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

Can Providing Audiovisual Information Help Relieve Anxiety in Patients Having Wisdom Teeth Removed?

An interesting article titled “Effect of Audiovisual Treatment Information on Relieving Anxiety in Patients Undergoing Impacted Mandibular Third Molar Removal” written by Sung-Hwan Choi and et al. appears in the 2015 Journal and Oral and Maxilofacial Sugery (vol. 73, pp. 2087-2092). The authors set out to explore if providing patients undergoing wisdom teeth removal an audiovisual slide presentation that provided treatment information could improve patient knowledge of postoperative complications and decrease anxiety. It is well known that patients having wisdom teeth surgery can have anxiety due to the needles and drills involved. Studies have shown that a lack of information about surgery and complications can lead to increased anxiety. Typically a written informed consent document is provided to patients prior to surgery. However, it is not clear how well patients can understand this information. The authors of the article designed a study to provide treatment information using an … Read more

Shared decision making in cases of conflicted evidence

An interesting article titled “When clinical evidence is conflicted, who decides how to proceed? An opportunity for shared decision making,” appears in the October 2015 issue of JADA (vol. 146 issue 10, pp. 713-714) and written by Arthur H. Friedlander and et al. The article discusses the concept of shared decision making “…particularly necessary in dentistry at this juncture, given recommendations but inconclusive data available to support abandoning the provision of prophylactic antibiotics to patients with total joint prostheses.” I have previously talked about shared medical decision making in the blog post The Well Informed Patient http://blog.teethremoval.com/the-well-informed-patient/. The article talks about how historically patients were expected to consent to the recommendations of their doctors without much discussion. However, since this is not enough to be legally and ethically correct shared decision making can be used which is a “…collaborative process encouraging patients … Read more

Attending to the Patient in the Informed Consent Process

An interesting article titled “Personalized Disclosure by Information-on-Demand: Attending to Patients’ Needs in the Informed Consent Process” written by Gil Siegal, Richard J. Bonnie, and Paul S. Appelbaum appears in the Summer 2012 issue of the The Journal of Law, Medicine & Ethics (vol. 40, issue 2, pages 359-367). A discussion is made of the current informed consent process and how it is the foundation of medical ethics and health law. Now is clear from the complications page of my website http://www.teethremoval.com/complications.html, I have numerous problems with the informed consent process. In the article the authors state “The underlying ethical principle on which informed consent rests — autonomy — embodies the idea that as rational moral agents, patients should be in command of decisions that relate to their bodies and lives. The corollary obligation of physicians — to respect and facilitate … Read more

Patient Consultations for Wisdom Teeth Removal

In my last post on the Well Informed Patient I discuss how Dr. Thomas B. Dodson talks about “…a new brand of well-informed patient.” In that post I attempted to make that case that many patients are not being well informed at all when it comes to wisdom teeth extractions and is partially due to the current model of informed consent in the U.S but also failure to provide their patients with current scientific evidence and information. In this post I will look specifically at 2 examples of patients who have in the past few years visited oral surgeons to discuss the possibility of having wisdom teeth removed and/or had wisdom teeth removed. From their writing one can make the case that they may have benefited from being better informed and aware of the fact that no current evidence supports … Read more