What Exactly is Sedation Dentistry?
The Sedation Dentistry Center of Michigan is one of the few offices that can provide the full range of pain and anxiety control you may need.
General Anesthesia and IV Deep Sedation (Asleep)
General anesthesia and IV deep sedation: We group these two together because they are they only the two ways to allow you to be “asleep” and be pain free. This is also known as hospital grade total intravenous anesthesia.
After placing a continuous I.V. line, all of your medications are administered here during the course of your treatment. This will include medications to allow you to sleep as well as potent pain medication for both during and after the procedure. This is the ideal method if you don’t want to feel any pain, hear any noise from the drill and be truly asleep throughout the procedure.
We Are Certified In
During this time, you are fully monitored using equipment similar to any medical operating room at a hospital. This may include (but is not limited to) pulse oximetery (a computer reads the oxygen leaving your blood), a continuous ECG which monitors your heart, a non invasive continuous blood pressure monitor, temperature, capnography (monitors your breathing), bispectral indexing (an EEG monitors your brain activity) and an electronic bluetooth enhanced precordial stethoscope to further monitor your heart functions and breathing. We have delivered over 9,000 anesthesia and sleep sedations safely and pain free with these techniques.
I.V. Conscious and Oral Minimal Sedation
We group these together because by Michigan law you must be conscious or awake with these levels of sedation. You will receive a sleeping pill or tranquilizer like valium, Halcion, or Ambien, or a mild sedative in an I.V. You will be relaxed, but must be awake and aware of your surroundings. You must be able to respond to normal verbal commands and so you will be able to hear the drill and everything going on around you. For example, the maximum recommended dose for IV sedation with midazolam (Versed ) is 5 milligrams. Your monitoring will be appropriate to your level of sedation. You still have to have a shot and receive a local anesthetic because these medications can do nothing for pain. If you have difficulty getting numb, are a gagger or want to be asleep, these options may not be appropriate for you. Someone will still need to drive you to and from the office. Many Dentists that offer conscious sedation mislead people by saying that they'll fall asleep.
Nitrous Oxide Sedation
This mild inhalation agent also known as laughing gas will provide some relaxation for you. We offer this even for your routine teeth cleanings and other minor procedures to keep all of our patients as comfortable as possible and yes, you can even drive home after your visit.
Over 26,000 patient visits have been successfully treated by Dr. Kaminski utilizing the minimal and moderate sedation techniques. He is the single most experienced dentist using all of the sedation techniques in Michigan.
Dental Sedation and Michigan Law
There is a great deal of confusion among patients about sedation dentistry and whether they are going to be awake or asleep. Following is a brief overview and a link to the current Michigan laws.
Michigan Law and Guidelines
Sedation Dentistry and Anesthesia is the only clinical aspect of dentistry to be regulated by state law that goes above and beyond earning a dental degree. Why? Michigan finally established limited guidelines in 1992 due to the number of incidents involving brain damage and deaths of patients. Usually this has occurred because dentists did not have the proper training for the techniques they were using. A well known expert witness, this is certainly true for every case that Dr. Kaminski has reviewed or testified for multiple law enforcement agencies and attorneys.
Finally, Michigan was one of the last states to mandate training in this area. Briefly, these requirements are 2 days for oral sedation, 2 ½ days of class and (40 hours working on patients) for moderate sedation, and a minimum 1 year hospital based anesthesia residency for sleep dentistry or general anesthesia. Quite a difference in training levels that the average patient is unaware of. Michigan is now the ONLY state that does require a state issued permit verifying training. Unlike most states, Michigan doesn’t require an on-site facility inspection for minimum emergency equipment, staff training and medications to insure your safety. Dr. Kaminski has spoken extensively to the state dental board of Michigan on this issue. As a patient, you have no way of knowing what level of sedation your dentist can legally provide. In every other state, you can check with the state to make sure that your dentist has the proper permit and facility inspection.
If you give drug X at 5mg it can produce a range of sedation going from awake to asleep. It is like putting a gallon of gas in a vehicle. Are you going the same distance in a car, an F150 truck or a motor home? Of course NOT! If you take the same gallon of gas will you go further driving up a hill, level ground, or downhill with or without wind in the same vehicle? It’s always different because the conditions are different. If you’re in a good mood you will take less sedation for the same effect. People will even vary in their response from 1 appointment to the next. Can anyone predict with 100% certainty what the patients’ response will be on any given appointment - absolutely not! Shouldn’t the dentist be trained and prepared for anything - absolutely!
You need to ask yourself. Do you feel lucky? Do you want to take a chance with someone that might have only minimal 2 ½ days training (not state certified) or someone fully trained and qualified to handle all aspects of sedation, anesthesia and any complications.
So when you hear such ads touting sedation dentistry, you should look into the training and certification of dentists providing this service. You also need to decide if you want to be awake or asleep and not to be misled into thinking a single pill or conscious minimal sedation will put you to sleep.
There are no safe sedatives or anesthetics, only safely administered ones!
Questions to Ask Any Dentist Before Sedation
Where did the dentist get their anesthesia training?
- In a hospital, surgicenter, office or a weekend hotel course?
- Who supervised their 20 live patient cases? And were they done in office or in hospital?
- Call the hospital
Are you trained for conscious minimal (awake) sedation or deep (sleep) sedation?
- Some dentists and periodontists use the term "deep conscious sedation". This is very misleading to patients as they don't have the state mandated training to offer deep sedation.
- How many live patient intubations and rescues have your done in your training?
- "I wouldn't recommend a friend or family member to have IV conscious sedation done by a dentist with less than 25 live patient intubations"
How will I be monitored?
- As of July 2011, the American Society of Anesthesiologists state the current standard of care for IV sedation are ECG , Blood pressure, pulse oximetry, and end tidal CO2.
- Ask to see their equipment, and ask if they monitor end tidal Co2
Ask the Dental Assistant:
- Where is your emergency rescue equipment?
- How often do you practice?
- Where is your written emergency plan?
- Have you taken an anesthesia/sedation assistant course?
- How long do you monitor a patient afterwards?
Depending on the medications used, you should recover within 30 minutes to 1 hour for ultra short acting agents.
If you are given a reversal agent to wake you up, you MUST be kept for a minimum of 2 hours after the agent (Flumazanil or Narcan) is given.
If you are given a second pill orally, you should be monitored for 6 hours before it is safe to send you home. Otherwise you may have difficulty with or even stop breathing when you are at home. A second pill changes an oral minimal sedation into deep sedation / general anesthesia and an oral sedation dentist isn't properly trained to provide deep sedation.
In an emergency, your dentist has about 3 minutes to recognize, assess and rescue a healthy adult before hypoxia and possible brain damage. Children and patients with heart disease, asthma, emphysema, sleep apnea, the frail or elderly have much less time and the dentist must respond much faster.
The problem with Nurse Anesthetists (CRNA)
If a nurse anesthetist is used, the dentist cannot legally use a CRNA unless the dentist is fully trained to at least the level of sedation given (conscious or deep/general anesthesia) in order to properly supervise the sedation. This is often not the case in Michigan. CRNA's are not allowed independent practice in dental offices in this state. If you are told otherwise, you should consider leaving that office since that sedation / anesthesia would likely be illegal in Michigan. Only dental anesthesiologists, physician anesthesiologists, or oral surgeons can provide/supervise deep sedation or general anesthesia. The Michigan Dental Association has also published a lengthy article on this well known issue. Some of our patients have come from offices where CRNA's have been introducing themselves as a doctor. A doctorate in nursing is not the same as a physician. So always ask if they are a physician or nurse. Who would you want putting you to sleep?
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