Treating Children without setting up a damaging future phobia.
Young people who need dental treatment present a difficult challenge. There are so many adults out there who have neglected their oral health because of the memory of atrocious dental treatment when they were younger. Patients we come across everyday in practice.
It makes me feel much more responsible that not only are we trying to sort out any dental issues right now but what we do may set a tone for compliance in the future. I don't want to be the one that gets blamed for putting someone off great dentistry in the future.
This is where RA fits in beautifully. Treating children becomes a lot easier when there anxiousness levels are reduced and their analgesic levels are increased. Giving a local becomes almost in-perceivable to the patient and the RA helps a better depth of general analgesia, making for a more comfortable experience.
Dr Rob Endicott is a General Dentist and Sedationist based in Stratford upon Avon, carrying out dentistry for patients under sedation almost every day.
Http://Www.phobiadentist.com
Saturday March 23rd sees the training centre at Stratford Dental (www.stratforddental.co.uk) hosting an RA training day with Dr Richard Charon, the RA Coach (www.the-RA-coach.co.uk) for the whole dental team.
Thursday, February 14, 2013
Relative Analgesia in my General Practice Part Two
Patients losing a day
With IV sedation there's no way a patient is trying to make it home on their own afterwards. I did have a case once of a late teenage boy who brought his mum with him, they had both signed the appropriate consent forms, including the escort instructions, I took a tooth out under sedation and unbeknownst to us, she had changed her mind and left. The young lad waited in the waiting room, phoned her and then discharged himself, tried to walk home and ended up asleep on a bank round the corner from the practice!
Even with verbal and signed written consent in advance to bring an escort, patients can arrive for an appointment and say "I'll just order a taxi". Of course we then refuse to treat them.
With "Happy Air" nitrous oxide, it's quite different. The patient is still fully consented but they don't need to being someone with them. They can even drive to their appointment and return to work afterwards.
This means that life starts to get simpler for all of us! We can consent and treat at the same visit which means we can use it opportunistically.
I love the effect nitrous oxide has on the gag reflex. I have treated the most crazy of gag reflexes using RA. I love the fact that for a while after the RA the gag reflex is still reduced.
Two patients we saw last week.
Patient A was a chap who needs a bridge but we need to plan it first using a wax up. He's got a pretty bad gag reflex so impression taking was going to be interesting.
After 5 minutes of RA at 40% NO2, I took a lower alginate. nothing! We took the mask off so I could get better access anteriorly. Upper alginate - nothing!
The patient reported that he thought he could feel a gag reflex trying to start but it wouldn't properly appear. There wasn't any nausea at all.
He's now asked to have Happy Air for everything! No problem!
The second chap has the most incredible sounding gag reflex. You know how some people just make slight retching sounds? This guy is can be heard outside the building, even when a mirror touches the side of his tongue.
Everyone in the practice knows about this chap, but in a nice way. He's a great guy (beats me at table football though) and is really easy to get on with. I think though that over the years, previous dentists have been dreading the thought of ever doing posterior restorations on him.
He comes in one day with a lingual cusp fracture on a lower right posterior amalgam filled tooth. Colleagues said "good luck trying to sort this tooth out!"
I did an opportunistic 10min Happy Air trial session with him, 5 minutes at again 40%NO2 and the gag went completely.
We then saw him a few days later, uses the same dose, put in an ID block, he was able to communicate how numb it was and how comfy he was. Good skin peripheral analgesia, it's a very nice sensation.
We did the composite restoration for him totally without event. Afterwards he said "would have loved to have seen you try that without Nitrous!"
He drank coffee in the waiting room for about half and hour and then drive back to work.
I'd had my RA machine for years but had got so tied up in IV, I had neglected to realise the potential. So i got to spend some time with Richard Charon in Newbury.
Richard is a great proponent of RA and lectures all over the world. He trains many dentists hygienists and therapists every year to practically allow them the next day to introduce RA to their practices, to start making a huge difference to their patients.
Dr Rob Endicott is a General Dentist and Sedationist based in Stratford upon Avon, carrying out dentistry for patients under sedation almost every day.
Http://Www.phobiadentist.com
Saturday March 23rd sees the training centre at Stratford Dental (www.stratforddental.co.uk) hosting an RA training day with Dr Richard Charon, the RA Coach (www.the-RA-coach.co.uk) for the whole dental team.
With IV sedation there's no way a patient is trying to make it home on their own afterwards. I did have a case once of a late teenage boy who brought his mum with him, they had both signed the appropriate consent forms, including the escort instructions, I took a tooth out under sedation and unbeknownst to us, she had changed her mind and left. The young lad waited in the waiting room, phoned her and then discharged himself, tried to walk home and ended up asleep on a bank round the corner from the practice!
