The Matrix - Oral Sedation Dentistry
Michael Silverman

Envision your office as a matrix; a sanctuary for patients that are in physical and emotional pain due to their oral condition. They need our special care. We have been providing miracles with technology, but now is the time to provide these miracles in a matrix where people feel safe from their fear of pain and discomfort. With oral sedation dentistry our patients are treated without fear or pain and little memory of procedures. Can you imagine caring for a fearful patient that is so comfortable that they drift into a total state of relaxation?

Since incorporating oral sedation dentistry into my office, I have created a practice that continually expands and improves the quality, quantity and scope of my patient’s experience. My ability to be creative in this process originated from my intention to form a matrix. As you will see, with nothing to defend in this matrix, it generates boundless creative power. Let me show you how THE MATRIX was created. The matrix is a term used to describe an incredible safe and beautiful sanctuary (our offices) for our patients to experience their dental care. There are three elements required to provide a practice with a matrix:
1. A source of possibility
2. A source of energy to explore that possibility
3. A safe place within which to explore the possibility

A source of possibility: Of the three elements of a matrix, the first one is a source of possibility. What if we could provide a matrix – a source of possibility - where people with high fear, a bad gag reflex, very sensitive teeth, extremely low pain threshold, a phobia for the smells or sounds of our offices etc. - could have their dental care accomplished with no worry about these conditions?

Oral sedation dentistry can offer this and more. It is especially ideal for implant surgery because post-operative pain is drastically diminished.With up to 50% of the population avoiding our technical care due to fear, it is easy to see that we have underserved the people we have trained to help. Dentistry has evolved considerably in the last 25 years to an improved state of gentle almost pain free care. However, our target market: implant, cosmetic and reconstruction patients have experience of yesterday’s techniques that were less gentle. They have formed a deep-seated fear of us that is standing in their way of requesting our care for beautiful, functional dentistry. Now is the time to approach our patients with what they have been missing – comfort. Together we can bridge this void between technology and patient comfort.

Science has taken us to a place where our offices are centers for technologically processed dental care. Digital x-rays, titanium implants, bone augmentation, intra-oral cameras, laser treatment of hard and soft tissue, CAD/CAM impressions and restorations, nickel-titanium rotary endodontic systems, metal free restorations and smile redesigning techniques are just some of our technological processes. A matrix for patient comfort and improved dental care with conscious sedation spans this bridge. Conscious sedation is defined as a minimally depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and responds appropriately to physical stimulation and verbal command, and that is produced by a pharmacologic or non-pharmacologic method, or a combination thereof. A patient is totally relaxed, yet is co-operative. The route of administration may vary from oral to intravenous. I will be referring to oral sedation, but the matrix still applies for other routes of administration.

With the economic value of a new sedation patient statistically shown to be 350% higher than an average new patient, it is easy to see the bottom line consequences. By adding implant and cosmetic care to this statistic, a 500% increase in new patient value may be realized. In an interview with certified financial planner Suzanne DuMolin MPA, CPA, CFP, she calculated, “a five year earlier retirement can be shown by simply incorporating sedation dentistry into a general practice.” Sedation patients are more often than not high fear – avoidance patients. They have neglected their mouths for years and often decades resulting in a need for extensive care. These sedation patients understand that years of neglect will require considerable investment. They are an untapped resource of financially prepared patients for our practices.A source of energy to explore that possibility.

The second element of a matrix is a source of energy to explore that possibility. The energy to explore a matrix comes from our patients, our team, our office, our education and us. Organizations such as the ICOI, DOCS (Dental Organization for Conscious Sedation), AACD and so many more have inspired us to create practices of quality. They have offered us the encouragement to quest seek knowledge and develop specialized skills to promote better oral health. They have provided the expansion of this energy to our team members and laboratory colleagues. In my experience, when a dental team attends a seminar together it truly generates a source of energy to explore any possibility. Dental team members generate an incredible amount of enthusiasm. In the hundreds of oral sedation practices that I am involved with, a phenomenon consistently occurs in the practice the day after a sedation patient. The dental team fight over who is going to call the patient on the phone to follow up. It used to be the opposite where the task was uncomfortable. Now with sedation, our patients are singing our praises the very next day. Who doesn’t love to receive praise? I encourage you to involve your team. The team enthusiasm is a rewards felt by all.

