Board Certified Periodontist

71 – Comfort and Sedation

Hi there. You are listening to the Perio Patient Podcast, a podcast for my patients and anyone else who cares to listen. Dr. Ben Young here, and I am a periodontist in private practice here in beautiful San Antonio, Texas.  
The title of this podcast is: Comfort and Sedation 
I have taken this title from the first subheading under the tab we have called Periodontal Services. This is because as the Perio Patient Podcast has developed as part of my push to continue to communicate with you, my patients, regardless of whether you are currently under care or have moved back to receive most or all of you care in your home or family dental office, I have moved to place these podcasts based on their topics into the different areas of my website.  
The hope for new patients is that it might help them hear from me what it is they are reading on a particular page and for the rest of you, it will be sort of a review with perhaps something you didn’t know thrown in. 
I know I repeat often why I do this, and the answer is that in our busy lives with the work we need to do – you out in the world away from my office and me in my office moving from patient to patient, we don’t have the luxury of just sitting and talking – and yet, sometimes the most important thing we can be doing is talking and sharing about what is important to us. For example, I wrote The Joy of Flossing, because I found I did not have the time to explain as well as I wish I could during patient visits the profound importance of this little seemingly unimportant daily habit in keeping people healthy with regards to the two most destructive diseases dentists face daily – tooth decay and periodontal disease. So, I wrote the book because I couldn’t just give it up – it’s too important for the health of so many people, and yet I also knew that I couldn’t give it my best in the few minutes I had available with each patient without messing with the appointments of other patients.  
I guess I am a teacher at heart who also wishes to maintain a level of independence from bureaucracies because I understand how easily they can control speech and behavior. If I were working within a university environment today, and let’s say I was doing research, it may not necessarily be the research I would want to do, I would need to find the research that could be funded. Because I know this, I’m a skeptic whenever I hear there is a consensus of scientists who believe one thing about anything. 
I’ll leave it there and let you figure out the rest. The bottom line is that I believe it is critical to have independent voices speaking into society – especially today – and this is not to say that there aren’t those who are doing an outstanding job speaking truth within institutions today, but it is not without its personal risks – especially as you are younger and wanting to obtain a tenured professorship, for example, or that higher rank, if you are in the military.  
And when it comes to you as a patient, I believe you will receive the best care when you are curious, do a lot of reading, even if it is on the Internet – where there is always a lot of bogus stuff – and you use people like me and your primary care physician, nurse practitioner or physician assistant – not as your health decision makers, but first and foremost, as you health consultants. This is really fundamental. You have to retain your ability to decide and your decisions, if they are going to be good ones, should come only after you understand the problem and all reasonable options at the level that will allow you to relax. 
Which conveniently brings us back to the topic of this podcast – comfort and sedation. 
So, what I am going to do now is simply go down this list of topics on this page and make a few comments.  
First, patients have discovered that my dental chair vibrates. I wish I could tell you that I planned this and purchased the chair because of this feature, but I actually did not know it had this feature when I purchased in. It was shipped from Florida a number of years ago when its predecessor gave up the ghost. Some people like it. Some people could care less. What you need to really know is that you are welcome to use it or not and that it doesn’t bother me in the least as to the procedures I do. I will say this. I have never used it myself because I might like it so much it will distract me from the work I need to be doing. So that’s the first comfort amenity mentioned on this page. Plus, it’s a fun one.  
In the treatment room we have an air filter that filters out particles the size of viruses and we also have a fan. In addition we have blankets and small pillows that can help support the neck if you need this. Please let us know if you have limitations in sitting back, or how to get you up and back comfortably.  
Now let’s talk music. Depending on when you visit you will hear music playing that may be 40’s, 50’s, 60’s, 70’s, country, as well as I think are a few more modern sounds. Heavy metal is not a favorite and most rap music I have not found conducive to relaxation.  
My personal favorite is classical and easy listening jazz without words – but when it comes to music, the first thing you need to know is that you, the patient, gets to pick. If you like heavy metal and you are the patient, then heavy metal it is. Also, if you like Christian music, that’s great, everyone of us in the office do as well – just ask for it. Also, I am never opposed to praying out loud for anyone who requests this as well. I am very much aware of how important it is for God to oversee and heal people. My skill set is to enhance the body’s healing abilities, but I am just an instrument in the healing process. I believe God is ultimately the one who heals all of us. Sometimes he just chooses to allow others of us to participate in the work he is doing.  
Let’s go to the items under MINIMALLY INVASIVE TREATMENTS next.  
The first one is “Dental laser for periodontal disease treatment.” I guess this one is here in case someone has yet to look at the tab that is entirely about lasers, but I am not going to remove this as a topic here because one of the things I love about the laser I work with is that it is truly minimally invasive compared with surgeries that require exposing bone. Lasers alone are not the answer, as you will learn if you do not already know, but their contribution to other procedures is on the level of amazing. Lasers can reduce the number of office visits someone would have to schedule and also the costs compared with other options can be much lower overall.  
