Finding the right dentist for a special needs patient is always a daunting task. It’s made even more daunting these days by the number of practitioners who claim expertise in sedation dentistry, an emerging mode of dental treatment that can be very beneficial for medically compromised and disabled patients.
You’ve undoubtedly heard radio advertisements or seen other promotions that promise that a patient can, with the help of a “simple pill,” sleep through his or her treatment. But these promises can be misleading, says Dr. David Blende of San Francisco, one of the nation’s foremost special needs dentists and an expert who has offered patients a full spectrum of sedation for more than 20 years. “Indeed, the use of the term ‘sleep dentistry’ is illegal in some states.”
Sedation dentistry can unburden and transform the lives of special needs patients by restoring smiles and making the acts of chewing and eating pleasurable again. Special needs dentists also embrace the use of sedation because it has meant they can readily avoid and abandon the use of physical restraints and restore dignity to all their patients, even those most intolerant of treatment. After having complex work done by a sedation dentist, patients can often return to their local family dentists for routine dental appointments.
Yet, Dr. Blende recommends that before you arrange treatment for your mother with Alzheimer’s or your daughter with Down syndrome, arm yourself with the basic facts about sedation dentistry and plan to interview a prospective dentist with the questions listed below.
Sedation Dentistry & Special Needs
The emerging use of sedation in dentistry will change the way many of us think about the dreaded dental chair. While dentists have long used Novocaine to numb nerves and prevent pain, dentistry has lagged behind medicine in its use of sedation, or relaxants, to help patients endure uncomfortable and nerve-wracking procedures. Today, many dentists can prescribe a “simple pill,” usually Valium or Halcion, for patients who want to be relaxed and less cognizant of dental work during their appointments. Together with nitrous oxide or “laughing gas,” these are often the only sedatives so-called sedation experts offer.
For those of us who get nervous about dental appointments, mild relaxant medications make routine check-ups and dental work much less bothersome. However, it’s important to note that mild sedatives such as Valium or Halcion, when properly dosed, do not induce sleep. Patients who need to sleep through treatment—people who are profoundly afraid of dental treatment, who are medically compromised or developmentally disabled, or who need extensive dental work done—will not be not well served by these limited sedation options.
Only a select few dentists nationwide, including the Blende Dental Group and a number of university-based hospital dentistry programs, offer the full spectrum of sedation—which includes sleep-inducers such as intravenous and general anesthesia.
Fortunately, these select practitioners know each other well and readily refer patients to each other, depending on a patient’s location and mobility. In Dr. Blende’s case, he and a team of specialists including endodontists (root canal specialists), periodontists (gum disease specialists) and anesthesiologists (pain relief specialists), routinely perform full-mouth rehabilitation under general anesthesia in a hospital setting. Together with his dentist, a patient in a sedation practice can choose the form of sedation that best suits his case and is not limited to a pill or laughing gas.
Critical Questions To Ask
With this preliminary knowledge of sedation dentistry in mind, you can interview a dental practitioner and/or his staff about the specifics and ensure that your loved one is in good hands. Here is a list of questions Dr. Blende recommends:
What sedation options does the dentist offer? Again, the vast majority of sedation dentists offer only two sedation options: the simple pill or “laughing gas.” Be wary of a dentist who claims that these two forms of sedation will enable a patient to sleep through treatment. Remember, the term “sleep dentistry” can be very misleading and its use is now illegal in several states.
If you want to choose from a full spectrum of sedation choices, from mild sedatives to I.V. or general anesthesia, for your loved one, ask a special needs dentist for a recommendation, or call the Blende Dental Group at1-800-575-3375, they can recommend a sedation dentist who works near to you.
Is the dentist experienced? What safety measures are in place to protect your loved one? You should always inquire about a dentist’s training, licensure and accreditations, and experience. How many cases similar to that of your relative’s has the dentist completed successfully?
Also ask about the dentist office’s safety record, and make sure the practice has adequate staffing, resuscitation and safety equipment in the event of an emergency. If you are seeking intravenous (I.V. sedation), Dr. Blende believes it is safer for a physician anesthesiologist rather than the dentist to administer the I.V. sedation since the dentist is also occupied performing complex dental procedures on your family member.
Does the dentist routinely care for patients with special needs? If your daughter has cerebral palsy, for example, make sure the dentist you’re considering routinely treats patients with this condition and stays abreast of research developments that pertain to this condition. He or she should listen to and respect your concerns and requirements. Your family member’s needs for safety, both physically and emotionally, should be readily and empathetically addressed.
Does the dentist offer the full range of services needed for dental treatment? What types of sedation are offered to you on behalf of your relative who has special needs? Can you work with the dentist to determine the appropriate course for your loved one, as an individual, or are you "forced" into a certain approach because other options are not offered? After all, different people have different sedation requirements, due to medical conditions, disabilities, or personal desires. Not every sedation option is appropriate or safe for every person -- nor even for every type of dental procedure.
Does the dentist work in partnership with specialists such as periodontists, endodontists, and oral surgeons? If so, how does this process work? Find out if the dentist will coordinate this care for you. Can the procedures be easily coordinated into one appointment or will you need separate and multiple appointments to see your dentist and the appropriate specialists? At the Blende Dental Group, for example, a patient can receive sedation that enables him or her to sleep through all her dental work, in which a specialist can complete a root canal at the same time. That way, your relative does not have to be put to sleep again on another day.
Among other questions you should ask, are:
Do you take our insurance plan? A good dental practice will try to optimize the amount of treatment covered under your health and dental insurance. The staff should also help you identify other resources for the financing of necessary dental work.
Are you comfortable traveling for expert care and then returning to a dentist in your community for continuing care?
How will the dental office help you to coordinate your appointments and travel?
Is the dentist affiliated with any local hospitals?
Does the dentist listen to you, treat you with respect, explain your treatment clearly, and encourage your questions?
Now that you’re a discerning, informed consumer, you can more easily make the right choice on behalf of your family. In the hands of a skilled sedation dentist in an office that cares deeply about people whose daily lives are complicated by illness or disability, transformations and compassionate, comfortable care can be achieved.