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ABC News had an interesting report on dental sedation.

http://abcnews.go.com/Blotter/death-greed-dentist-american-c...

In the last five years, more than 18,000 dentists across the country have signed-up for weekend-long courses in oral sedation that are set up in local hotel ballrooms and promise to add tens of thousands of dollars to the bottom line.

"Pain-free dentistry can means tens of thousands of dollars of extra income in your pocket annually, and as much as half a million extra in your pocket at retirement," wrote Dr. Michael Silverman, a dentist who runs a company that offers weekend-long training sessions for dentists in the use of oral sedation.

A national spokesperson for the American Academy of Pediatric Dentistry, Dr. Indru Punwani of the University of Illinois, said a weekend course is "inadequate" for preparing dentists to deal with emergencies that can arise through the use of oral sedatives.

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intercst
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No. of Recommendations: 0
Illinois had a well publicized case not too many years ago where a dentist killed a patient with improper sedation.
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When I was growing up, we lived in a fairly small town that only had a couple of dentists. Our dentist was on the older side, and he was deaf. Numbing the mouth was not much in use in those days, and our dentist didn't believe in doing it. At that time, dentists also used the old drills that were run drive belts. They didn't drill, they grinded. It was very, very painful, particularly for a kid. Anyway, having a deaf dentist meant that he couldn't hear you shout out for him to stop so you could catch your breath. I hated going to the dentist. When I was around 14 or so, he finally died, and we went to a new dentist who believed in all the more modern stuff, such as pain killers.
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Numbing the mouth was not much in use in those days, and our dentist didn't believe in doing it. At that time, dentists also used the old drills that were run drive belts. They didn't drill, they grinded. It was very, very painful, particularly for a kid.

Oh God YES! I'd blocked that. I had a neighborhood dentist who worked out of his house, around the corner from us, who HAD to hate kids. I literally remember him saying "Now, what method of torture should we use today." The smell! And when he did use a needle it was HUGE. It took me years to get to a dentist when I was old enough to resist my Mom.

And then came Marathon Man. I was going to post the YouTube video but couldn't.

Hockeypop
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Nice story but nothing new. A few comments in no particular order...

...these examples are part of the argument that anesthesiologists have been making for years. The person doing the sedation should not be the person doing the procedure. You can have all the proper monitors, bells, and whistles, but if your attention is divided you're asking for trouble. Especially in kids where you might have 30-60 seconds to save the life where as in an adult you have 3-5 minutes.

...weekend courses disgust me. Sitting in a room and listening to someone talk for a few hours and then maybe doing one hands on case does not make you proficient. Currently one surgeon I work with went to a weekend course on robotic surgery. He has successfully now turned a 30 minute procedure into a 2.5 hour procedure. I doubt he will ever get proficient enough, but he can charge more and the hospital will like it because they get to charge the rental fee for the robot.

...they didn't mention the drugs or the dosage. Only said "dangerous" or "X times normal dose", no context. I sedate kids every day. They often spit out some of the medicine. So what is documented given isn't necessarily what was ingested.

...they go up in arms about "as young as 18 months". I'm sure they'd do an expose on "cruel dentist restrains children, lets them scream and cry until they pass out" if they didn't sedate.

...railing on the guy that had a kid die and is still practicing was wrong. Acting like the state board should have permanently revoked his license, WTF?!? Everyone makes mistakes. If this was the only incident and he has done "remedial" work, OK. If it happens again, another story.

...pediatric sedation/anesthesia is safe in the proper hands. Some of these characters it is obviously not safe. But you can blame insurance companies and government (via medicare/medicaid) for approving these types of office procedures because they can be done cheaper than going to the OR.

JLC
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No. of Recommendations: 6
When our son was younger, he had to have quite a bit of dental work (2 extractions, something like 6 fillings and a crown). The first dentist we went to talked about sedation, but when we showed up for the procedure, all she had ready was novacaine (or something similar). She was going to attempt all that work with just physical restraints. I stopped the work after she administered the novacaine and didn't even have nitrous ready. I don't mind the restraints, but I wasn't going to subject my son to that kind of torture.

We walked out on that dentist and never looked back.

The one we finally settled on actually had nitrous available, but suggested general anesthesia for that much work. She said it's easier on the kid and on her, letting her do a better job. She has a pediatric anesthesiologist she calls in for this. That sealed the deal for us. I knew that having a second professional in the room to keep an eye on things was the way to go. The anesthesia wasn't covered by his insurance, but it was the best $900 out of pocket we've spent on him.

The anesthesiologist let me stay with my son until he was out to comfort him, and the dentist was done in less than an hour. We've stuck with that dentist ever since.

--Peter
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