WANNA BE SEDATED? Is sedation dentistry the next big thing - or just the next big promotion?

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WANNA BE SEDATED? Is sedation dentistry the next big thing - or just the next big promotion?
January 04, 2008
By LANE LAMBERT
The Patriot Ledger

RANDOLPH - Until a few months ago, Sandra Doucette dreaded going to the dentist.

The 50-year-old Dedham resident had some painful experiences in the chair when she was a teenager. But when a bad case of tooth decay spread to her jawbone, she was forced to go back.

Now the customer-service agent has a healthy mouth, and sheÌs singing the praises of Randoph dentist Dr. Robert Emami and sedation dentistry.

ÎÎIt solved every problem,ÌÌ Doucette said.

Emami is one of a small number of dentists - and one of only a few south of Boston - offering everything from oral tranquilizers to intravenous sedatives in an effort to coax phobic patients like Doucette back into the dental chair.

A few Boston-area dentists have taken to the radio to advertise themselves as sedation specialists. The ads give it the elective aura of cosmetic dentistry. But Emami strongly rejects the notion that sedation is a promotional gimmick.

ÎÎWeÌve told the public they should learn to live with the pain,ÌÌ he said, ÎÎbut we go to doctors for a lot of invasive procedures and we want to be sedated for those. Why should we expect dental patients to tolerate extractions or root canals when theyÌre totally alert?

ÎÎWeÌre telling them itÌs OK to be afraid. We have a way of dealing with that.Ì

Unlike local anesthesia, which deadens the area around the tooth, or nitrous oxide gas, which provides a buoyant, relaxed feeling, sedation creates a drowsy, semi-conscious condition that typically leaves the patient with no clear memory of the procedure.

The American Dental Association approves of sedation if its guidelines are followed. At Tufts UniversityÌs Center for Sedation and Anesthesia, Dr. Morton Rosenberg said sedation ÎÎcan be appropriate for some patientsÌÌ and is safe and effective if properly administered by trained dentists.

Rosenberg, who is also an anesthesiologist at Tufts New England Medical Center, sedates a large number of his phobic dental patients. He estimates that as many as 60 percent of all dentists on occasion use something beyond a shot of local anesthetic to calm a patient - typically a nitrous oxide/oxygen mix or a single oral dose of Valium.

Emami stuck to shots and nitrous oxide until a couple of years ago. The New York City native has been practicing since 1990, after training at Boston UniversityÌs dental school. He said the stories from some of his own patients changed his mind.

ÎÎSome of them hadnÌt had any care in three to 10 years,ÌÌ he said.

Emami took some courses with the Seattle-based Dental Organization for Conscious Sedation (DOCS) and started offering the service in 2005. Since then, heÌs used it with about 100 patients, from retirees in their late 60s and 70s to a 16-year-old girl.

His most recent sedation patient underwent a six-hour surgery of five root canals, with extractions and implants. He does not offer sedation for fillings and other basic visits.

How many Massachusetts dentists offer sedation is not clear. The state society has no statistics, but national numbers suggest that there arenÌt many. Of some 150,000 dentists in the United States, 8,000 have taken DOCS courses.

Emami follows the standard sedation protocol. The patient takes one dose of Valium the night before the procedure, followed by a 0.5 milligram dose of triazolam (marketed as Halcion) an hour before the visit. He often gives added doses of triazolam before the surgery begins. (ÎÎLow and slow,ÌÌ he said.)

The patient must be taken to and from the visit by a friend or family member. Emami monitors every patientÌs pulse, blood pressure and other vital signs, and he keeps the overdose-reversing drug flumazinol on hand in case a patient has an unexpected reaction to the sedative.

ÎÎIÌve never had to use it,ÌÌ Emami said.

He said sedation patients tend to have less post-surgery pain and recover more quickly - partly, perhaps, because they have no memory of the pain.

Doucette scheduled a visit with Emami after she saw a TV show on sedation dentistry. Her daughter and mother have driven her there and home three times.

She had four teeth pulled on the first visit, didnÌt remember any of it, and woke up that night ÎÎwith not one care in the world.ÌÌ

Lane Lambert may be reached at Unlike local anesthesia, which deadens the area around the tooth, or nitrous oxide gas, which provides a buoyant, relaxed feeling, sedation creates a drowsy, semi-conscious condition that typically leaves the patient with no clear memory of the procedure.

The American Dental Association approves of sedation if its guidelines are followed. At Tufts UniversityÌs Center for Sedation and Anesthesia, Dr. Morton Rosenberg said sedation ÎÎcan be appropriate for some patientsÌÌ and is safe and effective if properly administered by trained dentists.

Rosenberg, who is also an anesthesiologist at Tufts New England Medical Center, sedates a large number of his phobic dental patients. He estimates that as many as 60 percent of all dentists on occasion use something beyond a shot of local anesthetic to calm a patient - typically a nitrous oxide/oxygen mix or a single oral dose of Valium.

Emami stuck to shots and nitrous oxide until a couple of years ago. The New York City native has been practicing since 1990, after training at Boston UniversityÌs dental school. He said the stories from some of his own patients changed his mind.

ÎÎSome of them hadnÌt had any care in three to 10 years,ÌÌ he said.

Emami took some courses with the Seattle-based Dental Organization for Conscious Sedation (DOCS) and started offering the service in 2005. Since then, heÌs used it with about 100 patients, from retirees in their late 60s and 70s to a 16-year-old girl.

His most recent sedation patient underwent a six-hour surgery of five root canals, with extractions and implants. He does not offer sedation for fillings and other basic visits.

How many Massachusetts dentists offer sedation is not clear. The state society has no statistics, but national numbers suggest that there arenÌt many. Of some 150,000 dentists in the United States, 8,000 have taken DOCS courses.

Emami follows the standard sedation protocol. The patient takes one dose of Valium the night before the procedure, followed by a 0.5 milligram dose of triazolam (marketed as Halcion) an hour before the visit. He often gives added doses of triazolam before the surgery begins. (ÎÎLow and slow,ÌÌ he said.)

The patient must be taken to and from the visit by a friend or family member. Emami monitors every patientÌs pulse, blood pressure and other vital signs, and he keeps the overdose-reversing drug flumazinol on hand in case a patient has an unexpected reaction to the sedative.

ÎÎIÌve never had to use it,ÌÌ Emami said.

He said sedation patients tend to have less post-surgery pain and recover more quickly - partly, perhaps, because they have no memory of the pain.

Doucette scheduled a visit with Emami after she saw a TV show on sedation dentistry. Her daughter and mother have driven her there and home three times.

She had four teeth pulled on the first visit, didnÌt remember any of it, and woke up that night ÎÎwith not one care in the world.ÌÌ

Lane Lambert may be reached at llambert@ledger.com .

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