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olores Mattox's teeth had gotten so bad, she was considering having them all pulled.
The 57-year-old Stafford County resident was so afraid of the dentist that she'd let her teeth completely deteriorate. She thought the easiest way to deal with it might be to have all of her teeth removed and get dentures.
But Mattox discovered a growing trend in dentistry--conscious sedation--before she hit the dentist chair. And now she has a mouthful of shining white teeth to show for it.
Awake but relaxedTo put patients in a state of conscious sedation, dentists administer incremental doses of benzodiazepines. The drugs put patients in a sleeplike state while actually keeping them awake.
The patients' heart rates and blood pressure are monitored throughout the procedure.
While they're sedated, patients are extremely relaxed and unaware of the pain associated with the dental procedure. But they aren't knocked out as with general anesthesia. Though they likely won't remember doing it, they are able to respond to the dentist and answer questions.
Mattox said that before she discovered conscious sedation, she hadn't been to a dentist in 15 to 20 years and had had her teeth cleaned only twice. She said she has been scared of the dentist since she was a child.
"I think it started with the first time I got a tooth pulled," she said. That was when she was 10 years old.
It was a bad toothache about a year ago that caused her to make an appointment with Dr. Michael Schulte of Stafford Dental Cosmetic Center.
Mattox said she was petrified to have any work done.
"I told them, I said, 'I can't do this, I am too afraid to do this, I can't do it,' and they told me about the sedation dentistry," Mattox said.
After learning how it works, Mattox decided to use the method to go through with her wish for a complete dental makeover, instead of having all her teeth pulled and replaced with dentures.
She ended up seeing Schulte more than 10 times for visits lasting up to six hours.
Mattox spent about $23,000 for her dental work, including getting multiple veneers, having three teeth pulled and having a bridge and partial denture put in.
A two-way streetEven though the sedation is meant to help the patient, Schulte said he enjoys working on patients who are consciously sedated.
Schulte tries to set Fridays aside for sedation cases and he generally sees fewer patients for lengthier procedures on those days.
"It's less stressful dentistry," he said. "Because instead of running from chair to chair seeing 20 or 30 patients a day, you are working with one, and it's almost like a doll because the patient's relaxed and you're relaxed and there's no rushing."
Schulte said he gives patients with extreme anxiety a dose of Valium to take the night before their procedure so they can get a good night's sleep.
They then take a dose of a sedative before their appointment.
Patients must be escorted to and from the dentist's office because it is not safe to drive while sedated.
During the procedure, Schulte said, he asks patients if they're comfortable and will give them additional doses of sedatives if they are experiencing discomfort.
The medicine is crushed and put under the patient's tongue, not given intravenously.
In case of an emergency, Schulte said a shot of flumazenil can bring a patient to full consciousness in seven seconds.
Getting educatedMany different drugs for conscious sedation are available. The type of medication a patient is given depends on the length of the planned procedure.
Schulte received training on how administer the drugs during a training course in Orlando run by the Pennsylvania-based Dental Organization for Conscious Sedation, or DOCS.
Dr. Anthony Feck, who is dean of the faculty and one of the founders of DOCS, said interest in conscious sedation is growing tremendously.
Feck said the tools for conscious sedation have been around for some time, but that they weren't widely used.
"What DOCS did was it basically organized systems that were in place in such a way that they could be taught to dentists en masse," he said.
DOCS offers a basic three-day training for dentists who want to use conscious sedation in their practices, as well as more advanced courses.
"It's not a hard thing for a dentist to learn over a course of three days to implement this in their practice," Feck said.
The 22.5-hour training teaches dentists about all aspects of sedation including pharmacology, psychology and emergency situations.
Participants must score at least 75 percent on the final test to pass the course.
The basic course meets the Virginia Board of Dentistry's requirements to practice conscious sedation in the state. Each state has its own requirements, many of which are based on recommendations by the American Dental Association.
The Virginia requirement includes 18 hours of instruction and seeing at least 20 conscious sedation experiences. Videotaped procedures on patients who were sedated are used to satisfy that aspect at DOCS.
Feck said DOCS already has trained more than 10,000 dentists and about 200 to 400 sign up for classes every month. Some, like Schulte, already practice conscious sedation before taking a DOCS course. The classes help dentists hone their skills, and keep up with state requirements.
The cost of being consciously sedated ranges from a couple of hundred dollars to about $1,000, Feck said.
Schulte said his office charges about $670 for the practice, regardless of the length of the procedure. Insurance usually doesn't cover the cost.
Conscious sedation is useful for many patients, but Feck said no one with a medical condition should undergo sedation.
Dentists are supposed to take detailed medical histories of their patients before giving conscious sedation their approval.
A growing practiceAlthough it is often used on patients who are scared of the dentist, conscious sedation is a viable option for many people.
Kelley Wallace, 38, of North Stafford, used conscious sedation to have extensive cosmetic dental work done.
Wallace wasn't afraid of the dentist, as Mattox was, but she said she was apprehensive about having the work done.
She said the sedation medication helped her relax so she could achieve the straight, white smile she'd always wanted.
"The first time through it I was very apprehensive because I didn't know what to expect," Wallace said. "I was not afraid of pain, but I didn't know, am I going to be telling all the family secrets?"
Like many conscious sedation patients, Wallace said she remembers very little about the procedures.
"I really couldn't account for that time," she said. "I saw the effects of it, but I really couldn't remember any of the pain or what it took to really get there."
Once a patient decides to use conscious sedation, the results of the dental work can be drastic.
Mattox said the sedation changed her life.
"I never ever thought that I would have the smile I have today," Mattox said. "It just means so much to me."
For more information, or to find a dentist who practices conscious sedation, see sedationcare.com.
To reach JESSICA SCHONBERG:
Email: jschonberg@freelancestar.com
| The first time through it I was very apprehensive because I didn't know what to expect. I was not afraid of pain, but I didn't know, am I going to be telling all the family secrets? |
