2019 Agenda

Milestones and Challenges: The State of Sedation Dentistry in 2019

11th annual Sedation safety week

Twenty years ago, a revolution began in the dental profession.

Like all transformations, this one disrupted the conventional method of doing things: In this instance, caring for fearful and anxious patients.

The argument for change was compelling: Tens of millions of individuals avoided seeing a dentist out of fear or made an appointment only when they could no longer stand the discomfort of their oral pain.

The need for a safe, effective way of helping these patients was unassailable.

Proven science offered a solution that relied on the careful, safe application of oral sedation; thorough medical screening of prospective patients; and specialized training on the customer service aspects of caring for anxious patients.

But the dental profession was hardly ready to adopt the new, safe oral sedation protocols on a large scale. Nor was there a reliable continuing education program where dentists and their team members could acquire the necessary protocols and hands-on training to introduce oral sedation into their practices.

 

Laudable Progress and Incomplete Tasks

Thus, in 1999, DOCS Education was born as a professional educator and membership organization dedicated to the safety and comfort of even the most dental phobic patients.

This year’s 11th Annual Sedation Safety Week (SSW) – Looking Back and Forging Ahead –  coincides with the milestone 20th Anniversary of the founding of DOCS Education, which has hosted SSW since 2009.

As its name clearly states, the sole focus of SSW is safety, and the need for dentists and their team members to always place the well-being of their patients above all other considerations.

Beginning today, and each weekday this week, SSW will showcase the laudable progress that sedation dentistry has made since 1999, as well as some of the tasks that are as yet incomplete.

In its earliest days, the trailblazers who trained with DOCS Educations were in a teeny tiny minority of all general dentists, as were the faculty instructors who had enough clinical experience and formal education to be knowledgeable.

Despite the many naysayers who pooh-poohed the concept of making patients comfortable and alleviating their fears using oral sedatives, there would be no denying the popularity of the protocols with both patients and their oral health caregivers.

 

“At no time in American history have dental patients been in better hands than they are today”
– Dr. Michael D. Silverman

 

Founder and Chairperson, Dr. Michael D. Silverman
Founder and Chairperson, Dr. Michael D. Silverman

Moreover, the ‘end-of-the-world’ forecasts made by some in the dental establishment concerning the safety of patients treated with oral sedation by general dentists, proved baseless.

Flash forward two decades and oral sedation is mainstream, with more than 24,000 practicing dentists now relying on the DOCS Education protocols and training to treat millions of grateful patients annually.

The safety record of oral sedation has been exemplary – with no known incidents of an adult or child ever being harmed by a qualified sedation dentist when the patient was screened, sedated, and monitored following the guidelines set forth by the American Dental Association, as well as all state regulations and standard of care protocols.

 

Safety Education is Never Static

“At no time in American history have dental patients been in better hands than they are today when needing care from a properly trained general dentist who specializes in using oral sedatives to alleviate the anxiety that millions of adults have about dental visits,” observes Dr. Michael D. Silverman, SSW’s founder and national chairperson.

Yet the dental profession can’t afford to rest on its laurels.

For one, the safest protocols for treating patients with oral sedation are never static. As the patient population, in general, becomes more medically complex and ages, and as new pharmaceuticals are introduced annually, the need to update the optimum oral sedation protocols is never-ending.

An excellent example is the alarming epidemic of opioid abuse which has swept the country, and how well-educated sedation dentists are finding non-narcotic painkiller alternatives to protect their patients.

Then there are, to this day, a small – but influential – contingent of self-interested dental specialists who’d like nothing more than to roll back the hands of time to the pre-DOCS Education era when they enjoyed a near monopoly on sedating patients.

 

In multiple states, general dentists who have provided oral sedation to their patients for years – without incident – find themselves on the cusp of losing the right to continue to do so.

 

Given the safety record that general dentists have demonstrated following current oral sedation guidelines and regulations – as well as the millions of patients who insist on receiving oral sedation when seeing their dentists – one might think that these prophets of doom would find no traction for their groundless arguments.

Yet revolutions – even those celebrating 20 years of progress – do not receive universal acceptance from the uprooted establishment.

