Josh Bernstein, DDS, Cosmetic Dentist

Many of my adult dental patients tell me that they have avoided important dental work because they had painful or scary experiences at the dentist when they were younger. Some people avoid the dentist because they gag easily or have had bad experiences getting numb; others may feel out of control and panic when they're in the dentist's chair.

Fortunately, there is a solution and it is the answer to many a dental patient’s prayers. Like some other dentists in the San Francisco area, I can now provide my patients with a more positive dental experience with sedation dentistry.

Sedation dentists can use a variety of drugs to sedate patients before a dental procedure. Most often, sedation dentists use triazolam, which has proven to be very safe and effective. This medication has a short half-life (the length of time it stays in your system) and will wear off in 2-3 hours being fully metabolized so it does not cause prolonged sedative effects. Because triazolam has an amnesiac effect, patients rarely remember what happened at their appointment—this is especially effective for patients who are afraid of the dentist.

Valium (generic diazepam) also works well when used appropriately. Valium is often given to the patient the night before the procedure as it has a long half life, so it enhances the feeling of sedation the day of the appointment, also.

Ativan (generic lorazepam) is a great sedative to use when triazolam cannot be used. Lorazepam is excellent for lengthy appointments and for use in patients who cannot tolerate triazolam due to their health history.

Vistaril (generic hyrdroxyzine) is an antihistamine that works as a sedative. This drug is used in combination with triazolam or lorazepam to smooth over the sedative process. Hydroxyzine is used with gaggers and patients who have stuffy noses. Also, many smokers have a hard time getting sedated and getting numb for that matter. Hydroxyzine works very well to help smokers get sedated.

Sonata (generic zaleplon) is a short-acting sedative that is used for appointments lasting 1-2 hours. It has rapid onset and a short half-life and is appropriate for patients having their teeth cleaned or other shorter dental appointments.

Before having any dental procedure done:

• See a properly trained sedation dentist
• Provide a complete health history
• Follow your dentist's instructions to the letter
• Make sure you have a ride home if necessary
• Do not drive or operate machinery until the following day
• Do not make important decisions while sedated

With sedation dentistry, people who have feared dentists for years or even decades now really have something to smile about!

For more information about sedation dentistry, please visit my sedation dentistry website

In my last entry, I was talking about how we hated the long new patient exams in dental school, but after all these years we're taking just as much care in the initial visit to help patients understand their condition and their options.

Back in dental school, we also used to complain about only treating a couple patients a day. Is that still worthwhile? When I first got out of school, I bought a very busy practice where we would see dozens of patients a day, typically treating only the very worst tooth for each patient. This is not the way we were taught in school. The dental schools, to their credit, teach comprehensive dentistry--looking at the entire mouth and treating it as a whole.

Unfortunately, what happens when a young dentist joins a private practice is that he/she finds that the practice and the patients allow patient care to be dictated by insurance benefits. The insurance model provides an incentive to dentists who place oversized fillings and do other treatment that is "usual and customary." Sadly, "usual and customary" is not the highest standard of care. To my way of thinking--and to many others who strive for excellence--it is in the patient's best interest to look at the mouth as a whole and make a diagnosis and treatment plan for the very best quality treatment available, without regard to insurance coverage.
Insurance usually pays for very little anyway so why allow the insurance plan to influence treatment planning?

So once again, I have to admit that the dental schools were right in the approach to "Comprehensive Patient Care." And the patients are the ones who benefit most. If a patient has multiple problems, we treat all the problems, not just the worst tooth in the mouth.