Why don't regular dentists use IV sedation in the US?

[Kajikit]

I had to go to an oral surgeon last year to get IV sedation and they couldn't do anything to fix my broken teeth - they could only pull them out. I didn't mind because it was the very back molars and nobody can see them, plus they'd been broken for a long time already. But I'm wondering why regular dentists don't offer IV sedation? It was WONDERFUL. The best dental experience I've ever had in my life because it sidestepped all my phobias. I sat down, they put the tiny little needle in, and I woke up when it was all over. I wish I could have it for ALL my dental work. Okay, anything more major than a clean, they're not hard to handle.

 

[Stress Doc]

The main reason is liability. Your malpractice insurance premiums can skyrocket if you offer this option. You also need to have special training, crash carts and a staff that is trained in emergency procedures. Most dentists also believe this type of sedation is overkill and is presents a greater risk for the patient.

You must also be well versed in medication interactions and health conditions. If the treatment required is complex enough to need I.V. sedation then a referral to an Oral Surgeon is the best option for all concerned.

In the standard dental practice in the USA the use of Halcion and I.V. sedation is becoming a thing of the past due to the reasons I have sighted. L.A. is usually all that is needed for almost any procedure in their office. Even Nitrous is becoming used less and less due to the interference the mask causes with performing treatment (this is the most common objection I hear from dentists). Also some of the newer anti-depressants can cause interactions with Nitrous.

I have spoken with many dentists and they are very sensitive to the downside of offering these sedation options. I think we will see them become confined to the world of the O.S.

I hope this helps.

Have a great day.

 

[Kajikit]

That may help the dentist but it doesn't do much for the dental-phobic patient... a local anaesthetic takes care of the pain but it doesn't do anything to help your gag reflex, or a panic attack in the chair when they start doing stuff to your mouth.

 

[Stress Doc]

I understand. There is also another side to this. The ideal solution is to asisst the patient in controlling the anxiety/phobia. If a patient relies on I.V. sedation or oral sedation to make it through a dental visit, this is a setup for future problems.

What happens when they switch dentists, for whatever reason, and the new dentist does not offer these options?

My goal is to help my patients overcome these conditions so they do interfere with life. Anxiety/phobia thrives on feelings of hopelessness and helplessness. If you rely on a medication to cope with a situation you reinforce these feelings because without the medication you cannot cope.

I never have my patients take anti-anxiety medications on a regular basis for more than 4 weeks. Studies have proven they lose effectiveness after this time and the brain does not respond to them effectively after that time.

We are way too quick to prescribe these medications, in a manner they were never intended to be used in. My desire is to help my patients to overcome these conditions and not setup a new dependency.

I have found this to be the most helpful thing I can do for the people under my care. I know dentists must become increasingly proactive in helping their patients with anxiety/phobia, better drugs are not the answer. Dentists need to partner with their counterparts in the mental health community.

Together a lasting solution can be found for all concerned.

 

[Gordon]

My take as an outsider looking in and talking with a variety of interested parties in the US...

The big reason is politics in the US, the OS lobby is extremely powerful and appears to be trying to monopolise the provision of sedation in dentistry. I've been told by several dentist/sedationists in the US that they do not have to pay extra premiums for their practice liability insurance if they offer IV, but their State Boards impose sweeping restrictions on the use of IV which they don't feel able to meet and so give up offering IV sedation.

Like I say, just an opinion from an outsider.

 

[Stress Doc]

I did not think of the political side of the equation. Sounds very plausible.

I did some checking. In California it is very difficult to be licensed to perform I.V. sedation. Less than 1% of the dentists in this state are licensed to use this method.

 

[brit]

The big reason is politics in the US, the OS lobby is extremely powerful and appears to be trying to monopolise the provision of sedation in dentistry.

Which from a patient's point of view would maybe be acceptable IF Oral Surgeons were willing to do restorative dentistry....since apparently they are not, it seems to be another market distortion working against the best interests of patients.
Surely in a free capitalist society like the USA, it should be possible to buy some restorative dentistry under i/v sedation? It can be done easily enough in the UK.
We really don't know we are born in UK sometimes, the existence of a 'not half bad' 'often free at point of use' state system, means the private sector can exist only if it 'adds significant value' to the standard experience...

 

[hdf2]

The main reason is liability. Your malpractice insurance premiums can skyrocket if you offer this option. You also need to have special training, crash carts and a staff that is trained in emergency procedures. Most dentists also believe this type of sedation is overkill and is presents a greater risk for the patient.


I reallyyyyyyyyyyy dont wanna hear this.........I have to have all my treatment done under IV sedation , I have an appt for iv sedation looming

 

[Stress Doc]

Hello hdf2:

I did not mean to frighten you. I.V. sedation is very safe. I am speaking of what you are required to do to offer this type of sedation. These are procedures that look at worse case scenarios that are as rare as hen's teeth. The safety aspect is that the more drugs you introduce into the equation the more variables.

