One of my best friends is what I would call a “big case dentist.” He denies it when I tell him this, but it’s true. At least compared to me and most of the dentists I talk to…he does a lot of big cases.
He chides me with the “you can’t do big cases without presenting big cases…” Totally true. And totally for another piece.
He’s gotten a ton of advanced CE in implants, treatment planning, case presentation and sedation. He markets for all of these things, but a large part of his practice is sedation. He’s certified to do oral and IV sedation himself, but typically he uses a nurse anesthetist to sedate patients. Either way, he does multiple big cases with sedation in his practice each week.
I’m not trained to do this kind of stuff. For multiple reasons, I haven’t explored sedation in my practice. I can see the draw to be sure. Patients who have held off doing treatment because of fear often need a lot of work. A dentist that can a) deliver the complex treatment necessary and b) medically handle the patient’s anxiety is doing the patient a great service and it can be financially rewarding for the dental office as well.
I talk with this dentist almost every day. He’s a great friend of mine. The view from here is interesting. Yes, he does a lot of complex care and “big cases.” Yes, his practice is doing really well financially. No arguments there. But here’s the downside that I see. He has a much higher percentage of crazy in his dental life. What exactly do I mean?
- highly fearful/sensitive: Who needs sedation? It used to be only people going to the oral surgeon, right? Now it’s become more mainstream for people to seek out sedation for restorative dentistry. If you ever talk to a veterinarian you’ll realize that there is no surgery that they will do without general anesthesia. Sometimes I think to myself (as I’m retracting a tongue the size of Indiana) “why don’t we sedate EVERYONE?” That’s a distraction, though. People who seek out sedation are those that have decided or realized that they cannot or will not have their dental needs met without it. When you realize that most people don’t choose sedation, the ones that are “must haves” stand out a bit more. These are people that are highly fearful and highly sensitive. It’s unreasonable to believe that they are only this way around dentists. They are probably more high maintenance in other parts of their lives as well.
- bad dental experiences: It goes without saying that many folks seeking out sedation for their dental care have had bad dental experiences with dentistry in the past. The expectations of these patients need to be managed. It’s kind of difficult to deliver dentistry with absolutely no discomfort. As a profession, we’re pretty good at making the discomfort minimal. Absolutely no discomfort is not a realistic expectation.
- demanding: These folks know that they’re paying a premium because sedation ain’t free. Furthermore, there is a push to get more dentistry done every appointment so the patient is exposed to sedation less times. These people come in knowing that they’re going to pay more, so they’re likely going to expect more.
- drug seekers: I’m not sure if it’s the fact that he does a lot of surgery or such a high percentage of his patients require medications that sedate you to be treated, but man does he have a bunch of drug seekers. Worst of all, these are drug seeking patients who have extensive dental needs. He’s getting wise to it now by running a preoperative report on his patients to see if they use a lot of opiate pain meds. But in the past, he’s run into problems because he started treatment without realizing the patient’s history.
- time suck: When you’re seeing a sedation patient, you cannot be doing other things. Most states require uninterrupted supervision by the dentist unless you have an anesthesiologist or nurse anesthetist chairside.
- more likely to fail: Be honest, sedation dentists…these folks are more likely to not show than the average patient. They’re also more likely to not be able to go through with the treatment because they ate something that they shouldn’t have or they didn’t bring a driver or something else that’s a deal breaker.
I can almost hear an audible groan from those of you that have successfully included sedation into their practice. For those that have, it allows patients to follow through with treatment that they probably wouldn’t have done and in many cases it helps drive large, profitable cases. I get it. I also realize that my viewpoint is a touch jaded. I have a personal history of drug abuse and addiction, so I don’t really want to deal with maintaining a supply of these medications even though I’m very aware of how it can be done safely and effectively. It’s just not something I need in my life at this point.
All I’m saying is that including this service in your office will attract this kind of patient. Not maybe. It will. For many people, this risk is worth it. And more power to you, because we need you. But it definitely isn’t for me.