Financially, an investment of time and money will be required to begin providing sedation dentistry. Equipment and supplies are necessary and may involve an investment of up to $4000. Education of you and your team is necessary with a varied investment depending on the size of your team and your local certification requirements. Your total investment will easily be recovered with the additional fees that your sedation technique will generate. As an added bonus, your profit per hour will increase dramatically with sedation cases.The oral sedation formula that is presented in the DOCS seminar, “The Essentials of Oral Sedation”, is based on a carefully measured system that delivers the appropriately desired effect at the correct time. The system confidently provides the dental team with the ability to offer an all day appointment for extensive care and multiple procedures. During a second level seminar offered by DOCS, Dr. Jason Goodchild co-presents “The Complex Sedation Patient, 20 Hours Live.” This is an exploration of the use of sedatives for complex medical conditions, as well as live-patient demonstrations including patient interviews after recovery. Your confidence in the system will continue to grow and give you the energy to help your patients explore their possibilities. A safe place within which that exploration can take place.

The last element of a matrix is a safe place within which exploration can take place. An office that is a matrix signifies that everyone that works in the practice must be a sanctuary for the patients and each other. In order to be a sanctuary, our team must never judge, criticize or gossip. This provides an arena for everyone’s self-acceptance and growth. Our sedation patients have marvelous emotion detectors that can feel the integrity of this policy and flourish in its environment. Each contact our patients have with our office should emanate the intent of safety. Your new sedation patients should feel that their fear is understood. From the very first call to a reception area void of fear invoking information through financial arrangements and scheduling, should all be part of our symphony of safety. Our own safety is equally as important. Here is where a shift in philosophy may be required.

Imagine having the security of knowing that all sedation appointments were prepaid. Imagine having a reversed accounts receivables where you owe the patient dentistry. Shift your philosophy to patients paying for scheduling our time. This philosophy feels safe to the practitioner because high fear patients show up for their appointments. This also feels good to the high fear patient because it financially supports their emotional intent for a healthy mouth. In the “Essentials of Oral Sedation” we teach these fundamental financial arrangements for all new sedation patients. Marketing for sedation dentistry also requires safety. Advertising on the radio or print advertising should share this intent to never judge or criticize people. Due to neglect and procrastination these people already carry a heavy weight of shame. When a patient discovers our sedation practice through advertising, they are hesitant to call due to this shame. The Internet and websites can play an enormous role in marketing a sedation practice. Eighty percent of high fear patient will seek out a non-threatening, non-judgmental website prior to calling an office. This is because they need a safe place in which to explore the possibility.

The oral sedation formula has multiple levels of safety as well. Only adult patients are treated with the basic technique. A pulse-oximeter blood pressure monitor is used the moment our patients walk in our door and they are always with a trained member of the team through out treatment. A careful and complete medical history is utilized to assess a patients ASA (American Society of Anesthesiology) status, and only ASA I, ASA II and some ASA III patients are treated. An agonist reversal agent is available for use on an emergency basis for complete reversal of the sedative effects. With this conscious sedation formula we can temporarily lighten the level of sedation at any time to get x-rays, bite registrations or when it is time for dismissal. Airway management and emergency medical kits are also available. Imagine your practice with these three elements:
1. A source of possibility
2. A source of energy to explore that possibility
3. A safe place within which to explore the possibility

You can now see the power of a matrix and how a matrix can be created in your office with the incorporation of conscious sedation dentistry. I encourage each practitioner to learn about introducing conscious sedation dental care into their practice. There are a number of educational institutes that have courses in sedation. In order for us to best serve the people we are so committed to, and utilize our education for “miracles in the mouth”, apply the matrix to your practice.

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