Even with verbal and signed written consent in advance to bring an escort, patients can arrive for an appointment and say "I'll just order a taxi". Of course we then refuse to treat them.
With "Happy Air" nitrous oxide, it's quite different. The patient is still fully consented but they don't need to being someone with them. They can even drive to their appointment and return to work afterwards.
This means that life starts to get simpler for all of us! We can consent and treat at the same visit which means we can use it opportunistically.
I love the effect nitrous oxide has on the gag reflex. I have treated the most crazy of gag reflexes using RA. I love the fact that for a while after the RA the gag reflex is still reduced.
Two patients we saw last week.
Patient A was a chap who needs a bridge but we need to plan it first using a wax up. He's got a pretty bad gag reflex so impression taking was going to be interesting.
After 5 minutes of RA at 40% NO2, I took a lower alginate. nothing! We took the mask off so I could get better access anteriorly. Upper alginate - nothing!
The patient reported that he thought he could feel a gag reflex trying to start but it wouldn't properly appear. There wasn't any nausea at all.
He's now asked to have Happy Air for everything! No problem!
The second chap has the most incredible sounding gag reflex. You know how some people just make slight retching sounds? This guy is can be heard outside the building, even when a mirror touches the side of his tongue.
Everyone in the practice knows about this chap, but in a nice way. He's a great guy (beats me at table football though) and is really easy to get on with. I think though that over the years, previous dentists have been dreading the thought of ever doing posterior restorations on him.
He comes in one day with a lingual cusp fracture on a lower right posterior amalgam filled tooth. Colleagues said "good luck trying to sort this tooth out!"
I did an opportunistic 10min Happy Air trial session with him, 5 minutes at again 40%NO2 and the gag went completely.
We then saw him a few days later, uses the same dose, put in an ID block, he was able to communicate how numb it was and how comfy he was. Good skin peripheral analgesia, it's a very nice sensation.
We did the composite restoration for him totally without event. Afterwards he said "would have loved to have seen you try that without Nitrous!"
He drank coffee in the waiting room for about half and hour and then drive back to work.
I'd had my RA machine for years but had got so tied up in IV, I had neglected to realise the potential. So i got to spend some time with Richard Charon in Newbury.
Richard is a great proponent of RA and lectures all over the world. He trains many dentists hygienists and therapists every year to practically allow them the next day to introduce RA to their practices, to start making a huge difference to their patients.
Dr Rob Endicott is a General Dentist and Sedationist based in Stratford upon Avon, carrying out dentistry for patients under sedation almost every day.
Http://Www.phobiadentist.com
Saturday March 23rd sees the training centre at Stratford Dental (www.stratforddental.co.uk) hosting an RA training day with Dr Richard Charon, the RA Coach (www.the-RA-coach.co.uk) for the whole dental team.
Relative Analgesia in my General Practice Part One
My Relative Analgesia "Happy Air" experience in General Practice
I am delighted to help host the Richard Charon Inhalation Sedation training event on Saturday 27th March 2013 in our modern training facility in Stratford upon Avon. I can highly recommend Richards approach to handling nervous patients and its great to do a day like this and go away fully prepared to start using these techniques.
I have been involved in IV sedation for quite a few years, carrying out over 1000 sedation dental procedures. I am used to it, I like the technique, I like how it makes people feel and I know that even the most phobic patients, those who haven't been for 20 years, can be treated with the minimum of fuss, pain free and anxiety free.
However, there are quite a few problems and barriers I have come across on my Dental Sedation Journey. I'll run through them over the coming articles and then explain how Relative Analgesia with Nitrous Oxide has helped me and my patients overcome them. Hopefully you'll get to see how much more it is possible to become a "Hero" to our patients!
Richard has helped me to understand that IV is not the "be all and end all" and having an "armamentarium" of sedation techniques means we can help the most people with the widest range of comfort levels and dental needs.
The topics I am going to cover are:
Easing Patients expense, making sedation more affordable
Patient having to lose a whole day
Treating Children more easily, so helping to prevent future phobias
Those who don't feel that things are bad enough to require "knocking out"
Hygienists and therapists making patients lives easier on a day to day basis.
Lets talk about Patient Expense.
In my private practice, I allow generally an hour for an IV sedation session. Once I have consented the patient again, confirm the treatment plan and gone through aftercare, cannulated, induced, reached end point, I am ready to start dentistry. This may be 15-20minutes into the session already.
I can then do about 30 minutes dentistry, take out a few teeth, do lots of root surface debridement or maybe a few fillings.
Then the patient recovers and is ready to go 50 or so minutes after they came in.
This is fine, I enjoy working like that but it does mean that what could be a simple extraction ends up being unaffordable for a lot of people.