The dentist is required to have every safety protocol in place, even though they will never in all likelihood use them. There are regulations that stop most dentists from even considering these options due to making it very difficult and expensive to obtain a license for this option.

I sincerely apologize if I wrote anything that came across as disconcerting. My point is why more dentists do not offer this type of treatment. There are many barriers and hurdles you need to jump through that prevent offering more options.

For example; Hypnosis is a very safe and effective treatment for many conditions. It is good for the patient as it gives them control and can be very helpful. Much safer than a medication option. Yet, I do not know of any insurance company that will pay for this treatment. If the patient cannot afford to pay out of pocket then this option cannot be considered. The way not to pay for a treatment is to label it "alternative or experimental" and eliminate it. It does not matter how many studies or how much clinical evidence.

Many times it is not what is best for the patient, which is sad. red tape and politics get in the way of good medicine.

Please rest assured that I.V. sedation is very safe and is used thousand of time per day in dentistry. I know you will be fine.

 

[brit]

The main reason is liability. Your malpractice insurance premiums can skyrocket if you offer this option. You also need to have special training, crash carts and a staff that is trained in emergency procedures. Most dentists also believe this type of sedation is overkill and is presents a greater risk for the patient.


I reallyyyyyyyyyyy dont wanna hear this.........I have to have all my treatment done under IV sedation , I have an appt for iv sedation looming

Well funnily enough Happy Dancing Feet 2, I'm sure Gordon is fond of saying that i/v sedation plus local anaesthetic is SAFER statistically speaking than local anaesthetic alone...you have no need to worry it is very safe and you are in excellent hands now as you know.

 

[hdf2]

Thanks for the reassurance brit and stress doc, I was just feeling a wee bit negative last night regarding future appts. I had been sitting thinking whether i could eventually have treatment without the sedation, and tried to "walkthrough" a normal appt in my mind. Cant see it happening just yet tho
Having had iv sedation 4 or 5 times in the past 4 years, I know its ok, but it doesnt stop me worrying prior to other appts.
I certainly agree with Gordon,.........if I had to have treatment using L/A alone, my bp would be through the roof and I would be in a blind panic.

brit, remember the infection I had that just wouldnt clear up even after taking antibiotics for weeks on end? I was on holiday at my mum's when it flared up........ I went to the local hospital on the island to get more antibiotics, but they called the dentist out, who wanted to extract it there and then even after i explained my phobia. ( they dont offer sedation on the island) I cried like a baby and screamed that I would rather jump off a motorway bridge!

 

[brit]

brit, remember the infection I had that just wouldnt clear up even after taking antibiotics for weeks on end? I was on holiday at my mum's when it flared up........ I went to the local hospital on the island to get more antibiotics, but they called the dentist out, who wanted to extract it there and then even after i explained my phobia. ( they dont offer sedation on the island) I cried like a baby and screamed that I would rather jump off a motorway bridge!

No I think that was before I joined because I usually remember the details. Your fear then could well have been justified if an infection were present as numbing could have been an issue.
If any dentist can get you eventually doing it without sedation...Mike can...because he has that whole relaxation paraphernalia up his sleeve (i.e. hypnosis) and because he can take the time..you are travelling a long way..it is in your best interest to wean yourself off long term because with the right dentist there is no need to be so anxious but we all understand (having been there with negative experiences too) that that is easier said than done. At the end of the day getting treatment you need is more important than how you achieve it. You have to trust the person who is sedating you too, so arguably with the right person...it is a small step to crank down from i/v sedation a bit. You actually have much more control without sedation, provided you can relax enough...if anyone can get you to relax more it's him.
Carry on with the baby steps.....don't put too much pressure on yourself....it's Mike's job to keep you comfortable not yours.
I know you'll be fine..it's an amazing step that you can even begin to comtemplate maybe eventually ditching sedation - there are other types too of course.

 

[Snowball]

Why are their insurance premiums so high for providing IV if it is proven to be safer? (Which I know it is!) Doesn't make sense, unless it is political.

Also, Kajikit, I don't understand why they could only do extractions with IV as the advantage of IV versus General Anaesthesia is that you can do fiddly procedures and you don't have to do just extractions! Wonder why they told you that?

I've pretty well ditched any sedation - having 2nd half of my RCT treatment tomorrow and the first, done with the infection still present and by another dentist because my phobic friendly one was on holiday (sods' law) convinced me that I can do it. Afterwards the dentist and nurse said you don't ever need sedation again if you can do RCT without it, and that gave me so much strength, I can't tell you! It is a huge step but if I can get there - trust me, anyone can. As usual, the worst thing has been all in my head - not the reality of the treatment. It's a nice psychological back up to think, well if I did panic or there was a problem getting me numb, I could still go the IV route and even just knowing that is enough.

My next aim is to get them to take 'dental phobic' OFF my notes and put words to the effect 'Slightly perturbed by dentistry but not overly fussed anymore'.....