Delivering Sedation in Dentistry

It has become increasing popular to deliver sedation to patients receiving dental work. Sedation is defined as the deliberate drug-induced depression of consciousness used to reduce anxiety and awareness associated with unpleasant medical procedures. Sedation is used to reduce anxiety.  In some cases dentists or oral surgeons deliver both the dental work and the sedation, while in others there is a separate anesthesiologist to do so. One should always verify proper training and license prior to undertaking any sedation from a healthcare professional. Sedation is generally considered very safe as long as it is performed by an appropriately trained practitioner in a monitored environment. Sedation dentistry uses different approaches depending on personal choice and comfort. In the order of increasing anesthesia these are local anesthesia, minimal sedation, nitrous oxide/oxygen, moderate (conscious) sedation, deep sedation, and general anesthesia. A more thorough discussion … Read more

Informed Consent in Dentistry: Can Change Impact Personal Injury Cases?

An excellent article appears in the Spring 2017 edition of the The Journal of Law, Medicine & Ethics (vol. 45, pp. 77-94) written by Kevin I. Reid titled “Informed Consent in Dentistry.” The article discusses how informed consent is respecting the ethical right of an individual to make decisions about one’s body and only have actions undertaken on their body with authorization without undue influence. In order for informed consent to be considered valid in dentistry the following must occur: (1) the patient is competent and has the ability and capacity to understand and decide, (2) the dentist discloses material information, (3) the patient understands, (4) the patient is voluntarily entering the arrangement, and (5) the patient provides authorization to go ahead. Every patient however comes to a different degree of understanding to authorize treatment based on their prior dental experiences, education, motivation, attention, … Read more

Patient Safety and the Culture of Cover-Up

An interesting article was written by George Lundberg titled “A culture of cover-up has slowed the patient safety movement” on December 1, 2012, on KevinMd.com located at http://www.kevinmd.com/blog/2012/12/culture-coverup-slowed-patient-safety-movement.html. In the article Dr. Lundberg says “Promoting patient safety, preventing medical error, preventing physician error, preventing errors in diagnosis, preventing nurse error, preventing surgical error, preventing communication error, preventing health illiteracy error, preventing errors from language barriers, preventing laboratory error, preventing computer error, preventing patient mix-ups, preventing right and left side of body mix-ups, preventing mistakes, since mistakes are the stepping stones to failure. Recognizing human frailty, recognizing physician humanity, recognizing system fallibility, owning up to problems, eliminating cover-up, acting out professionalism, recognizing that professionalism means self governance, individually and as groups. Self criticism, peer criticism, a culture of peer review, honesty, truth, disclosure, fairness, and negotiated settlements. Objective evaluation and commitment … Read more

The American Dental Association: Is it Patient-Centered, Science-Based and Ethically-driven?

Some time recently (within the past 6 months) the ADA (American Dental Association) has updated their about me page over at http://www.ada.org/aboutada.aspx. A new video appears and under it the text reads “This American Dental Association video tells our story and highlights how the ADA has always been a patient-centered, science-based and ethically-driven association. It captures the ADA’s spirit and what the ADA strives to be.” Viewing the video the words patient centered, science-based, and ethically-driven are repeated. The video also throws around the terms continuous learning, research and development, patents, and up to date. In one segment a dentist presumably says do no harm, always do good, treat people with fairness and honesty, and respect the doctor patient relationship. Unfortunately I disagree with the ADA’s assertion that they have always been patient-centered, science-based, and ethically-driven. As stated before on … Read more

What is the Prevalence of Patients with Asymptomatic, Disease-Free Third Molars (Wisdom Teeth)

An interesting article titled “How Many Patients Have Third Molars and How Many Have One or More Asymptomatic, Disease-Free Third Molars?” appears in the September 2012, supplement 1. (vol. 70, issue 9) of the Journal of Oral and Maxillofacial Surgery written by Thomas B. Dodson, DMD, MPH (pg. S4-S7). The article seems to attempt to arrive at an answer to the question of how many patients really have a wisdom tooth (third molar) that is not causing problems and that has no disease. In the article Dr. Dodson recommends that patients are divided into 4 different categories when having their wisdom teeth evaluated. symptomatic, disease present (based on history and radiological examination) symptomatic, disease absent (includes teething and vague pain symptoms unrelated to wisdom tooth) asymptomatic, disease present (disease is evident from radiological findings or clinical exam but not patient … Read more