for the child:

• Place the child in a reclined position during the injection.
• Place a topical anesthetic (a gel or spray) on the child's gums where the injection is to be given. This should remain in contact with the tissues for at least one minute.
• Use of a distraction technique, such as pulling or shaking the child's lip as the needle is slowly inserted.
• Injecting the local anesthetic drug slowly. This is critical to a comfortable injection.
• Permitting the local anesthetic drug time to work. Most local anesthetics will become fully effective within approximately five minutes after their injection.

The duration of the numbness varies from drug to drug - some providing a short duration (two to three hours), with others remaining effective for up to twelve hours. The sedation dentist will select a drug for the child that is appropriate for the planned dental care procedure.

Since a child's tongue and/or lip may remain numb for several hours after the completion of their dental care treatment, the parent should carefully watch the child to prevent them from accidentally biting and injuring their lip or tongue during this period of time.

Properly administered, local anesthetics are safe and effective in almost 100% of younger patients. If a child is unable to tolerate the injection of the local anesthetic in their mouth, it may be necessary to use one of the techniques of conscious sedation, deep sedation or general anesthesia.

Local anesthetics can safely be administered by a trained sedation dentist to patients receiving sedation or general anesthesia during their dentistry visit.

By Stanley F. Malamed, DDS

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