As such, in multiple states, general dentists who have provided oral sedation to their patients for years – without incident – find themselves on the cusp of losing the right to continue to do so unless they bow to demands that they undertake extensive, expensive – and unnecessary – additional continuing education.

So, once again, for the 11th consecutive year, Sedation Safety Week in 2019 will also serve as a reminder to regulators, politicians, and dental profession leaders that the battle over oral sedation is about more than internecine rivalries.

It is, first and foremost, a fight for patients’ access to care.

For when the ADA or state regulators succumb to the pressures of self-interested dentists and unnecessarily tighten the governance of general dentists who use oral sedation, they are effectively restricting the number of patients who can receive safe, effective dental care. And that is unconscionable.

Whether you are a dentist, team member, or patient, we invite you to join us each day this week as we review the substantial progress we’ve made in safely treating fearful and anxious patients, as well as examine the challenges that remain.

 

Related Reading:

• An Optimistic Forecast for the Dental Profession in 2019
• The Regulatory Storm Clouds Are Headed Your Way
• Get the Science: Where Facts, Not Myths, Have the Final Word
• Upcoming Sedation and Advanced Dentistry Courses – Washington D.C. (May 17-19th)

 

About Sedation Safety Week:

The theme of the 11th Annual Sedation Safety Week (SSW) is “Looking Back and Forging Ahead.” This year’s SSW programs and activities coincide with the milestone 20th Anniversary of the founding of DOCS Education, the world’s leading educator of sedation dentists and the host of the annual safety campaign.

While general dentists have made enormous progress in safely and effectively using oral sedation to comfort their fearful and anxious patients, there remain essential tasks as yet incomplete.

SSW was founded and is chaired by Dr. Michael D. Silverman, a globally recognized educator, author, lecturer, and patients’ rights advocate. Dr. Silverman is also co-founder and president of DOCS Education.

[Editor’s Note: The theme of the 11th Annual Sedation Safety Week (SSW) is “Looking Back and Forging Ahead.”

While general dentists have made enormous progress in safety and the effective use of oral sedation to comfort their fearful and anxious patients, there remain essential tasks as yet incomplete. One of the largest of those responsibilities is the reduction of patient injuries and deaths stemming from abuse of opioids and other narcotic painkillers.]

 

Opioids and Dentistry Are Too Often a Dangerous Pairing: There Are Safer Alternatives

Ken Blanchard, author of the classic The One Minute Manager, was quoted some years back noting, “the gap in our country between ‘knowing’ and ‘doing’ is significantly bigger than the gap between ‘ignorance’ and ‘knowledge.’”

Blanchard’s observation aptly sums up the state of the dental profession today when it comes to prescribing opioids: most dentists understand the risks but are not always committed to taking the necessary steps – including learning about effective alternatives – to maximize the safety of their patients.

There is mounting evidence that, as a group, dentists have contributed to the opioid crisis in America, a problem that the American Dental Association (ADA) labels a “scourge.”

Estimates are that 130 Americans die daily due to opioid overdoses – provided to them from a wide variety of medical and non-medical sources – that include prescriptions initially provided by oral health professionals. The economic cost is staggering – exceeding $500 billion annually, according to The Council of Economic Advisors. And the legal liabilities facing opioid manufacturers and providers, including dentists, according to published reports, may surpass the sum total of all cancer claims against Big Tobacco.

 

The Best of Intentions

Opioid addiction often begins with the best of intentions: Dentists seek to minimize the post-operative pain of their patients.

Moreover, as the ADA acknowledges, when taken as prescribed for short periods of time under the care of a licensed oral health professional, opioids can be a safe and effective pain management tool.

However, too often patients don’t follow their dentists’ usage instructions; they continue taking these narcotic drugs long after the pain has subsided, obtain refills from other providers, and even share their medication with family and friends.

Dentists, too, sometimes exacerbate the problem by renewing prescriptions for painkillers without making certain the drugs are still necessary; and, much earlier in the process, by prescribing the opioids in the first place to patients with a history of addictions, such as alcohol and recreational drugs.

Oral health professionals write 12 percent of all opioid prescriptions, including 45 percent of opioid prescriptions for adolescents — an age group especially vulnerable to addiction, according to UnitedHealthcare, a health benefits provider.

