GDA Action October 2021

October 2021 • 29 work in an operating room. The facilities have become more restrictive, more cautionary, more crowded, and more fiscally oriented. Still, it is the best game in town for treating those who cannot safely be managed in an office setting. All too often it boils down to hospital dental care or no care. And then they would have to see the oral surgeon. And where do the oral surgeons do much of their work? They do it in an operating room, be it in the hospital, the surgical center, or in their own private facility. When Anesthesia in the Office is Not Enough: Modalities of Anesthesia ASA 1–5 classifications are assigned for good reasons. They address the medical complexity of the patient and the anesthetic risk. The American Society of Anesthesiologists developed this physical classification system to help assess risk factors for general anesthesia: • ASA 1- normal health • ASA 2- mild-moderate systemic disease • ASA 3- severe systemic disease • ASA 4- severe incapacitating systemic disease that is a threat to life • ASA 5- moribund, not expected to survive without an operation Categorizing the patient’s risk factor helps the anesthesia team assess what is best for the patient in terms of type of anesthesia including premedications, precautions, and post-op care. While the array of modalities of anesthesia is beyond the scope of this dental article, we must applaud the anesthesia team for their depth of knowledge in determining what level and type of anesthesia keeps the patient safe, asleep, and allow us to do our finest dentistry on a non- moving patient. Who are the patients? My OR patients are as diverse as the rest of my ambulatory practice. While patients with autism, cerebral palsy, Alzheimers, and other intellectual or developmental disabilities comprise the majority of our ASA 2 and 3 OR cases, we have also treated hundreds of ASA 1 cases. This includes lawyers, teachers, businessmen, professors, young frightened children, and others we call our neighbors. People with panic attacks, situational anxiety, uncontrollable gagging, microstomia, needle phobia, or those who will not or cannot have a local anesthetic are included in our roster of people requiring to be put completely to sleep to accomplish their needed dental care. What are the benefits to the dental practice? In my courses and lectures, I ask the attendees why anyone would drive past 20 offices to go to yours. The typical answer is that you are a specialist and the other practices are not. But why would they drive past 20 offices of your same specialty or 20 other GP offices if you are a GP? The answer must be that you offer something the others don’t. Oral Conscious Sedation (OCS) and general anesthesia are a niche and unique offering that is not commonly found. As we know from marketing and advertising, satisfied customers tell others. People who found a professional to help them will tell others of their success with you. Our greatest practice builder comes from patients who tell friends and families of others who had difficulties locating a dentist who can perform the needed and usually overdue dental care under OCS or out-patient general anesthesia. With the current social media networks, it is no longer just the family at the dinner table or close friends who learn of these successes. It is now everyone who reads or hears of a formerly exasperated parent or caregiver who finally found a dentist willing and able to treat their special loved one. As a practice builder for your overall growth and expansion, offering something your 20 nearest competitor colleagues don’t offer places your practice right at the top. And there is no marketing fee for this extraordinary word-of-mouth referral expansion. How to go about providing OR dental care? Once approved by the OR facility, you need to bring your clinical staff to that site for several reasons. The most important would be to have them share your vision of treating patients while asleep, and have them “buy-in” to your professional goals. You’ll want » 1-Patient resists office care 2-Safe dental care in OR 3-Nasal intubation; NOMAD Pro; X-ray sensor