Thursday, May 14, 2009

Trauma-free Dental Care

I don't know who is traumatized most by my son Danny's dental appointments. Danny? Me? The dental hygienists (it takes at least two)? The brave group home staff person who is in charge of keeping Danny's head still while juggling the sunctioning device? The dentist? We are all victims.

Danny has severe cerebral palsy, profound mental retardation, severe visual impairment, and an extreme aversion to touch, especially around his face, mouth, arms and hands. He is 32 and has been this way since he was a baby, although his tolerance of touch has improved some over the years.

The worst dentist we ever encountered had no idea what he was in for. He ignored everything I told him about Danny's aversion
to being touched and the problems that every dentist and dental hygienist had with him over a period of at least 15 years. The dentist plunged in without warning, jamming his fingers in Danny's mouth to do an examination. Danny flailed his arms, screamed,
gritted his teeth and shook his head back and forth until the dentist finally extracted his fingers from Danny's mouth and proclaimed that Danny had a "behavior problem".

No, the dentist had a "behavior problem".

A determined dental hygienist with the full support of a dentist and the rest of the team, can get Danny's teeth pretty clean. Fortunately, he has never had a cavity or needed other work on his teeth, so cleaning has been the greatest challenge so far. But I have often wondered why we can't just knock him out for 20 minutes every 6 months to do a really good cleaning and examination? He has had several surgeries with no problems with anesthesia, his breathing is good, and he is generally in good health.

I know there is a risk to placing a person under anesthesia and perhaps dentists worry about safety, the expense and who will pay the bill, and lawsuits when something goes wrong. But consider the risks of periodontal disease and its connection with serious health problems, such as heart disease, strokes, kidney disease, and diabetes. There are also horrendous stories about people with developmental disabilities whose behavior spun out of control until it was determined that the underlying cause was tooth decay or gum disease.

An article in the May 2009 issue of Exceptional Parent Magazine, caught my attention. "Anesthesia in Dentistry for People with Developmental or Acquired Disabilities" is by Anthony Charles Caputo, a Dental Anesthesiologist (DA). DAs specialize in providing a full spectrum of anesthesia services for special needs patients and dentists. They are trained to manage pain and
anxiety. A postdoctoral Dental Anesthesia residency is a 2-year program that must include experience providing anesthesia for patients with developmental or acquired disabilities. Most DAs provide office-based anesthesia (OBA) services in the offices of other dentists. By having the most modern anesthesia monitors, medications, and equipment normally found in operating rooms, DAs can provide safe and effective anesthesia and other pain and anxiety management in a regular dentist's office.

Dr. Caputo makes the point that just because "dentistry was able to be done" with a patient using milder forms of sedation, does not mean that it was done well. Dental anesthesia allows the dentist to focus on the needed treatment and not worry about the management of the patient. A paper published this year in the Special Care in Dentistry Journal concludes that when considering the risk of anesthesia with the benefit of delivering quality dental care, the risks were minimal and benefits significant to both the patient and the dentist.

The EP article concludes that,
With the full spectrum of sedation and anesthesia services available to dentists in the office-based setting, it is possible to treat the vast majority of patients successfully with sedation or OBA whether it is accomplished by the dentist or a separate anesthesia provider. Sedation and anesthesia techniques are available to dentists so that when other approaches to care are not successful, these treatment modalities are possible allowing the patient to receive treatment safely, comfortably, and successfully.

For more information go to the American Society of Dentist Anesthesiologists and the Special Care Dentistry Association.

Danny's dentist is going to hear about this.

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