Dr. Ted Wong, UnitedHealthcare’s chief dental officer, estimates roughly 70 percent of the five million patients who have wisdom teeth removed annually are prescribed an opioid by their dentist or oral surgeon.

A July 2018 study in Pediatrics reported that more than 30% of the opioids used by children were prescribed by their dentists.

In August 2018, as Dr. Calista M. Harbaugh and her team at the University of Michigan reported in JAMA, a review of 56,686 patients who had their wisdom teeth extracted between 2009 and 2015, found that 1.3 percent of them went on to “persistent opioid use,” which they defined as two or more prescriptions filled in the next year by any provider for any reason.

 

Dr. Leslie Fang
Dr. Leslie Fang

A Definitive Online Course

Leslie Shu-Tung Fang, MD, PhD, understands the pharmacology and physiology of drugs used in dentistry as well as any expert in the country. Dr. Fang, who is affiliated with Massachusetts General Hospital and Harvard Medical School, wrote the book – literally – on the use of medicine – and potentially harmful interactions and side effects – in dentistry.

His Ultimate Cheat Sheets: A Practical Guide for Dentists (2019 Edition) is a comprehensive chair-side resource that thousands of dentists rely on daily to have up-to-date information at hand when they need to make critical clinical decisions.

Dr. Fang, who is also on the faculty at DOCS Education, which hosts Sedation Safety Week, regularly lectures on the availability of safer alternatives to opioids that dentists can prescribe to their patients.

Since the ADA in 2018 called for mandatory continuing education in prescribing opioids and other controlled substances – with an emphasis on preventing drug overdoses, chemical dependency, and diversion – Dr. Fang has been offering a definitive online 3 CE Class that fully comports with the ADA’s policy.

 

How Opioids Work

Dr. Fang’s core message is simple: Dentists can see to it that a majority of their patients have adequate post-surgical pain relief without the risks associated with opioid use.

In response to the current epidemic of opioid overdoses and deaths, the Drug Enforcement Agency, state regulators, and the ADA have deliberately set the bar high for dentists before they are allowed to prescribe any narcotic, Dr. Fang notes.

Once dentists realize the hoops they are required to jump through to prescribe an opioid legally, Dr. Fang warns those dentists attending his course, “You’re going to take one look at this and say, ‘Wait a second here, you guys are making it painful to prescribe narcotics.’”

That, Dr. Fang adds, is the objective.

“The whole point is to dissuade you from using an excessive – particularly unnecessary – amount of narcotics,” he explains.

The ADA policy supports statutory limits on opioid dosage and duration of no more than seven days for the treatment of acute pain. That position is consistent with the Centers for Disease Control and Prevention evidence-based guidelines.

As the ADA explains at www.mouthhealthy.org:

 

“Opioids work by making your brain feel like your pain is lessening. They also make your body release a hormone called dopamine. Dopamine causes you to feel pleasure, which could lead to addiction.”

 

Opioids include hydrocodone (Vicodin), oxycodone (OxyContin or Percocet), morphine and codeine. These drugs, the ADA notes, are frequently abused and can act as a “gateway drug” into the abuse of other drugs, such as heroin.

Among the most frequently used safe alternatives to opioids are nonsteroidal anti-inflammatories and other non-narcotics, including over-the-counter medicines such as ibuprofen and acetaminophen.

Even those dentists who follow the ADA opioid guidelines and all regulations to a T may face unprecedented financial liabilities from patients and their plaintiffs’ attorney, according to Dennis Kneale, a financial journalist, who wrote on the topic for The Wall Street Journal. Kneale warns that each and every time dentists prescribe opioids for their patients, they may also be writing themselves an invitation to costly litigation.

“When safe and effective alternatives exist, it seems incumbent on all dentists to take the type of course offered by Dr. Fang to learn what they are and how best to use them,” observes Dr. Michael D. Silverman, founder and chair of Sedation Safety Week. “In this case, the adage should be, ‘An ounce of prevention is worth a ton of cure.’”