I could finish the procedure, get the patient out of the chair, into a wheelchair and out into a recovery facility with a recovery nurse but I always feel I've got part of my brain in with them. I'm also conscious that as its just me doing IV, if the sedation was complex or difficult and my attention is required, I have to leave another potentially sedated patient. One thing at a time for me.....
Since my coaching with Richard, I have been able to do more RA procedures in half the time with patients feeling very relaxed and with really great analgesia from the nitrous. They recover in the chair in two minutes and are on their way home in 15 or so. This makes safety even better and allows me better control over my working situation.
So the patients who want "oblivion" get the IV, those who want to make it pleasant and really comfortable, I can use RA. It actually opens up my market of patients to those who are on more of a budget whilst still providing a chargeable service to my patients.
The next thing I will talk about is patients having to lose a whole day because if dentistry. Thanks for reading!
Dr Rob Endicott is a General Dentist and Sedationist based in Stratford upon Avon, carrying out dentistry for patients under sedation almost every day.
Http://Www.phobiadentist.com
Saturday March 23rd sees the training centre at Stratford Dental (www.stratforddental.co.uk) hosting an RA training day with Dr Richard Charon, the RA Coach (www.the-RA-coach.co.uk) for the whole dental team.
I am delighted to help host the Richard Charon Inhalation Sedation training event on Saturday 27th March 2013 in our modern training facility in Stratford upon Avon. I can highly recommend Richards approach to handling nervous patients and its great to do a day like this and go away fully prepared to start using these techniques.
I have been involved in IV sedation for quite a few years, carrying out over 1000 sedation dental procedures. I am used to it, I like the technique, I like how it makes people feel and I know that even the most phobic patients, those who haven't been for 20 years, can be treated with the minimum of fuss, pain free and anxiety free.
However, there are quite a few problems and barriers I have come across on my Dental Sedation Journey. I'll run through them over the coming articles and then explain how Relative Analgesia with Nitrous Oxide has helped me and my patients overcome them. Hopefully you'll get to see how much more it is possible to become a "Hero" to our patients!
Richard has helped me to understand that IV is not the "be all and end all" and having an "armamentarium" of sedation techniques means we can help the most people with the widest range of comfort levels and dental needs.
The topics I am going to cover are:
Easing Patients expense, making sedation more affordable
Patient having to lose a whole day
Treating Children more easily, so helping to prevent future phobias
Those who don't feel that things are bad enough to require "knocking out"
Hygienists and therapists making patients lives easier on a day to day basis.
Lets talk about Patient Expense.
In my private practice, I allow generally an hour for an IV sedation session. Once I have consented the patient again, confirm the treatment plan and gone through aftercare, cannulated, induced, reached end point, I am ready to start dentistry. This may be 15-20minutes into the session already.
I can then do about 30 minutes dentistry, take out a few teeth, do lots of root surface debridement or maybe a few fillings.
Then the patient recovers and is ready to go 50 or so minutes after they came in.
This is fine, I enjoy working like that but it does mean that what could be a simple extraction ends up being unaffordable for a lot of people.
I could finish the procedure, get the patient out of the chair, into a wheelchair and out into a recovery facility with a recovery nurse but I always feel I've got part of my brain in with them. I'm also conscious that as its just me doing IV, if the sedation was complex or difficult and my attention is required, I have to leave another potentially sedated patient. One thing at a time for me.....
Since my coaching with Richard, I have been able to do more RA procedures in half the time with patients feeling very relaxed and with really great analgesia from the nitrous. They recover in the chair in two minutes and are on their way home in 15 or so. This makes safety even better and allows me better control over my working situation.
So the patients who want "oblivion" get the IV, those who want to make it pleasant and really comfortable, I can use RA. It actually opens up my market of patients to those who are on more of a budget whilst still providing a chargeable service to my patients.
The next thing I will talk about is patients having to lose a whole day because if dentistry. Thanks for reading!
Dr Rob Endicott is a General Dentist and Sedationist based in Stratford upon Avon, carrying out dentistry for patients under sedation almost every day.
Http://Www.phobiadentist.com
Saturday March 23rd sees the training centre at Stratford Dental (www.stratforddental.co.uk) hosting an RA training day with Dr Richard Charon, the RA Coach (www.the-RA-coach.co.uk) for the whole dental team.
Leichtenstein blog day one
Thursday 14th February.
Still reeling from the flu, I am on board the flight to Zurich hoping that the taxi at the airport will have some sort of sign so I know who they are!
I've been invited by dental materials manufacturer Ivoclar Vivadent for the second year in a row to attend their "train the trainer" event at their headquarters in Leichtenstein. I occasionally carry out paid lectures for Ivoclar on Composites, adhesives and ceramics but I am not on their payroll. I am also privileged to be a Uk product tester and evaluator so I get to see the cutting edge stuff just before its released.
