Patient safety

Dear friends,

A while back, there was article in the Dallas Morning News that questioned the safety of being sedated in the dental office.  I wanted to provide you some information to reassure you and your patients that safety is very important.  Patient safety and comfort have always been very important to me. As a board certified oral and maxillofacial surgeon, I have taken the following steps over the years to improve patient safety in my office. This includes anesthesia training with active simulation mannequins for myself and my staff through the American Society of Dental Anesthesia, monthly in office emergency drills and working with the Texas State Board of Dental Examiners to help increase safety for patients throughout the state.

If you are a dentist, a sample emergency drill that you can customize for your office is available here. Work with it and modify it to suit your staff and your practice: 

general emergency written plan

I recently gave a lecture to the Dallas County Dental Society on managing and preventing medical emergencies in the dental office. It is available here:

DCDS medical emergencies lecture in pdf format

I also have assistants who are certified by the Dental Anesthesia Assistant National Certification Examination. I have BLS, ACLS and PALS certification and am licensed by the state board to provide general anesthesia.

My position with the investigation division as a part-time staff dentist with Texas State Board of Dental Examiners has also given me the opportunity to evaluate what happens in dental offices when things go wrong. I try my best to use this information to optimize the care and safety of patient care in my office. I also speak of this subject to other doctors to try and help their patient care as well. Patient safety is very much a team approach!

Many of you may also be aware that I’ve done additional training to help optimize the patient experience. This can also have a significant impact on safety. I have completed a two year Fellowship in Integrative Medicine through the University of Arizona School of Medicine.  One of the benefits of my fellowship training there is that it has given me the ability to utilize various non-pharmacological techniques to improve patient safety and comfort. We know that there are side effects with all medications and my goal as a surgeon is to make a procedure as safe and comfortable as possible while minimizing the medications that I use. Many of the negative outcomes involving sedation in a dental office are caused by higher dosages of sedation drugs. Unfortunately, as the dosages go up so do the complications. I have taken a multifaceted approach in my office to do what we can prior to the procedure to decrease the need for higher medications. Several of these approaches deal with decreasing preoperative stress. One simple example may involve specific breathing techniques to help alleviate stress and the increased sympathetic discharge that is taking place. Higher dosages of medications are often needed to blunt this “fight or flight” reaction if it is not reduced in other ways. Other approaches, especially for younger patients may involve a specific speaking style and word selection that utilizes my training through the American Society of Clinical Hypnosis to improve safety and comfort. I try to have a variety of “tools in my toolbox” to customize my approach for each individual patient. Every patient is different and I certainly feel the same about managing their anesthesia requirements.

I hope that you find this information helpful and allow you and your staff to help to reassure your patients.

 

Regards,

Robert G. McNeill, D.D.S., M.D.

 

The following are answers to a list of questions the Dallas Morning News article advised patients ask their dentist. To reassure both you and your patients that we make safety a priority I have outlined answers to these questions.

 

  1. Have you checked your dentist online via the state board website? I hold an active dental and medical license in the State of Texas without restrictions, suspensions or disciplinary action.
  2. Does your dentist put on fresh gloves before treating you? We do not reuse items such as gloves and try to use single use items as appropriate.
  3. Do you receive protective eyewear before treatment? Patients have the option of wearing protective eyewear such as their sunglasses. I have found this can interfere with nasal masks if being used and therefore can be difficult to use at times. The patient has the option of moist protectors being placed over the eyes if desired.
  4. Before treating or pulling a tooth, does your dentist verify that it’s the correct one? We verify the procedure to be performed prior to the start of the procedure. For several years we have been performing a surgical time out to make sure that the patient, staff and doctor are all on the same page. This is part of the reason that we very much appreciate a written referral prescription from a referring dentist.
  5. Does your dentist evaluate your current health and health history before drilling? We do evaluate your current health history prior to a procedure. One of the benefits or a pre-surgical consultation as a separate appointment is that it provides the ability to communicate with other doctors involved in the patient’s care when appropriate as well as discuss ways to best prepare for the procedure.
  6. Has your dentist recommended wisdom tooth extraction? As an oral surgeon I have seen too many cases of infections associated with wisdom teeth. I will also have a discussion about comparing the risks and benefits of removal with the patient being mindful that complications can increase as a patient ages.
  7. Are you considering dental sedation? The patient will determine what is appropriate for their situation. Many patients find sedation to be the most comfortable way to have oral surgery performed.
  8. Do you know how much emergency training and equipment your dentist has? We do many things in our office to optimize safety. These include anesthesia training with active simulation mannequins for myself and my staff through the American Society of Dental Anesthesia. We also have monthly in office emergency drills through the Institute of Medical Emergency Preparedness and the Six Links of Survival (this resource was mentioned in the DMN article). I also have assistants who are certified by the Dental Anesthesia Assistant National Certification Examination. As the doctor, I have basic life support (BLS), advanced cardiac life support (ACLS) and pediatric advanced life support (PALS) certifications. I am licensed by the state board to provide general anesthesia. We have an AED, airway supplies and an emergency drug cart available at all times.