 

Related Reading:
A COURSE THAT CONFORMS TO THE NEW ADA POLICY ON OPIOIDS
Prescribing Opioids for Wisdom Teeth Extractions May Set Young People on the Path to Long-Term Opioid Use – JAMA
A Recent Study Found That More Than 30% of the Opioids Used by Children Were Prescribed by Dentists
Using Ketamine as an ‘Alternative’ to Opioids Requires More Caution Than Previously Recognized

[Editor’s Note: This year’s annual Sedation Safety Week, our 11th, coincides with the 20th anniversary of DOCS Education, the event’s host and organizer.

Since Day One, the faculty of DOCS Education have focused on safely serving anxious and fearful patients who previously avoided seeing a dentist or only sought care when their oral pain became unbearable. Thanks to sedation dentistry, 20-plus million of these once-reluctant patients have overcome their hesitancy and received safe, pain-free, oral health treatments without incident.]

 

Lesson #1 is Always Safety: How Proper Education Protects Patients

Education and safety go hand-in-hand.

It is the reason that the DOCS Education Proclamation – which  expresses the operating philosophy of the world’s leading educator of sedation dentistry – notes: “We view education as a lifelong pursuit,” adding that “we educate and train dentists so that they can make quality care available to as many people as possible.”

Since its founding in 1999, many DOCS Education members and registrants have returned time and again to our educational conferences to sharpen their clinical skills, far exceeding the continuing education requirements set by their state dental boards.

One of our most popular courses, Master Series - Advanced Sedation, has its own informal “alumni association,” comprised of veteran dentists who re-enroll in the two-day intensive didactic and case-based seminar every few years.

These are experienced sedation dentists who are required to have completed at least 50 sedation cases before attending. Many of them have completed hundreds, even thousands of cases. Yet they share our faculty’s passion for continually refreshing and updating their knowledge and safety protocols.

At the pinnacle of the sedation dentistry community are DOCS Education Fellows and Diplomates – doctors who’ve demonstrated advanced knowledge and skills, and have completed at least 75 hours of continuing sedation education. (To achieve the Diplomate designation, a dentist must participate in no fewer than 200 hours of continuing sedation education.) These sedation “marines” not only excel in their clinical practices but they also author or co-author published articles or sedation case studies for the benefit of other dentists.

To date, 27 dedicated doctors have earned their Fellow [FDOCS] credentials, and six distinguished dentists have attained Diplomate [DDOCS] status.

While no seal of approval alone can guarantee patients that they will safely and effectively be treated by a qualified sedation dentist, thousands of DOCS Education graduates proudly display the DOCS Education logo on their websites and in their offices as an expression of their commitment to safety, knowledge, and public service.

 

“The single common thread that is shared by every class we hold – whether in-person or online – is our faculty’s complete dedication to patient safety and comfort.”
- Dr. Michael D. Silverman

 

Past is Prologue

Since DOCS Education’s founding two decades ago, many things have changed, and some things have not.

What is exactly the same today as it was in 1999 is the organization’s singular commitment to patient safety above all other considerations.

Karl A. Smith, DDS, FDOCS, is recognized by members of the DOCS Education faculty for the attainment of his distinguished Fellow certification.
Karl A. Smith, DDS, FDOCS, is recognized by members of the DOCS Education faculty for the attainment of his distinguished Fellow certification.

What has changed are the ever-growing number of patients – by the millions – who look to general dentists who’ve received supplemental training in sedation to help them erase the fear and anxiety that previously vexed them just thinking about oral health care.

What has also changed is the number and variety of options available to general dentists to safely and effectively serve their dental phobic patients.

DOCS Education’s renowned Sedation and Advanced Dentistry conferences – such as the upcoming seminar scheduled for Washington D.C., May 17-19th – now offer a variety of courses, including Adult Oral Dentistry, Single-dose Sedation and Nitrous Oxide, Innovative Digital Dentistry and Implantology, and Advanced Cardiac Life Support (ACLS) Certification.

Additionally, dentists have the opportunity to take in-person classes in Pediatric Sedation Dentistry and a popular hybrid course – home study combined with hands-on live patient lessons – for IV Sedation Certification.