It is truly is a beautiful place to have a manufacturing facility, nestled amongst the snow capped mountains next to the Rhine river. The view from every window deserves a photograph taken of it and I will endeavour to upload a few panorama pics onto the blog.
Ivoclar is a very famous business in Leichtenstein. It used to be known as the "False teeth factory", being historically the largest producer of denture teeth in the world. I was told by workers there that in the past, if you had been a naughty child in leichtenstein, you would be sent to work in the false teeth factory!
I am pleased to report that's it not thought of like that anymore. When you walk around, you notice how utterly state of the art this place is, really at the forefront of dental materials research and development.
There is still an enormous room full of false teeth which is a sight to behold but there is an atmosphere of immense pride amongst the staff here in what they do, from the guys on the shop floor or distribution centre to the chemists knew deep in resins and catalysts, nobody has to try very hard to give an impression of professionalism and contentment in their work.
Some factory highlights from last year:
The false teeth room
The mighty tumblers that mix up the various parts of composite filling materials
The huge vats of ceramic powders
Meeting the chemists who spend all day experimenting with different materials components to produce the next generation of materials
The cafeteria in the ICDE training facility that serves amazing lattes that you enjoy whilst looking out towards the mountains and talking to enthusiastic colleagues and dental industry partners.
We are looking forward to 2 days of lectures, product updates, factory tours and the chance to ask lots of questions. I love dental materials and have always been fascinated by how much time, thought and energy goes into things that we take for granted in our profession. I have always been a believer in knowing more than I need to about the individual facets in my job, it makes decision making about things like materials purchasing so much easier when I know what the differences are and what I want.
Just a quick footnote, it's Valentines Day today, I left my wife in bed at 6.30 this morning and I am grateful that she loves me so much that she she doesn't make me feel guilty about going away for a few days to indulge a passion (a passion that does not rival the one I have for her!)
Happy Valentines Day Lulu!
Monday, November 12, 2012
From the RA Coach Richard Charon
Richard wrote: "One for my dental colleagues
"From Dr. Ashley Davenport, Practice Owner, Balsall Common Dental Practice, in their own words
"Dear Richard,
We attended your Relative Analgesia course in December 2006.
I am writing to say a big thank you to you and your team for making the day so interesting and enjoyable.
I am particularly grateful to you for all your help and advice regarding the installation and set up of the equipment. We gained a great deal of knowledge about Inhalation Sedation and have since started offering Relative Analgesia to our own patients.
We have been using Inhalation Sedation in our practice for 3 months now and have found it a great help to our patients.
Thanks again, we couldn't have done it without your help!
Yours Faithfully
Rebecca Kilmurray
Clinical Manager "
So WE ARE NOW BOOKING
SATURDAY 23rd March 2013
Venue
Startford Dental Practice hosted by Dr. Rob Endicott
http://www.stratforddental.co.uk/dentists.php
Stratford-on-Avon
contact me: richard@the-ra-coach.co.uk for information and bookings"
Saturday, June 23, 2012
Another nice Intranasal Sedation case today
Http://Www.phobiadentist.com
Successful intranasal case today, lady had a problem with needles and drilling, not so much in the mouth, more in the skin so IV tricky. Great access though.
A quick 1ml spray of concentrated midazolam up the nose with the Mucosal Atomisation Device, and after 10 mins she was relaxed enough to have a local anaesthetic.
We did a large white filling and took a molar tooth out. Afterwards she said she had absolutely no recollection of the treatment. That's the great thing about sedation, there are no lasting memories of dental treatment, it all feels really easy.
She is now confident that In three months time we will make a bridge for her, again using intranasal sedation.
For more information on Intranasal Sedation visit my website http://www.phobiadentist.com
With best wishes
Rob
Dr Rob Endicott BDS
Successful intranasal case today, lady had a problem with needles and drilling, not so much in the mouth, more in the skin so IV tricky. Great access though.
A quick 1ml spray of concentrated midazolam up the nose with the Mucosal Atomisation Device, and after 10 mins she was relaxed enough to have a local anaesthetic.
We did a large white filling and took a molar tooth out. Afterwards she said she had absolutely no recollection of the treatment. That's the great thing about sedation, there are no lasting memories of dental treatment, it all feels really easy.
She is now confident that In three months time we will make a bridge for her, again using intranasal sedation.
For more information on Intranasal Sedation visit my website http://www.phobiadentist.com
With best wishes
Rob
Dr Rob Endicott BDS
Saturday, May 26, 2012
BBC Radio WM and Coventry / Warwickshire
Many thanks to all who listened to my Dental Phobia radio interview this morning, I will post it online soon. Thanks also to the great team at the station, coping with me whilst trying to do a live broadcast of Princess Anne from Coventry Cathedral!
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