Sedation Dental Care – What’s it All About?

Patients unfamiliar with sedation dentistry can find it confusing and wonder about safety. They often don’t understand how or if it is used in conjunction with “traditional” anesthetic approaches used in dentistry. One of the most significant changes in the field of dentistry is the availability of sedation dental care – providing the same levels of comfort that are routinely provided by doctors of general medicine and related fields of specialty. The ADA and regulatory state dental boards across the U.S. are facilitating this change in dentistry and helping to ensure that dentists who provide sedation dentistry do it safely. The questions and answers below are intended to help you understand both some of the history as well as a broader explanation of how dentistry is safely being made more comfortable than ever for patients.

When did dentists start using sedation?

Perhaps the better question is, “When did dentists start providing pharmacological pain management techniques?” Horace Wells, a Connecticut dentist, introduced the use of nitrous oxide in the 1840s. One of Wells’ students, William Morton, demonstrated the use of ether as anesthesia. They were progressive thought leaders in the field of pharmacological pain management for not only the field of dentistry, but also the field of medicine. Many, many decades have elapsed since then – long enough for the effects of many different types of anesthesia – both localized and general – to be very precisely understood. Different types of anesthesia are most appropriate for different types of treatment. The fields of dentistry and medicine at large now have an excellent understanding of the risks associated with all types of sedation/anesthesia.

What role does sedation play in providing comfort in dentistry?

There are actually two issues – anxiety and pain – that are often tightly intertwined when it comes to making patients comfortable during dental procedures. Dentists receive a tremendous amount of training that helps them understand this. They are taught about two techniques for managing both anxiety and pain – the psychological approach and the pharmacological approach.

Most patients have little or no awareness of dentists’ training in psychological anxiety/pain management, or that those techniques have been applied to them. At best, they will think that the expert in the psychological approach is nice, gentle, and caring – and that’s OK! Don’t worry, though – there’s nothing deviant about the approaches dentists use to make you more comfortable during your visit.

For many decades, the pharmacological approach used by general dentists has been centered on the administration of local anesthesia (often with needles) to numb the affected area. With new, expert training programs, dentists are starting to use broader approaches that nicely complement the use of localized (more traditional) pharmacological approaches. Patients are put in a relaxed state so they don’t mind having necessary or elective dental procedures performed. Sometimes this is needed to manage patient anxiety – including a phobia about the use of needles. Once the sedation is in use, the patient may become unaware of or uncaring about the use of a needle that is used to provide localized suppression of pain. So, expert pharmacological management of pain and anxiety involves the use of the right mix of sedation and local anesthesia – as appropriate for the procedure being performed.

Why don’t dentists use general anesthesia?

While general anesthesia (where the patient is rendered unconscious) is used by dentists in some fields of dental specialty (most notably oral surgeons), it carries with it a significantly greater patient risk. It also requires very specialized training. For this reason, general anesthesia is generally administered only in a hospital setting where an artificial airway can be maintained to facilitate an instant resuscitation attempt. Needless to say, the hospital setting (or equivalent investment in facility, equipment, and specialized staff members) makes it a costly option. Oral surgeons usually advise that lesser sedation techniques be used in conjunction with local anesthesia whenever practical to avoid the additional patient risk. Insurance coverage (or lack thereof) for using general anesthesia for lesser procedures is another consideration.

Are there different levels of sedation dental care?

The American Dental Association (ADA) has a general policy that discusses minimal, moderate, and deep sedation. The policy is fully described in Guidelines for the Use of Sedation and General Anesthesia by Dentists. However, it is important to realize that the ADA does not formally regulate the provision of dental care in the U.S.; the regulatory responsibility lies with each individual state.

The regulatory requirements on dentists who provide sedation dental care can vary from state to state. Some states provide requirements that define more granular levels of sedation dental care – each with an appropriate corresponding level of training and/or experience – for both the dentist and staff members. For example, the moderate level might be split into orally administered moderate sedation and intravenous moderate sedation. The latter carries with it greater patient risk. Some states are considering or have enacted new regulations for sedation dental care because of the increased public demand for sedation dentistry.

Aren’t all general dentists trained to perform sedation dentistry?

The state-administered regulations for sedation dentistry (when they exist) may be in addition to whatever state guidelines currently exist for the administration of “traditional” localized forms of anesthesia. (The use of local anesthesia may often be regulated by states by certifying that the practitioner holds a Doctor of Dental Surgery (DDS) from an accredited dental school, and may include some additional continuing education requirements.) The ADA is supportive of dentists who are appropriately trained in the use of minimal, moderate, and deep sedation. And of course, the ADA recommends that no dentist use drugs or techniques for which they have not been appropriately trained.

Across the U.S., there is training on sedation dental care available through pre-doctoral, post-graduate, graduate, and continuing education programs which may be appropriate for some levels of sedation. Again, each state defines what training and certification procedures are appropriate for dentists practicing in the state – including sedation dentistry. The ADA indicates that deep sedation and general anesthesia training are beyond the scope of either pre-doctoral or continuing education training programs. Check with the state dental board for your state for additional information about sedation dentistry regulations that apply to you and your dentist.

Dental Jobs in the United States

Dental Jobs in America – What you Should Know

When it comes to medical jobs in America, dental jobs are one of the most common types of jobs available. Actual dentist jobs may be more difficult to find, but lesser qualified positions are constantly available throughout the country.

Not all dental jobs require qualifications; though it would obviously help you if you did gain some form of qualification before you applied to any job role. Here you will find out more about the different dental jobs available and how you may be able to get into the field.

Understanding Dental Jobs

Dental jobs can sometimes be similar to emergency medicine jobs. You can often have to deal with emergency treatments and in many cases you will need to be able to deal with squeamish sights! However, there may be some clerical jobs available within a dental surgery. So if blood does put you off but you would still like to work in a dental surgery, a clerical position may be better suited to you.

One of the most common types of dental jobs available these days tends to be the dental assistants role. This involves assisting dental surgeons with operations and treatments. You will be responsible for setting up the surgery ready for the next patient. This includes finding all of the relevant equipment, cleaning the office and ordering new stock. It is vital that dental assistants be fast workers and they have to be able to work on their own initiative sometimes too. It can be a varied job but you will often see squeamish operations and so you have to be able to deal with this. You will also have to use various pieces of equipment to assist the surgeon whilst they are performing treatments. It is an important role and various skills will be needed.

Typically the skills needed to become a dental assistant are being a quick worker and you may also need experience in various areas such as taking x-rays and being able to create temporary crowns. Each dental surgery will require different skills and some may not ask for any qualifications or skills. If you don’t have any experience or knowledge in the area then you may be able to find trainee positions. The actual salary for dental assistants will vary depending upon the company hiring you. This is because the job role of the assistant is different at each company. Some may require you to do a lot more work than others. Therefore some positions will pay up to $25,000 whereas others will pay up to $16,000.

Another dental job which you may be interested in is a dental hygienist. The role of the hygienist is to ensure that the teeth and gums are as healthy as possible. You will mainly be responsible for cleaning the teeth professionally and for treating any infections which may have occurred. Many surgeries require a bachelor’s degree before they will allow you to work with them. The average salary of a dental hygienist is around $50,000.

Overall there are many different dental jobs available in the dental profession. Some will require more skills than others; though no matter what skills you currently have there will always be a role to suit you.