Online, working at their own pace from the comfort of their offices or homes, dentists can now complete an extensive buffet of CE classes, including:

Drugs that All Dentists Need to Learn to Use & Optimizing Use of Analgesics to Avoid Excessive Reliance on Opioids
Update in Coronary Artery Disease and Its Impact on Dentistry & Congestive Heart Failure: The Number 1 Heart Disease and The Dental Implications
Keep your Numbers Straight to Avoid Problems: Forensic Dentistry and the Standard of Care
Coumadin and NOACs: The Rapid Emergence of the New Oral Anticoagulants

[A complete listing and schedule of all DOCS Education courses is available here.]

“The single common thread that is shared by every class we hold – whether in-person or online – is our faculty’s complete dedication to patient safety and comfort,” explains Dr. Michael D. Silverman, president of DOCS Education, and founder of Sedation Safety Week. “The doctors who participate in our courses know that we take no shortcuts when it comes to assuring the safety of their patients.”

Since September 2000, DOCS Education has been an AGD PACE-approved education provider. All of its featured courses offer CE credits that help fulfill state regulatory requirements in addition to any specialized training that is necessary to obtain or renew state-by-state sedation permits. (Dentist should always check their state dental board regulations to verify the latest requirements.)

 

Related Reading:

Tracing Today’s Enormous Advances in Sedation Dental Care Back to the Founding of DOCS Education 20 Years Ago
20th Anniversary DOCS Education Member Spotlight
An Optimistic Forecast for the Dental Profession in 2019
A 'Best-in-the-Nation Sedation Dentist' – William Nudera, DDS, MS
A ‘Best-in-the-Nation Sedation Dentist’ - Dr. Keerti Sahasrabudhe
A ‘Best-in-the-Nation Sedation Dentist’ - David Kurtzman, DDS

Advances in Technology Are Making Sedation Dentistry Even Safer

[Editor’s Note: The theme of our 11th Annual Sedation Safety Week is “Looking Back and Forging Ahead.” This year’s campaign coincides with the milestone 20th Anniversary of the founding of DOCS Education, the world’s leading educator of sedation dentists. DOCS Education serves as the host of SSW.

The strides that sedation dentistry has made over the past two decades are particularly impressive when it comes to the advances in technology that have resulted in significant improvements in patient safety and comfort, as today’s SSW essay details.]

 

A great deal of attention has been paid to how digital dentistry can make dental practices more efficient and less stressful for dentists and their team members.

Importantly, however, advances in technology – especially the transition from analog devices to digital ones – are also improving the safety of dental patients throughout diagnosis, assessment, and treatment.

“Dentists and their team members remain the most important link in guaranteeing the comfort and safety of their patients,” says Dr. Michael D. Silverman, founder and chairperson of Sedation Safety Week. “But the modern digital dental office – when combined with proper training in its various applications – is helping to make sedation dentistry safer than ever.”

Although they are ubiquitous in sedation dentistry practices nowadays, even the use of pulse oximeters was not considered the standard of care back in 1999 when DOCS Education, host of Sedation Safety Week (SSW), formed in order to train general dentists on the safest oral sedation protocols.

Standard of Care Expert Dr. John W. Dovgan
Standard of Care Expert Dr. John W. Dovgan

Dr. John W. Dovgan, a practicing dentist and a 1303 permit examiner for the State of Arizona, is widely considered the nation’s foremost standard-of-care investigator. “Yes, the standard of care has changed since DOCS Education was founded,” he confirms. “Today, basically, you’d be considered negligent if you sedated a patient for minimal sedation and did not use pulse oximetry,” he said in a recent interview.

Another standard of care device that American Dental Association guidelines now mandate and many states have adopted for oral sedation is capnography, which provides an instant display of a patient’s respiration – possibly the most important vital sign to monitor during a sedation procedure.

 

Identifying Pathology Sooner

On the digital front, Dr. Dovgan notes, “Digital x-rays and dental cone beam computed tomography (CBCT) have advanced dentistry greatly by being able to identify pathology such as oral cancer much sooner.”

In 2018, The American College of Prosthodontists (ACP) introduced a new curriculum designed to prepare dental students and specialty residents to use advanced digital technology in patient care. In a digital practice, ACP noted, “patients will benefit from the improved communication, comfort, and quality of health care….”

One rapidly emerging area of general dentistry where digital technology is having a significant impact on patient safety and comfort is implantology.

