Gas v's injection

Capri

Customer of mine from US is getting some procedeure done and needs to be sedeted - he's wondering why gas isn't used here ?

btkm8unsl0w5r4

Gas is used here. The effects of NoS is mild and generally only allows relaxation during the giving of local anaesthetic. It works well for children mostly. Most dentists dont use it cause they dont need to. Dentists are skilled at doing minor surgical proceedures under local anaesthetic only.

Elfski

Most dentists don't provide it because:
1. It requires further study and training to be able to provide it
2. It costs a lot of money to set it up in a dental practice
3. Many dentists seem to think patients don't need it.

It's a pity that:
1. Undergraduate training is lacking and insufficient
2. No incentives or financial aid is provided to help set it up
3. Many dentists are blind to the fact that a large number of their patients of all ages are terrified to have basic dentistry performed under local anaesthetic alone and this mild form of sedation can help.

Your response fitzem is a poor one and does not paint a good picture for those who provide it.
I am surprised with your response as you seem to think those who provide sedation lack skill. Maybe you feel that way, believe me many patients are very appreciative of these other skills.

btkm8unsl0w5r4

Elfski wrote: »

Most dentists don't provide it because:
1. It requires further study and training to be able to provide it
2. It costs a lot of money to set it up in a dental practice
3. Many dentists seem to think patients don't need it.

It's a pity that:
1. Undergraduate training is lacking and insufficient
2. No incentives or financial aid is provided to help set it up
3. Many dentists are blind to the fact that a large number of their patients of all ages are terrified to have basic dentistry performed under local anaesthetic alone and this mild form of sedation can help.

Your response fitzem is a poor one and does not paint a good picture for those who provide it.
I am surprised with your response as you seem to think those who provide sedation lack skill. Maybe you feel that way, believe me many patients are very appreciative of these other skills.

I have used and am trained in NoS and IV sedation. Its not hard to train with it nor does it take a long time. The equipment is expensive for inhalation sedation, IV sedation is cheap enough. Dentists are very well aware of patients fears of dental treatment.

However Inhalation sedation on adults doesnt do very much, IV sedation is much more profound. NoS more of a placebo. A dentists with good la technique will be able with time and patience to get even a phobic patient to tolerate routine treatment under LA. Patients are also unwilling to spend the large amount of extra money required to have treatment this way.

So if you reread my post you will see I said that there are a large number of dentists that provide treatment under NoS and IV sedation in Ireland. The majority do not because the majority of patients do not require it. Most dentists doing sedation techniques will stick with IV sedation or oral sedation as NoS has a limited benefit at best.

Elfski

Again your response leaves a lot to be desired.
I have read your first post, you do not mention how many dentists provide inhalation sedation, your second post mentions a " large number" of dentists providing sedation in Ireland. If you go to the April 2011 JIDA the article seems to inform us that very few dentists provide sedation at all. http://www.dentist.ie/_fileupload/2011%2057%20No_%202%20-%20April%20May.pdf

I never mentioned the further study required to use inhalation sedation being long or difficult, I mentioned it was necessary. In saying that one of the only courses available for the general dentist to learn about inhalation sedation is a 1.5 year part time postgraduate.

The lack of exposure to inhalation sedation as an undergraduate can unfortunately led to the attitude towards inhalation sedation that we see in fitgeme's responses.
Placebo, only good for giving anaesthetic, only good for children etc.
Really ? The training you received taught you this ? ....... Really ?

A skilled inhalation provider uses hypnotic suggestion along with the nitrous oxide to help the patient stay in a relaxed, anxious free state of mind. The patient may be of any age and does not need to be a child.

The OP was about why it isn't available, I was explaining why it wasn't, you were making it seem like it was a waste of time, am just disagreeing

btkm8unsl0w5r4

And what is your background in this? It is available so the OP's answer is that you can get it in at least 5 dentist I know of in Dublin. The article you linked to is from 6 year old data.

And yes, hypnotic suggestion is the dentist way of talking to enhance the mild effect it has, any woman that has used gas for childbirth can tell you its effects on its own. My only experience is treating special need patients as a registrar in a children's hospital, and yes the gas is used along with relaxing words to calm patients. I have found that relaxing words alone allow the vast majority of adult patients to have treatment comfortably. If you want something that is more profound then IV sedation is the only way to go for adults.

What exactly is it you desire from my answers other than my opinion? Would I be right in suggesting you have a clinic that possible provides inhalation sedation, it seem to be a particular interest of yours.

Elfski

My desire is for a highly qualified specialist dentist with a wealth of experience and knowledge to not be so flippant about the uses, effects and worth of nitrous oxide in dentistry today. I also desire the answers to be thought out and not hastily rushed. You are a moderator, your posts hold some weight.
I responded to your comment because yes obviously I do provide it. I tend to comment on things i know about. Your tone seems to imply that is a bad thing, I don't understand why.

And really, commenting on the link and trying to disregard it because it is 6 years old? Now you are showing your rushed responses. Alot of the dentistry we do is based on evidence from more than 6 years ago. So what if its 6 years old - do you think we have seen an influx of qualified dentists providing inhalation sedation in those 6 years? I would guess no, so I feel that data is still relevant, maybe you don't.
I entered the thread as I felt your first comment was disregarding a form of sedation which for some people is the only option for access to dental care, you know better than to be so dismissive of it.

Capri

If I may interrupt this 'technical' discussion - my customer was satisfied with the outcome but I don't use Irish dentists because none of them provide a 'welcoming' scenario. Basically the attitude seems to be - WE'LL do the talking and you've got to trust us to know best :mad:

I get my work done in a 'Third world' country where they ask you what YOU would like done, they show you your teeth on video and the problem areas, as well as x-rays, and all for a fraction of Irish costs ( strangely there seems to be no competition on pricing here - €5-10 difference EVERYWHERE in Dublin anyway )

Maybe Irish dentists should study Marketing and Sales as well as Dentistry :rolleyes:

InTheTrees

I had heard that its almost impossible to guard aganst leakage of NOS in a dentists office and that as a result dentists who provided NOS were being over exposed to it. And its not without dangers especially with long term exposure.

