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No-pain drilling 'Sedating dentists' draw the fearful into their chairs

No-pain drilling 'Sedating dentists' draw the fearful into their chairs

As published by The Columbus Dispatch, Wednesday, July 24, 2002:

No-pain drilling
'Sedating dentists' draw the fearful into their chairs

Wednesday, July 24, 2002

Copyright © 2002, The Columbus Dispatch

In a dentist's chair, nothing is better than feeling nothing. 
Novocain doesn't cut it for many patients, who want something more -- to send them into dreamland or knock them out.

To visit a ''sedating dentist,'' Walter Ferger drives 70 miles from Mansfield to the North Side. 
Dr. Brian Kvitko has completed 80 hours of training, and classes in basic and advanced life support, to earn an anesthesia permit from the Ohio Dental Board. 
The permit ''tells my patients I care,'' he said. 
Since finding Kvitko, Ferger has breezed through a filling, a cleaning and a root canal.
''His was the first chair I was able to get into without gagging,'' said Ferger, 49. ''Valium was the answer. Ten milligrams did wonders.'' 
''Sedation dentistry'' is becoming a coveted option for patients such as Ferger, among an estimated 25 million to 40 million Americans with a dental phobia.

General dentists sometimes hire dental anesthesiologists or refer patients to oral surgeons, whose medical degrees grant them the right to anesthetize.

Nevertheless, an increasing number of dentists are marketing expanded services to attract patients who neglect dental care. 
''Fear -- not time or money -- is the main reason people don't go,'' said Michael Fair, a sedating dentist in Upper Arlington. 

Ferger hadn't seen a dentist in seven years. 
''I lived with rotten teeth,'' he said. 
Rick Stull, who hadn't visited a dentist in 15 years, described his first procedure last year with Kvitko as a ''life-changing experience.'' 

A combination of Novocain, nitrous oxide and Valium ushered Stull through five pain-free root canals.

Share concerns with your dentist
In overcoming dental anxiety, talk is free and perhaps as effective as sedation. 
Dr. William Kuttler, spokesman for the Academy of General Dentistry, encourages patients to express fears to their dentists and to describe unpleasant experiences. 
''Talking about it is more than half the battle,'' said Kuttler, an Iowa dentist. 
His other anxiety-easing suggestions: 

  • Look for a dentist whose personality and office decor send a message of comfort.
  • Let go of bad memories. Consider the dental visit a ''spa treatment for the mouth.''
  • Avoid caffeine and sugar before an appointment.
  • Ask for a pillow and blanket, or take your own.
  • Establish hand signals to communicate feelings of pain and discomfort.
  • Request mouth props to prevent a tired jaw.
  • To block the intimidating sounds of dental instruments at work, listen to music -- especially through headphones.
  • Take slow, regular breaths throughout the procedure.
  • Take breaks during a long procedure.

''I fell asleep during three of them and have no memory of any of them,'' said the 40-year-old Columbus resident, who drives from the Far East Side to see Kvitko. ''He told me there should be no pain in modern dentistry.''

Ferger and Stull attribute their dental fears to unpleasant childhood experiences with ''old-school'' dentists. 

''When I was in junior high, my dentist would smack me in the head if I gagged -- and my parents supported him,'' Ferger recalled. 
His dentist, Stull said, refused to use even Novocain. 

Most sedating dentists practice conscious sedation, defined by the state dental board as a "minimally depressed level of consciousness" that preserves the ability to respond to touch and speech.

The board allows Ohio dentists to administer nitrous oxide, a gas, and oral sedatives.

Yet, to guard against overdoses, it recently limited pills to one a day.

"A movement has been afoot in this country among dentists to use repeated doses of oral sedatives to achieve a profound state of conscious sedation." said Dr. Steven Ganzberg, an Ohio State University College of Dentistry professor and anesthesiology specialist. "In some cases, it is possible that this could lead to unintended unconsciousness."

Kvitko is among a few hundred Ohio dentists who have received permits for intravenous sedation. (A permit is also required to give oral sedation in patients younger than 13.)

Intravenous delivery enables dentists to adjust the volume by the drip.

"You can give more if you need more or give less if you need less." Ganzberg said.

Nikki Robinson, a 26-year old Columbus nurse, received IV sedation in the fall to have four wisdom teeth extracted.

"Nitrous would not have been enough." she said.

Despite the options available, most dentists don't offer anything except Novocain and nitrous oxide.

Many are unwilling to invest the time and money to earn an intravenous sedation permit.

For oral or intravenous sedation, they are reluctant to raise fees, assume slightly increases risks--or ask patients to bring drivers.

Some simply don't want to attract phobic patients, who might be difficult and time-consuming.

"General dentists just don't feel like they need to offer oral or intravenous sedation." said E. Karl Schneider, an oral surgeon and a member of the Ohio Dental Association executive committee. "Their practices are fine without it."

Others, however, "are doing niche marketing" said Iowa dentist Williams Kuttler, spokesman for the American Academy of general Dentistry "and one of those niches are extremely apprehensive patients who think they need more than nitrous oxide."

The OSU College of Dentistry regularly receives calls from patients seeking sedation for dental work, Ganzberg said.

More than 1,300 dentists have joined the Dental Organization for Conscious sedation, formed 26 years ago to promote sedation dentistry.

Sedating dentists "are sweeping the country like wildfire," said Connie Fadigan, executive director. "They want to make sure quality care is provided to those people who are not seeking care."

Oral sedation enable Fair to keep patients in a chair for up to six hours.

"We can accomplish extensive amounts of dentistry during one appointment," he said.

Kvitko is loath to market sedation.

Still, "I can't imagine practicing without it. It has been really great for a lot of people."

Among them is Ferger.

"I'm nearly 50 years old," he said. "For the first time in my life I found a dentist who could help me."

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