C. Ray Coleman, DDS, is an old school dentist who is trailblazing a path that will allow other general dentists like him to embrace digital dentistry and reap the many benefits. Dr. Coleman, in practice in Salt Lake City since 1989, instructs the two-day Innovative Digital Dentistry and Implantology course for DOCS Education.

Dr. Coleman teaches general dentists how to bring in-house the accurate and quality manufacture of fully guided surgical guides. Doing so is one of several digital advances that allow dentists to avoid the wait and expense of outsourcing common processes to third-party laboratories.

Dr. C. Ray Coleman demonstrates a 3D printer at a recent DOCS Education conference.
Dr. C. Ray Coleman demonstrates a 3D printer at a recent DOCS Education conference.

Dr. C. Ray Coleman demonstrates a 3D printer at a recent DOCS Education conference.

In the case of fully guided surgical guides, as Dr. Coleman explains, keeping the manufacturing process in-house reduces the risk of morbidity from implant placement. With digital technology, dentists can place implants with unparalleled precision. Moreover, digital scanning allows dentists to identify and fix problems immediately. A good example is when the dentist can’t read a margin, he or she can adjust it instantly, rescan it, and have exactly what is required.

The stress-relief that dentists experience once they learn the uses and protocols of digital implants cannot be overstated. A stressed dentist – and many dentists feel the pressure of trying to place implants without the help of fully guided surgical guides – is a dentist who is more prone to errors.

Likewise, patients who are relaxed in the dental chair – a primary goal of sedation dentistry – engender less stress for the dental team.

As Dr. Coleman notes, “patients love their digital dental implant experience, which is far more comfortable for them and takes considerably less time to complete – typically three days.” Very few patients, if any, object to having their dentist use a digital scanner rather than taking old-fashioned impressions using putty.

 

A digital x-ray taken by a Genoray America imaging unit.
A digital x-ray taken by a Genoray America imaging unit.

Digital More Than Pays for Itself

As the technology that drives digital dentistry has advanced, the cost of equipment and classroom training has moderated. Dentists who once dismissed the notion of converting their practices to all-digital due to price are now discovering the transition frequently more than pays for itself in the first few months.

Moreover, providers of digital dentistry equipment – such as Genoray America – are making impressive “next-generation” dental imaging equipment available now, with innovations that include safety, accuracy, ease-of-operation, multi-functionality, and even portability.

Genoray, an 18-year-old company, made its debut as an exhibitor at the recent DOCS Education Sedation and Advanced Dentistry Conference held in San Diego. Attendees reported that they were particularly impressed by the company’s Papaya 3D’s small free-standing footprint, huge 14cm x 14cm field, separate sensors for the 3D and panoramic imaging functions, and a user-friendly fast mode that reduces scanning times to as rapid as 7.7 seconds.

“The general dentists of today are successfully expanding their repertoire of skills, providing in-office treatments that they lacked the confidence to perform just a few years ago,” notes Dr. Silverman, the SSW chairperson who is also president of DOCS Education.

“Advances in dentistry, especially sedation care, mean that fewer and fewer people avoid us altogether out of fear. Moreover, thanks to superior continuing education courses and advances in digital dentistry, we can do more for patients, in fewer visits, and with greater comfort, than ever before,” Dr. Silverman adds.

 

The Future of Dentistry is Digital

The American College of Prosthodontists, which is committed to accelerating the adoption of digital dentistry through education, has designed a curriculum that encompasses all four years of predoctoral and advanced education in prosthodontics.

“In 2017, the curriculum was piloted at five dental schools, with all reporting positive outcomes and ease of integration with existing programs of study,” ACP announced in a May 2018 news release.

Indeed, with an estimated 6,000 new dentists entering practice each year, the future of dentistry is undoubtedly a digital one. That’s good news for the overall safety and comfort of dental patients.

 

Related Reading:
7-Step Sedation Dentistry Safety Checklist: A Review of Protocols, Equipment, and Supplies
Capnography in Sedation Dentistry and Why It Matters
Capnography May Prevent Dangerous Events When Using Moderate Sedation
Tracing Today’s Enormous Advances in Sedation Dental Care Back to the Founding of DOCS Education 20 Year Ago
For information on ordering Genoray equipment and supplies, click here. (Note: DOCS Education members may be eligible for special savings. Contact a member of the client loyalty team at 855-227-6505.)