Is there any truth to this?

Elfski

Capri wrote: »

If I may interrupt this 'technical' discussion - my customer was satisfied with the outcome but I don't use Irish dentists because none of them provide a 'welcoming' scenario. Basically the attitude seems to be - WE'LL do the talking and you've got to trust us to know best :mad:

I get my work done in a 'Third world' country where they ask you what YOU would like done, they show you your teeth on video and the problem areas, as well as x-rays, and all for a fraction of Irish costs ( strangely there seems to be no competition on pricing here - €5-10 difference EVERYWHERE in Dublin anyway )

Maybe Irish dentists should study Marketing and Sales as well as Dentistry :rolleyes:

I don't know what business you are in but as a dentist I cannot and will not provide treatment that is not proper or necessary.
I had a patient come in to me last week, she thought she had evil demons in her teeth, she WANTED me to take them all out, they were healthy, I did not do it, that is the correct thing to do.
I am happy you have found a dentist that can take care of your dental issues, when dentistry in Ireland become more about sales and marketing I for one will be leaving the profession. Don't worry mate, Irish dentistry is going that way, give it 10 years ......
As for the cost and lack of competition, maybe that is because that is the actual cost of providing the service in THIS country. Not sure what" 3rd world" country you go to for dental treatment and I don't know what job you have, but the question I have is, would you make the same money in this "3rd world" country as you do here ? Does it cost the same to rent/buy a property there as it is here ?
Did you know that dental materials from suppliers are cheaper to buy in other countries also? Some countries even subsidise private dental treatment by giving lump sums of money to private dentists in the community....you have to compare like for like.

Elfski

InTheTrees wrote: »

I had heard that its almost impossible to guard aganst leakage of NOS in a dentists office and that as a result dentists who provided NOS were being over exposed to it. And its not without dangers especially with long term exposure.

Is there any truth to this?

There are procedures in place that help reduce the amount of exposure of nitrous oxide, active scavenging, good ventilation, regular servicing and optional monitoring. Evidence is poor on the effects of exposure in the dental setting, however it is real......but then again we expose ourselves to mercury everyday we place and remove those silver fillings.... sucks to be us

btkm8unsl0w5r4

Capri wrote: »

If I may interrupt this 'technical' discussion - my customer was satisfied with the outcome but I don't use Irish dentists because none of them provide a 'welcoming' scenario. Basically the attitude seems to be - WE'LL do the talking and you've got to trust us to know best :mad:

I get my work done in a 'Third world' country where they ask you what YOU would like done, they show you your teeth on video and the problem areas, as well as x-rays, and all for a fraction of Irish costs ( strangely there seems to be no competition on pricing here - €5-10 difference EVERYWHERE in Dublin anyway )

Maybe Irish dentists should study Marketing and Sales as well as Dentistry :rolleyes:

Problem is you go to a sales man you get sold treatment, usually gross over treatment. A good dentist is not in the game of selling dental treatment to patients, but there to advise patients based on their desires and disease status. Despite what you would think regardless of what photo you are shown, it's very easy for a unethical dentist to recommend unnecessary treatment, the patient that thinks they are savy is the easiest mark.

Elfinski...6 year is a long time for a survey, it's not a scientific empirical study and it's External validity degrades drastically with time, 6 years is a long time epically sine the DDH sedation course started since then,and the paediatric and special needs postgraduate courses started all of which produce dentists trained with nos. so yes I do know there are a lot more now than then using gas. I don't dismiss gas sedation but it's only needed for some patients and there are stronger alternatives, that's why so relatively few dentist provide it. Your time would be better spent posting what you feel the advantages of nos are and how your patients like ut, than attacking my posts, educate me on your opinion not on why mine is invalid, that's what the forum is for...discussion. Attack the post not the poster please, your input is welcomed but please don't think I don't think out my posts, moderating this forum for 8 years, and I can spot a thread with a chip about "irish' dentists a mile off, being concise usually stop these escalating.....

Mingetoad

I really do think you are underestimating the benefits of nitrous oxide Fitzgeme. I have used both Nitrous and IV sedation. Obviously IV gives a deeper sedation and is more suitable for the true phobic. To say that nitrous doesn't do very much on adults is an underestimation of the psychology involved I feel. PArt of my training was to use it to experience it. Beleive me, it has quite an effect! Look at how many of our patients are apprehensive/anxious about treatments, rather than truly phobic. These patients benefit greatly from the mild sedative effect of nitrous. It is very easy to administer, safe and the effects are gone very quickly. Patients do not need a tv screen to undergo dental treatment, nor do they need music/a massage chair etc. Were nitrous a more dangerous chemical/medicine I would understand but it is proven to be very safe. If it gives somebody a vastly improved experience in the dental chair who are we to say they dont "need" it?

btkm8unsl0w5r4

Wow mingtoad you put your view across contrary to mine in a logical concise way without personally abusing me, points well taken. Yes I realise that it's a help, I have had to inhale myself when training, and I found its effects are mild in the sedative hierarchy. But anyway that was not my origional point, any patient that wants nitrous can get it, there are plenty of dentists who proved it, two on this thread. Why don't dentists use it more...cause patients like the op won't pay for it. I am nobody to say patients don't need it, but the fact that 99% of dental treatment in the country proceeds successfully with only good local anaesthetic would suggest its not entirely necessary for most patients. Want it...maybe.