Tuesday, January 10, 2012

You Ain't Getting Me in That Chair! Not Without a Boatload of Valium!

That's my sentiment. I'm a dentist. I don't like the dentist either. No kidding. I love who my dentist is. She is my very good friend for the last eighteen years and the most gentle dentist I know. She probably cringes when she sees me in the schedule and I don't blame her. 

No one "likes" to go to the dentist. This sentiment, as a society, has spawned a whole new generation of available sedation. Take a few pills, a whiff of gas, maybe a little needle in the arm, and we can make all our fears and inhibitions disappear. It could also kill you. Death is bad. Really bad. It could ruin your whole day.

Nitrous oxide was invented in the very late 1700's with the intent to be used to relieve pain. It was immediately used as a recreational drug for the British upper class at "laughing gas parties," everyone would get all dressed up to sit in the parlor whiffing gas and giggling uncontrollably. It was fun. People died. There was little known about what the gas was or how to correctly administer it. Sometimes there was too much gas and not enough oxygen causing asphyxiation and death. It wasn't until the 1840's that doctors started using nitrous oxide as an anesthetic drug. It was first used to relieve a patient from pain during a dental extraction in 1844. 

Then came the advent of anti-anxiety drugs in the 1940s and '50s. These were brought into dentistry around the 1980's to decrease anxiety in those with a fear of the dentist. Dentists also started teaming up with anesthesiologists to provide IV sedation. IV sedation is very safe, has a very low risk of death, but is also very expensive. It requires an anesthesiologist to be present as well as an extensive monitoring equipment. 

In the late 90's a local dentist named Michael Silverman popularized an oral sedation technique called anxiolysis in which the patient is sedated with a concoction of pills. A handful of different pills such as Valium and Halcion are mixed together to put a patient under a "conscious sedation." This is cheaper than IV sedation because it doesn't require extensive monitoring equipment or an anesthesiologist, the dentist can administer the concoction himself. This is also very unsafe. It is non-reversible, in the event that a patient has a medical emergency or an unexpected reaction to the medication then there is nothing that can be done since the medication is already flowing through their system. It is also unpredictable- it's impossible to know how the medicine is going to take effect from one individual to the other. Dentists are required to be licensed to administer oral sedation and although many dentists feel uncomfortable with this technique it is still being used in some dental practices today. Michael Silverman has written many articles about this technique but no longer practices dentistry. 

Our office uses nitrous oxide, also known as "inhalation sedation," for patients with anxiety. We can also administer Valium in a liquid form that relaxes a patient. I discovered liquid Valium in a pediatric practice where we used it very successfully on children. It was only a short thought process to begin using the same medication for our adult patients, with even greater success. Many of our patients liken the sedation to having a glass of red wine. There are few medical problems that prohibit the use of these materials, unlike the other forms of sedation, and it can be reversed if needed. Patients can come take a short nap in our chair while we work on their teeth with no risk of death! 

A Family Dental Care Center: Dr. Seth Rosen
2030 West Main St. Norristown, PA 19403

Thursday, January 5, 2012

Is Joe the Plumber Your Dentist?

The epidemic of non-dentists owning dental practices and corporate dentistry.

Until the 1980's dentists were precluded from advertising. There were extreme limits to advertising put into place by the varying Dental Boards. It was seen as improper and beneath our profession to advertise. The phrase "putting a shingle on your door" was used, meaning that a small sign with the dentist's name would be hung outside their office. This was the extent of advertising in dentistry. Practices did not have "names" and corporations and non-dentists were prohibited from owning dental practices. All that changed in the mid-eighties. It was decided that advertising in dentistry would not be limited as long as certain guidelines of good business were followed. Alongside this, non-dentists were also allowed to own dental practices in some states, including Pennsylvania. The flood gates were opened, never to be shut again. 

And therein lies the problem. Dentistry has become income focused. So much so that non-dentist businessmen are opening up shop. These facilities are usually staffed by dentists that have no real interest in the practice itself or the treatment of its patients. They are there for the paycheck. Dental franchises have also come to the surface. These franchises may be owned by a dentist, but rarely is that person found at that location or practicing on patients. Many times these types of dental practices will bring in independent specialists, such as oral surgeons, periodontists, and orthodontists. We've all seen the billboard ads for such practices, in fact I often see one right down the street touting braces for some unbelievable low monthly cost. The name on the sign is a dentist that owns many practice locations yet is not found in any of those locations and is not the one doing said orthodonture. It is easy to get sucked in to the fancy advertisements of these types of practices and just as easy to be disappointed by their impersonal and expensive care. We often hear the same sentiment of huge promises of great modern dental care, but they are usually unable to deliver on that promise. They can talk the talk but can't walk the walk.

These corporate dental offices usually adopt business models meant for non-medical sales, mainly scripting. Many times the staff has had extensive off-site training and exercises brought in by an outside consultant. I call it brain washing, they call it team building. This poses a problem when applied in the medical field since every patient needs to be seen as a unique individual, not a specific dollar sign.  This can not happen in a scripted or franchised office since the office has a financial goal to meet with every patient. This means that you will not be able to get an appointment for a "simple cleaning" or even a "toothache," you can only get an appointment for a whole mouth evaluation including x-rays, photographs, study models, a treatment plan, and may even have your credit report ran. You will be brought back and presented with a whopper list of work you "need" to the limits, or exceeding limits, of your financial capacity. They are there to drain every penny possible from you, all with a smile!

Dentistry is supposed to be patient centered care, we are here to serve our patients as best as we can. When a patient enters our office with a specific problem then it is our job to address that problem. We will inform that patient of other work that needs to be done and how it should be done, but our priority is always to make our patients comfortable at the moment and hopefully be able to address their whole mouth needs when they are ready to move forward. My office emphasizes personal, compassionate care for all our patients. We offer payment plans and reduced-fee plans for patients without dental insurance and create individual treatment plans for each person depending on their need. Since we are a smaller more traditional office we are able to get to know our patients individually on a personal level. 

A Family Dental Care Center: Dr. Seth Rosen
2030 West Main St. Norristown, PA 19403