Continuing Education: 
Upcoming Sedation and Advanced Dentistry Courses – Washington D.C. (May 17-19th)
To register for Dr. C. Ray Coleman’s next Innovative Digital Dentistry and Implantology course – to be held in Washington, D.C. May 17-18th, click here.
The Who, What and How of Legal Trouble: Forensic Dentistry and the Standard of Care – an online course taught by John Dovgan, DDS, a Standard of Care Investigator.

Meet the 2019 ‘Safe Sedation Dentist of the Year’ and Discover How He Utilizes IV Sedation to Maximize Patient Comfort and Safety

Michael A. Knight, DDS, shares an anecdote arising from his participation two years ago in the popular DOCS Education IV Recertification course taught by Dr. Anthony S. Feck and his colleagues.

At the beginning of the class, Dr. Feck polled the dentists in the room about how often they perform dental surgery using IV sedation. One doctor replied, “once a month.” A second dentist estimated he did four or five surgeries a month using IV sedation.

A third doctor proudly told Dr. Feck that he handles 15 or more IV sedation cases each month.

Dr. Feck then turned to Dr. Knight, a rural Georgia dentist whose hometown has fewer than 6,000 residents, and asked him about his IV sedation caseload.

“Well, I average between 15 and 20 IV sedation cases a week,” Dr. Knight informed him in his rich Southern drawl.

“How many?” Dr. Feck asked,the puzzled look on his face signaling that Dr. Feck thought he misheard Dr. Knight.

“Fifteen to twenty a week,” Dr. Knight repeated.

In fact, Dr. Knight has maintained that amazing caseload – roughly 1,000 IV sedation surgeries annually – for years, drawing patients from many miles away to his central Georgia offices.

Dr. Michael A. Knight, Safe Sedation Dentist of the Year.
Dr. Michael A. Knight, Safe Sedation Dentist of the Year.

And over the past 12 months, how many patients did Dr. Knight treat using IV sedation who also required him to administer a reversal agent?

“Zero,” Dr. Knight says. “Zero.”

It is a safety record like that led the jurors who administer the annual Sedation Safety Week to designate Dr. Knight the 11th Annual ‘Safe Sedation Dentist of the Year’ honoree.

“The world of general dentistry is rapidly changing, with IV sedation increasingly becoming an indispensable skill in our arsenal of tools to safely and effectively treat fearful and anxious patients”, notes Dr. Michael D. Silverman, president of DOCS Education and national chairperson of Sedation Safety Week (SSW).

 

Father-and-Son Duo

Dr. Knight owns two practices in rural Georgia, in LaGrange and Fitzgerald, and is preparing to open a third one in Eastman, where he lives and formerly served patients for 24 years. Each office is operated under Dr. Knight’s American Dental of Georgia umbrella, a dental support organization that he launched.

[Click here to view a video of Dr. Knight and some of his patients discussing IV sedation, as well as read details about DOCS Education’s unique IV Sedation Certification course].

Dr. Knight, 57, shares duties with his son Mike, 27, a recent graduate of The Dental College of Georgia at Augusta University, as well as their dentist associates.

The father-and-son duo work with two highly skilled nurses and a surgical assistant. Each of them is dedicated first and foremost to the safety and comfort of their patients.

“The world of general dentistry is rapidly changing, with IV sedation increasingly becoming an indispensable skill in our arsenal of tools to safely and effectively treat fearful and anxious patients.”
- Dr. Michael D. Silverman, president of DOCS Education and national chairperson of Sedation Safety Week (SSW)

 

Dr. Knight is absolute that no other continuing education training has meant as much to his success – and the success and satisfaction of his patients – as his IV sedation education. It is because his offices provide caring, safe, and effective sedation dentistry that so many patients are drawn to his practices, he says.

“100%, no doubt about it,” Dr. Knight says, when asked if he believes other general dentists who already offer minimal and moderate oral sedation would be wise to get the IV sedation permit. “It will make them a better, safer, more confident dentist.”

 

Rigid Safety Protocols

Dr. Knight and his American Dental of Georgia colleagues are rigid in adhering to three specific protocols to ensure the safety of their patients.

