Think of a worst-case scenario, something you fear or loathe. Now compare
that vision with going to the dentist. You'd rather ride out an earthquake
than visit a dentist, right? Well, you are not alone.
One out of seven Americans experience a disorder called dental phobia in which
the thought of sitting in a dental chair for seemingly hours with a masked
man or woman prodding in your mouth is downright terrorizing.
Dr. David Blende, a Tiburon resident who practices dentistry in San Francisco,
feels your pain. World-renowned for using general anesthesia on the toughest
patients with multiple problems, Blende is respected by his peers and revered
by patients, many of whom have not been to the dentist in decades.
"I'm so mad at myself for not doing this sooner," said Len Linley,
a 56-year-old from Sausalito. "I was just noticing I have a good smile.
I didn't smile a lot before."
Linley, a Vietnam veteran, survived combat and was even a prisoner of war,
but couldn't bring himself to go to the dentist. He didn't have a choice last
spring after he broke a front tooth, leaving a nerve exposed. "I was in
so much pain, I couldn't drive."
The broken front tooth was one of many oral problems plaguing Linley.
During six hours of surgery, Linley had 15 crowns placed, two root canals,
gum work in four quadrants and one extraction. He was eating, and smiling,
the next day and never had to listen to the sound of a drill.
"He would have needed seven or eight appointments," Blende said. "He
would have never done it."
Last year, Blende worked on patients from 27 states and 14 countries. As the
chief of dentistry at California Pacific Medical Center, he often performs
his longer surgeries at the hospital, where general anesthesia is used.
Blende, whose office is in Pacific Heights, estimates that 40 percent of his
patients undergo general anesthesia or IV sedation.
"We do more definitive full-mouth rehabilitation under general anesthesia
than anyone else in the United States," Blende said. "There's one
goal in mind: Go to sleep and wake up with it done, period."
The buzz word these days in Blende's profession is "sedation dentistry."
The four major types of sedation are oral pills, nitrous oxide, intravenous
infusion of drugs and general anesthesia.
Blende warns that hundreds of dentists around the country boast of sedation
methods, but few have put together the sophisticated group of health-care professionals
that he has assembled. During Linley's operation, for example, three different
dentists worked on the patient: a root canal specialist, a periodontist to
handle the gum work and Blende placing the 15 crowns.
Buzz Thiercof, a Marin County businessman with many community ties, needed
five glasses of wine before he got the courage to make the call. Thiercof's
paranoia stemmed from childhood when a needle-wielding dentist got a little
too close to his eyes. Blende was so sensitive to Thiercof's fears that he
held their initial consultation in an office conference room, far away from "the
chair."
"The dentist is seen a strange man coming at your mouth with a needle," Blende
says. "The hardest and bravest step is picking up a phone. Most of the
people we see are at their last opportunity to receive care."
Besides the needle-near-the-eye aversion, patients are leery of having their
airway blocked, being in close proximity to a stranger, the dentist's smell
and sounds as he or she are working on the patient, and a general feeling of
helplessness sitting in the chair.
With Thiercof under general anesthesia, unaware of his surroundings, Blende
oversaw 10 extractions, gum surgery, three root canals, created a 10-unit fixed
bridge on his upper teeth and made a lower denture with precision attachments.
Blende's sensitivity was honed early on. His grandfather and godfather were
dentists, and his father was a doctor, covering a 1,000-mile radius near the
Washington-Canada border.
"You have an opportunity to develop empathy," Blende said. "We
were expected to go into a health-care field."
After graduating from dental school, Blende practiced in Los Angeles, treating
poor and malnourished children with numerous cavities and tooth decay. He discovered
he was fast and precise in complex cases, drawing notoriety and referrals from
other dentists.
Blende's patients have also included a 40-year-old woman with cerebral palsy,
and a Larkspur lawyer who had suffered a stroke and had a history of cancer,
high blood pressure and seizures.
"I'm very proud of what we do," Blende said. "It's a unique
practice."
DENTAL SEDATION METHODS
LOCAL ANESTHESIA: The most common form of anesthesia where a dentist numbs
the area with an injection that lasts from five minutes to three hours after
treatment.
INHALATION ANESTHESIA: The most commonly used inhalation agent is nitrous
oxide, known as "laughing gas" combined with oxygen makes the patient
feel relaxed.
ORAL CONSCIOUS SEDATION: The patient takes a pill before treatment and becomes
sleepy and relaxed with an effect the lasts up to four hours. Common sedatives
include: Valium, Halcion, Xanax and Ativan. This mode of sedation is often
called "sedation" or "sleep" dentistry; however, oral medications
do not and should not put a patient to sleep.
INTRAVENOUS SEDATION: Also known as IV or "conscious sedation." Patients
often think they are asleep and have no memory of the procedure but can respond
to the dentist when necessary. This can be done in an office setting; however
a physician anesthesiologist should monitor the breathing, blood pressure and
heart rate.
GENERAL ANESTHESIA: General anesthesia is a combination of several drugs that
block pain, paralyzes the muscles so the dentist can work more easily, and
renders patients unconscious and unable to remember the operation. This should
be done in a hospital setting with a physician anesthesiologist monitoring
the patient oxygen level, blood pressure and response to the sedation.
(c) 2005 Marin Independent Journal. All rights reserved. Reproduced with the permission of Media NewsGroup, Inc. by NewsBank, Inc.