Also, lasers can treat more than periodontal disease. If you have mouth ulcers, for example, come it and in a few minutes, we can usually relieve the pain and speed up the healing.  
So what is a Non-traumatic extraction? 
A non-traumatic extraction is one that preserves the surrounding bone. In other words, if the tooth has to come out, then the objective is to remove the tooth but keep the rest of the bone behind because we need the bone. To do this, the tooth is often sectioned and removed.  
Beyond a non-traumatic extraction, additional comfort can come with a bone graft. This is particulate bone placed into the socket which covers over all the exposed nerve endings. Bone grafts can essentially eliminate the risk of dry sockets – something I use to see all the time before bone grafting became an important discovery and then available for routine care.  
Gentle injections 
I was taught to give injections by a particular instructor in my dental school by the name of Larry Day. He was an oral surgeon and one the gentlest men you would ever meet. His belief, which he passed down to us students, was that the slower the injection, the more comfortable. The reason for this is that the injection when it starts enters the skin just below the surface – it isn’t jabbed. Once below, a drop of anesthetic is delivered. This numbs the area ahead of the needle. The needle from that point on is moved within the numbed area of tissue. There are other techniques I won’t bore you with, but the bottom line is that most dental injections can be delivered in a way where they are barely felt. Having said this, it is unfair to promise anyone they will not feel anything. I have had patients react to injections before the needle has actually touched the skin at all. What this tells me is that the imagination can be our worst enemy. Finally, and this is most common with children, is that when they think they are going to get an injection they almost instinctively look at the needle. Discipline yourself to close your eyes or look away. You will find that the injection is barely felt if at all. When I have my blood drawn, I do not look at the needle going into my arm. I have and I can do it, but why should I? I prefer to just relax and let people work on me when they have to.  
Platelet Rich Fibrin – one of the newest techniques today in not only dentistry but orthopedics and plastic surgery is platelet rich fibrin or PRF. 
Before PRF we had to purchase specific growth proteins that are very effective in stimulating healing – but are also quite expensive. This is also true when it comes to materials we call membranes. Sometimes after a non-traumatic extraction and socket preservation bone graft, we cover the site with a membrane. This protects the socket environment.  
Membranes come it two types – those that dissolve over time and those that do not. There are reasons for using both of them and I won’t get into this here – but, now we have a very cool and less expensive option and that is PRF. 
Blood is drawn from a vein in your arm and is spun down in a centrifuge we have in another room. This separates out the blood platelets, white blood cells and clotting factors from the red blood cells. This part of the blood now rich with platelets, white blood cells and clotting factor enables us to create membranes, plugs and even incorporate the bone graft material into the PRF. What we then can place is a material containing the patient’s own infection fighting cells as well as a concentration of the proteins that start the healing process. The net result is a better healing event with less cost in materials.  
Let’s talk about Sedation options. 
In general, understand that pain is controlled by the local anesthetic. Sedation has only to do with someone’s level of awareness during procedures. 
For some people, a dental anesthesiologist is the best option and I work with a number of outstanding highly skilled and trained practitioners. With a dental anesthesiologist, we can go to the level of general anesthesia. I am not trained to the level of sedation and even if I were, I would either provide the anesthesia or accomplish the dental procedure, I would not wish to do both at the same time. So I will stick with what I do best.  
Oral conscious sedation is the use of tablets you swallow to relax you. It works very well but has a little slower recovery rate compared to IV sedation. It is certainly a back-up option for those where I may not be able to start an IV. 
IV sedation is a tremendous adjunct when it comes to dental extractions. Some extractions, especially those where there is some level of infection involved, can override the level of pain management of local anesthesia alone. For this reason, I personally sedate everyone who requires extractions.  
As for other procedures, this is elective to you, the patient. If you wish to be sedated, it is available, however, for most LANAP procedures that do not also involve extractions, most patients elect to simply have the local anesthetic and trust me that I can provide this to them comfortably.  
It is never wrong to have someone else drive you from any lengthy dental appointment, however, it is not legally required if you are not sedated. If you are sedated then you must have someone driving you and you should not drive or operate machinery for at least 24 hours following sedation – this is precautionary. Besides, if you get in an accident, and you are completely awake, but you were sedated within 24 hours, you insurance company, if they learned about this, would probably deny your coverage.  
Well, that’s what I have for you today. Thank you so much for listening. I hope it has been helpful. If it has been or if it has not been, please let me know – that way I can provide content that you find most useful  
This has been The Perio Patient Podcast and I am still Dr. Ben Young. Thanks for listening.  
Have a great day. Bye for now.