  1. Before any treatment, they do an extensive medical check, often including consultations with the patient’s physician.
  2. When sedating a patient, they always begin with a test dose – a minimal amount to alert them to any possible adverse reaction before fully dosing the patient.
  3. They titrate the patient to effect, meaning that they don’t determine a set amount of sedation based on standard tables – such as the patient’s age and weight. Rather, they customize the dosage for each patient, depending upon how he or she responds to the sedation.

Of course, Dr. Knight also adheres to DOCS Education’s long-standing safety tenet of knowing who not to treat in the first place. Some patients, due to their health conditions or behavior issues, should not be cared for in an outpatient setting.

‘Life’s short, make the most of it, you’re going to make mistakes. Well, pick yourself up, dust yourself off, and move forward.’
- Dr. Michael A. Knight

 

In fact, earlier this month Dr. Knight heard back from one such patient who he declined to treat, referring her instead to a cardiologist after he detected some irregularities in her heart rhythm. The patient, whose life Dr. Knight may well have saved, called him to express her appreciation after learning she’ll need one or more stents to treat her clogged arteries.

 

Teaching Dentistry and Bailing Hay

When he’s not tending to his own patients, Dr. Knight serves as an adjunct professor at Augusta University’s school of dentistry.

Back when he was graduating college, Dr. Knight recalls that he was accepted to both medical and dental school. The choice of which career to pursue was a difficult one.

In the end, the deciding factor was the lifestyle that each profession afforded. While Dr. Knight was not yet married, he wanted a family and observed that while the local dentists in his small town were visible in the community – seen at church, having meals out with their families, and participating in recreational activities – the local physicians were mostly absent, working all the time.

So he opted for dentistry and has never regretted the decision. Indeed, Dr. Knight and his wife, Dawn, enjoy a close relationship with their three children and large extended family.The Knights like to travel and go to the beach, and Dr. Knight and his two sons, Mike and Thomas, enjoy working their family-owned farm; even bailing their own hay.

“I do believe in family values, and the Lord’s been good to me,” Dr. Knight says. “I’m one of these people who believe, ‘Life’s short, make the most of it, you’re going to make mistakes. Well, pick yourself up, dust yourself off, and move forward.’”

 

(Editor’s Note: In addition to naming an annual Safe Sedation Dentist of the Year, the faculty and staff at DOCS Education spotlight outstanding sedation dentists throughout the year for their service and excellence. Our ‘Best in the Nation Sedation Dentist’ honors are conferred on fewer than 1-in-every-200 of our course alumni.

Recent ‘Best-in-the-Nation Sedation Dentists’ include:

William Nudera, DDS, MS
Keerti Sahasrabudhe, DDS, MDS
David Potts, DDS
David Kurtzman, DDS

If you know of a DOCS Education alumnus who merits inclusion in our awards program, please email us at Nominations@DOCSEducation.com. In 100 words or less, tell us why this dentist is among the elite of the elite. Please be sure to include your name and contact information, should we have any questions.
(By the way, feel free to nominate yourself. Who knows better than you what an outstanding job you're doing?)

 

Related Reading:
The ‘Forever Permit®’ for Your Dental Practice
The Future of Sedation Dentistry: A Dynamic Interview with Industry Pioneer, Dr. Michael Silverman
 

Continuing Education:
IV Sedation Certification: Combining The Best of Both Worlds: Moderate Parenteral and Enteral Sedation
IV Sedation Recertification: Proven, Safe, and Effective
In-Office IV Sedation Refresher Training: Gold Standard IV Training – Right Where You Practice
 

Other Opportunities:

  • Join with thousands of other dentists at the forefront of the profession by becoming a member of the DOCS Education community. Members receive numerous privileges, including on-call coaching, patient referrals, legal & regulatory advice, and peer recognition. To learn more, click here, or phone our Customer Loyalty Manager, Lindsay Olsen, at 206-812-7712.
  • Get your free subscription to Incisor, the biweekly e-newsletter providing cutting-edge dental news and features. Incisor is a living encyclopedia of relevant, timely, and actionable information for all oral health professionals, produced by a team of award-winning journalists. To start your subscription, click here.
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