Teaching sedation dentistry is almost second nature to me by now.  I have been training dentists and their team members on the techniques, pharmacology, psychology and safety protocols of oral sedation for a decade.

But recently I had the pleasure of leading a six-hour sedation dentistry overview for actual dental school students.  I found the experience, well, educational.   The 30 or so dentistry students joined me at the Micro Dental Laboratories classroom complex near Oakland, California.  Many of them were seniors completing their undergraduate studies at the Arthur A. Dugoni School of Dentistry at the University of the Pacific and at the University of California at San Francisco’s School of Dentistry.

What I discovered is that since my days nearly three decades ago at the University of Pennsylvania School of Dental Medicine not much has changed – and so much has changed!

The students who voluntarily came to hear me lecture at Micro Dental Labs were – like my Penn class – bright, inquisitive, motivated and among the best-trained dental students in the world. 

Yet there were differences, too – both cosmetically and substantively. 

The most obvious difference on the face of it was the greater presence of women and minorities among the graduating class.  Today’s dental school students more proportionately represent the populations they will serve – a most positive evolution.

Academically, I believe, these students will graduate better prepared to attend to the oral health of their patients than we were thanks largely to advances in both the clinical and theoretic foundations of their education.

While dental schools remain years away from incorporating formal sedation dentistry training into their curriculums, today’s dental students are well aware of the availability of such protocols and how sedation dentistry enables dentists to best serve patients who otherwise avoid regular oral health care due to fear and anxiety.

The students who attended my lecture will, in all likelihood, eventually return to a classroom to receive the complete, continuing education courses they’ll require in order to offer their patients sedation dental care.  In my day, we had no such post-school choices.

But there is another major difference between the dental students of my era and these dental students: debt. 

The current costs of a dental education and the fiscal cavities almost all of these students will bear upon graduation will afflict them and influence their career path for years to come. 

Few of the students, if any, will have the financial wherewithal to open their own practices as early after graduation as we did.  Rather, they will have to align themselves initially with existing dental practices or community clinics and not always work in their preferred locations.

I’d like to believe that the main reason these graduating dental students came to hear me speak is that they understand that oral sedation protocols, such as those developed by DOCS Education, are a valuable addition to their formal education when it comes to serving patient needs.

But I strongly suspect that these students also have reasoned, like so many established dentists who take our continuing education courses, that providing popular oral sedation services to their patients in 2010 is not only a safe, effective and valued patient option, it is also a fiscal necessity.

This became abundantly clear to me upon the completion of my formal presentation to the dental school students.  It was 3 p.m. in the afternoon and my allotted time had come to an end after a terrific give and take on the clinical and academic foundations of sedation dentistry.

The students hung in with me the entire six hours – not a one of them kicked back and blew off the lecture – as is quite common and understandable among graduating seniors after years of such lectures.

So I was not expecting the final question.  Would I be willing, one of the students wondered, to stay on and discuss the financial aspects of successfully incorporating sedation dentistry into their future practices?

I did stay on, as did most of the students, and we talked about money and marketing and the inextricable link between profits and quality professional service.

As it turned out, although I was the lecturer and thought that I was donating my time, travel expenses and a catered lunch to the students, they repaid me many times over by reminding me of a valuable lesson.

Dentists who want to serve their patients and communities in an optimal way can’t do so wearing financial blinders.  To repay student loans, establish oneself in a practice, alert the community to what services are available, and remain dedicated to that community for a lifetime, dentists must understand and respect the economics of our profession.

In my dental school days, most of us didn’t think often about the profit motive of dentistry and those who did, didn’t typically say so aloud.

These dental students are no less dedicated and no more financially self interested than we were.  But they are pragmatists.  At an early stage in their professional careers they understand better than we ever did that to be their best as healthcare providers they must also learn to maximize their income potential.

It’s a lesson well worth remembering.

The patient put on a happy face, but in fact, he couldn’t wait to escape the dentist’s office and return to his car to decompress and collect himself in private.

