Sedation Dentistry and Sleep Dentistry For The Fearful, Phobic & Special Needs Patient: The Blende Dental Group

By Dr. David M. Blende

If your son had an abscess, yellow pus, inflamed tissue, or live bacteria on his face, would you take him to the doctor right away? Of course you would! But often, when the same condition occurs inside a person’s mouth, where it is not so easily seen, it goes untreated for years and years. Routinely, other conditions that have “silent” symptoms are treated—conditions like high blood pressure, diabetes, high cholesterol, and cancers. However, dental conditions often go ignored. It is unfortunate that oral health is frequently overlooked by patients and physicians alike, because oral health is not just a cosmetic or a grooming issue. Rather, oral health is linked to total body health.

We all know that meeting the needs of a loved one with a disability or complex medical condition presents challenges everyday, and it becomes very easy for a parent or caregiver to allow concerns such as dental health to fall by the wayside in the face of other priorities. But healthy teeth and gums are necessary for overall health. And people with special needs are especially predisposed to rampant tooth decay and aggressive gum disease, often as a result of their medical conditions or prescribed medications. Not only can a person’s ability to chew, eat, and smile be affected, but infections can also seed to other parts of the body, jeopardizing the person’s overall medical health. Problems that go unchecked can result in costly future treatments.

For these reasons, taking care of the teeth and gums should be as important to every person’s daily routine as taking medications or exercising. And since dental diseases will not go away on their own, professional care from a dentist is necessary for maintaining oral health. Seeking the right dentist is important, as very few dentists treat those with special needs. To further complicate the lack of available care, many patients with severe medical conditions, dementia, or other disabilities are offered only tooth removal and dentures as a method for remedying oral problems, rather than the more functional and cosmetically appealing dental solutions more readily available to the general public.

The leading dental diseases are dental caries (decay) and periodontal (gum) diseases. They are so common that they affect nearly everyone at some point in life.

Tooth decay (sometimes called cavities) is actually a transmissible, chronic, infectious disease. Bacteria live in every person’s mouth and feed on the same carbohydrates we do (sugars and starches such as milk, soda, candy, and even sticky fruits). The bacteria produce acids that destroy tooth enamel, resulting in tooth decay.

Gum (Periodontal) disease is a transmissible, bacterial infection that destroys the attachment fibers and supporting bone that hold the teeth in the mouth. It begins as gingivitis, an inflammation of the gums around the teeth. Left untreated, gingivitis becomes periodontitis, which involves progressive loss of the bone around the teeth, which may lead to loss of teeth.

Children are at risk for tooth decay, which is the single most common chronic childhood disease (five times more common than asthma and seven times more common than hay fever).* It can affect children’s growth, lead to malocclusion (a misalignment of the teeth or upper and lower jaw), and result in significant pain and potentially life-threatening infection. Adults are especially vulnerable to gum disease. Chronic diseases such as temporomandibular disorders, Sjögren’s syndrome, diabetes, and osteoporosis further compromise oral health.* Older adults are at risk because dental problems continue to worsen with age and include recession of the gums away from the teeth, severe gum disease, tooth-root decay, decay around old dental fillings/crowns, oral cancers, and tooth loss.

Medications can exacerbate oral problems. Dry mouth (xerostomia) is the condition of not having enough saliva to wash away food and neutralize plaque. In addition to causing such problems as a sore throat, hoarseness, or difficulty swallowing and speaking, dry mouth can lead to rampant tooth decay, periodontal disease, oral infections, and pain. There are more than 400 commonly prescribed medications that cause dry mouth, including antihistamines, diuretics, pain killers, NSAIDS, high blood pressure medications, and antidepressants.

What if Dental Diseases Go Untreated?

If dental diseases go untreated, a person’s medical health is at risk. The U.S. Surgeon General refers to the mouth as a “window to your overall health.”* This is because an examination of oral tissues can detect signs of nutritional deficiencies as well as many systemic diseases, including general infections, immune disorders, injuries, and some cancers. Sometimes oral manifestations may be the first sign of a disease and may serve as a prompt for further assessment and diagnosis.

The mouth is also a route for infections to travel to other parts of the body. There are over 49 types of bacteria commonly found in dental plaque. These bacteria typically do not enter your bloodstream when your gums are healthy. However, gum disease may allow bacteria to enter your bloodstream, where they can travel to the heart, lungs, kidneys, and other parts of the body, affecting general health.

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The Blende Dental Group offers Sedation Dentistry and Sleep Dentistry for fearful, phobic and special needs patients. You can download a free copy of the Consumer’s Guide To Sedation & Sleep Dentistr at www.drblende.com.

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Finding the right sedation dentist for a special needs patient is always a daunting task. It’s made even more daunting these days by the number of practitioners who claim expertise in sedation dentistry, an emerging mode of dental treatment that can be very beneficial for medically compromised and disabled patients.

You’ve undoubtedly heard radio advertisements or seen other promotions that promise that a patient can, with the help of a “simple pill,” sleep through his or her treatment. But these promises can be misleading, says Dr. David Blende of San Francisco, one of the nation’s foremost special needs dentists and an expert who has offered patients a full spectrum of sedation for more than 20 years. “Indeed, the use of the term ‘sleep dentistry’ is illegal in some states.”

Sedation dentistry can unburden and transform the lives of special needs patients by restoring smiles and making the acts of chewing and eating pleasurable again. Special needs dentists also embrace the use of sedation because it has meant they can readily avoid and abandon the use of physical restraints and restore dignity to all their patients, even those most intolerant of treatment. After having complex work done by a sedation dentist, patients can often return to their local family dentists for routine dental appointments.

Yet, Dr. Blende recommends that before you arrange treatment for your mother with Alzheimer’s or your daughter with Down syndrome, arm yourself with the basic facts about sedation dentistry and plan to interview a prospective dentist with the questions listed below.

Sedation Dentistry & Special Needs

The emerging use of sedation in dentistry will change the way many of us think about the dreaded dental chair. While dentists have long used Novocaine to numb nerves and prevent pain, dentistry has lagged behind medicine in its use of sedation, or relaxants, to help patients endure uncomfortable and nerve-wracking procedures. Today, many dentists can prescribe a “simple pill,” usually Valium or Halcion, for patients who want to be relaxed and less cognizant of dental work during their appointments. Together with nitrous oxide or “laughing gas,” these are often the only sedatives so-called sedation experts offer.

For those of us who get nervous about dental appointments, mild relaxant medications make routine check-ups and dental work much less bothersome. However, it’s important to note that mild sedatives such as Valium or Halcion, when properly dosed, do not induce sleep. Patients who need to sleep through treatment—people who are profoundly afraid of dental treatment, who are medically compromised or developmentally disabled, or who need extensive dental work done—will not be not well served by these limited sedation options.

Only a select few dentists nationwide, including the Blende Dental Group and a number of university-based hospital dentistry programs, offer the full spectrum of sedation—which includes sleep-inducers such as intravenous and general anesthesia.

Fortunately, these select practitioners know each other well and readily refer patients to each other, depending on a patient’s location and mobility. In Dr. Blende’s case, he and a team of specialists including endodontists (root canal specialists), periodontists (gum disease specialists) and anesthesiologists (pain relief specialists), routinely perform full-mouth rehabilitation under general anesthesia in a hospital setting. Together with his dentist, a patient in a sedation practice can choose the form of sedation that best suits his case and is not limited to a pill or laughing gas.

In part 2 of this article will review the critical questions to ask before you select a sedation or sedation dentist.