Adult Oral Sedation Dentistry

Adult Oral Sedation in the Dental Office

Adult Oral Sedation as a part of your dental practice can be a wonderful adjunct to the services you can provide your patients. This article is not meant to provide any training in oral sedation, you are encouraged to take a board approved course.

The ability to treat patients that may otherwise go without proper care can be very rewarding to you, your team and your patients. Currently, in California, a permit acquired through the Dental Board is required. Section 1004 defines adult conscious as any patient over 13 years of age, although I personally only treat patients over the age of 18. This permit is only needed if the dentist is going to administer medication dosages that exceed the FDA daily recommended dose. A dentist can apply for a permit by either submitting 10 board approved sedations completed prior to Dec. 31, 2005 or having 25 hours of classroom instruction and observation of 1 live patient experience from a board approved CE provider. The permit needs to be renewed every 2 years with a minimum of 7 hours of CE in sedation. Proper training of the entire dental team, monitoring equipment, emergency training and equipment is essential.

Typically in our practice, our sedation patients fall into two categories- fear based and time based. Our fear based patients are just as you would think-they usually have some past dental experiences that has kept them form the dental office. It is not uncommon for us to see a patient that has not had a dental visit for 10, 20, 30 years in some cases. Typical concerns are bad childhood experiences, pain during treatment, fear of needles, sounds, smells, difficulty getting numb, gag reflex or bad rapport with the dentist. Time based patients typically have at least some fear but also want to have as few appointments as possible in order to get back to maintenance visit status. Patients with hectic work schedules and frequent business travel are an example of time based patients. The entire dental team must be very skilled, compassionate, well-trained and have excellent communication skills in order to properly handle sedation patients. The patient’s heightened fears or needs require that your team go the extra mile to put the patient at ease.

As mentioned before, we treat only patients 18 years of age or older. Generally ASA I or ASA II are good candidates and with advanced training ASA III’s can be treated. We consult with every patients Physician prior to treatment. Also, a complete medical history and pre-op vitals are taken. Oral sedation is very safe but there are a few contraindications – pregnancy, allergy to medications used, interaction of some medications that the patient is already taking – I will not go into all of that now. Triazolam is the main medication we use for oral sedation. Triazolam is a benzodiazepine in the sedative-hypnotic family. Amnesia is a normal and much appreciated side effect for my patients. Typically a patient will take a small dose of diazepam at bedtime and we can also supplement the triazolam with hydroxyzine. We also, quite often, supplement the sedation with a low dose of nitrous oxide during the administration of local anesthetic and oral surgery. A typical sedation appointment is 5-6 hours. We can be performing treatment from simple restorative, crown and bridge and periodontal therapy ( by one of our trained hygienists ) to full mouth reconstruction, endodontic therapy, oral surgery and laser gum treatment. Our patients are constantly monitored with a pulse oximeter/pulse/blood pressure monitor. We do not put our patients to sleep. They are in a relaxed state that allows them to complete their requested treatment. We can communicate with the patient throughout the appointment as needed. At the conclusion of the appointment, the patient’s escort is given post operative instruction and the patient will return home to nap the rest of the afternoon. Patients appreciate the amnesiac effect of the triazolam. I have had patients call the office later that day, upset that they have slept through and missed their appointment only to be told they were in our office from 7:30 am to 1:00 pm.

I hope this give you a brief insight into adult oral sedation and how this can be a wonderful service to provide your patients.

Finding an Adult Resort

These are the things you should look for;

Website – Normally your first contact with a potential provider is its website, does it give you a complete synopsis of the resort and the services rendered? Do they cover up lack of information with many photos and no substance? Are the FAQ’s informative and cover most basic questions?

Management – How long have they been in business and what is the experience of management? Always send a question to packager and see how long it takes them to get back to you; this is a good indicator of their overall service.

Location – Is the resort location in a democratic, stable and friendly country, Cuba and Venezuela are not. How long it will take you to get to actual resort after you land at the primary destination (some resorts require a night in hotel before reaching resort by a second flight or land carrier due to its distance from the airport? Costa Rica requires this. Thailand has a very unstable government with an erratic leader and difficult to get to. prostitution legal in the country? The Dominican allows prostitution and has a very stable democratic government.

Package – Be sure you know what the package includes. Are there any extra charges? What do you want it to include? Do you get a variety of package and accommodations?

All-Inclusive vs. Flexibility – Do you want the flexibility of your own apartment, hotel or all inclusive beachfront villa?

Food – Are you happy eating at the same location from a set menu or buffet with the same people or would you prefer eating you meals in different restaurants with an unlimited variety of foods, chefs, locations within walking distance?

Girls – If full-time girls (companions, escorts, tour guides) are the provided and shown on the website are they real or are they “representative”? Are they available when you will be there? Do they just show groups of girls or website visitors get to see individual girls that are currently there?

Choosing Girls – Does the website explain completely how you choose your companions? Do you need to compete with other guests for the companion of your choice? Would you rather choose your companions from over 25 girls in advance with the flexibility of trading out every day with no “bidding” or competition? Do you want to see the girl you will be with that night waking up that same morning with another guest? Do you want to see her during the next day with the guest she is going to be with the next night? If you want a girl you really enjoyed leave you because she is reserved by someone else?

Change Out – Is there any charge to change girls, do you have to pay for transport of new girls, how long does it take to get new girl? Costa Rica is infamous for this tactic since all resorts are at 3 – 6 hours away.

Accommodations – What are your accommodations and your specific room/apartment? Keep in mind that although you spend a good portion of the day outdoors, you do spend a considerable amount of time and more intimate moments in your room/apartment.

Air Travel – Check travel schedules carefully. Do you really want to arrive in the late evening when you have been traveling all day? This is a night wasted.

Things to Do – Discos, gambling, tours, water sports, are they available and how far are they from your accommodations.

Price – All adult service providers whether they be in-inclusive villas, apartments with full-time escort(s) or “call girls” at your resort supply the same basic service. Compare prices carefully, do you want to pay top dollar for basically the same thing?

Deposit – Do you want to send a 25% deposit ($1000 – $2000) to an unknown resort or send $250 deposit? Best Dominican Adult Vacation deposit is $250.

Help – Do you have a full-time concierge and local phone to reach him 24 hours a day in case of an emergency or just an important question?

Villa / Apartment / Call Girl? – Can your chosen provider give you a complete menu of superb and economical services with equal terrific customer service and facilities?

Forums – Although some forums give you a fair review be very skeptical as many owners create their own forum letters. Most guests that go to these type resorts do not write to forums and keep their visits very private.

Questions – Make sure when you send questions or requests the answer is addressed directly and not “glossed over” which stock platitudes or vague responses.

bestdominicanadultvacation – xxxtasyvactions.com in the Dominican Republic do very well in implementing these suggestions into their business model. I recommend them!

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