He was shaky, perspired and still somewhat short on breath.  His shirt collar was damp from where his tears had fallen.  He knew he was in no shape to drive.  So he sat, waited and phoned a friend to share his ordeal.

It had been only a one-hour and 20-minute periodontal cleaning appointment, but it felt like an eternity.  In the dentist’s chair he had harnessed all his mental focus to channel his thoughts away from the pain and discomfort.  He thought about nature, white sand beaches and lapping waves. When that didn’t suffice, he created an alternative stream of pain, repeatedly digging his own fingernails into the soft skin under his nail beds – like bamboo shoots.

The feints helped sporadically, but ultimately the stubborn oral discomfort overran these meek defenses and misery triumphed.

How sad that the patient, a well-educated health professional in his own right, hadn’t chosen to avail himself of safe, effective, dental sedation to put him at ease before, during and after his visit to the periodontist. 

Sadder, still, that the patient – me – is the cofounder and president of the world’s largest and most-respected dental sedation training program, DOCS Education .  I knew better and went without oral sedation anyway.

Why?

Because it had been more than a decade since I endured a thorough periodontal visit the old-fashioned way, without the comfort of oral sedation.  And I wanted to learn first-hand whether or not the state-of-the-art of dental pain and anxiety management – without the use of oral sedation – had advanced much over such a long time span.

Obviously, it was an education hard-earned: Pain is still pain.

I must say that the dental hygyenist who cleaned my teeth used impeccable clinical technique.  My discomfort was not her fault.

Indeed, both she and I recognized that one of the four quadrants of my mouth would require some extra attention, so she applied an anesthetic injection there to help numb the pain.  It is the other three quadrants that brought me to tears, literally.

For the record, I’m not a dental chicken nor have I had a lifelong fear of dentistry.  But I do have a low-pain threshold and – like so many others – even a routine cleaning can create severe discomfort for me.

Sitting in the dental chair I thought about how tens of millions of other patients also routinely endure the discomfort I was experiencing, because they have not yet discovered the benefits of sedation dental care.

My jaw was cramping. From all the water in my mouth I had the sense that I was drowning – like being “water boarded.” Although I didn’t cry, tears reflexively streamed down my face and I was embarrassed by them.  And of course, I was in nerve-jarring pain.

In my early professional days before I was trained in sedation dentistry protocols, I frequently wondered why so many of my patients left the operatory without even a “thank you,” especially when I knew I had done such a quality job of care and paid so much attention to my patients’ comfort.

Now, sitting in my car, reflecting on my experience, I realized that like so many of my early patients, I left the dentist’s office not ungrateful, but so focused on holding it together until I was out of observation range that saying “thank you” – even though I felt gratitude, was not my top priority.  Escape was!

So, to everyone who ever fled the dental chair to the privacy and serenity of a parked car, only to twitch at the thought of the ordeal just passed, I share your pain.  Both emotional and physical.

Being a patient is tougher than many of us recall.  Especially, those of us who have come to rely on sedation dentistry to make dental visits anxiety-free.  I do not recommend other dentists or their patients try doing without oral sedation just to share the discomfort that I had.  One educational guinea pig is sufficient.

But on those days when a skeptical fellow oral health professional or even a dental regulator questions you about the necessity of oral sedation as a method of bringing comfort to our patients – suggesting perhaps that other “conventional” methods of anxiety and pain relief are sufficient – please remember this tale and my experience.

What we specially trained sedation dentists provide is comfort and peace of mind to neutralize an experience that for many millions of dental patients is otherwise hellish.

I now know that, again, first hand.

A UK survey of more than 1,000 consumers this past June found that 44% of women who put off going to the dentist do so out of fear, compared with 38% of men. 

“For people with a phobia, visiting the dentist can be a very daunting experience,” noted Dr. Nigel Carter, chief executive of the British Dental Health Foundation.  “This is a real shame because modern dentistry should be completely pain free,” he said.