Media Monday: Lamar goes to the dentist

Comments (17)

1. 

   Jimmy Monday - 13 / 08 / 2012 Reply

   Why is being under general anesthesia "bad?" Would it have been better to have Odom suffer through all the work awake and full of anxiety? Even though it is non-traditional in terms of a "regular" dental visit, did the appointment and anesthesia do him and the profession a disservice? -Jimmy
2. 

   Brian Monday - 13 / 08 / 2012 Reply

   If you had Odom awake, I'm sure he would have hated the dentist and never show up again for another 6-7 years. Imagine if he was awake, nobody can sit for 7 hours with their mouth open. He'll be fidgeting etc, and prob would have taken more like 12 hours. If you had separated the appointments, then that means it would have taken 1/2 year to complete, and good chance he'll quit half way and not have some of the work done. A dentist would lose chair time, half the treatment plan, networking opportunities, referrals, if he had chosen to insist on just local anesthesia.
3. 

   Carolyn Norton Monday - 13 / 08 / 2012 Reply

   I definitely agree with all of your points. Recall and follow through with the treatment plan could have been an issue if we did all of this under local anesthesia and multiple appointments. On the other hand, if he did go to the dentist regularly and followed a treatment plan, preventive care and good oral hygiene habits could be more effectively established. I also think that general anesthesia should not be used unless absolutely necessary for the patient. Lamar Odom is also extremely wealthy. I don't think anyone in my patient pool can afford to do what Lamar did. I think there are pros and cons to both sides of this argument. It's all about what is best for each patient based on their individual needs. ~Carolyn Norton, Florida '14, Contributing Editor
4. 

   Jimmy Monday - 13 / 08 / 2012 Reply

   Although I agree that general anesthesia is a very defined treatment option, to cast dispersions that it a bad or "last resort" treatment option is perhaps misleading. You may not see the need in a general dental population in dental school, but consider the patient with special needs, the pre-cooperative 3 year old with early childhood caries, or the severe dental phobic who simply finds conventional dental treatment threatening and traumatic. Patients that we have outlined above DO exist. The ADA has published guidelines on the use of sedation and general anesthesia for use within a dental office setting, and pediatric dentists or those dentists who have trained in a GPR program are well accustomed to the general anesthesia modality of treatment. For example, I have a recurring patient that is 32 years old and has Down syndrome. He is otherwise very healthy and takes no medications, but he simply lacks the capacity to brush his teeth or go to the dentist regularly. I administer general anesthesia to him once a year to have his scaling and root planing, restorative, and fixed procedures done that otherwise would not occur. I don't think it is "bad" per se, but a treatment option. How else could this individual have his needs taken care of? To deem a procedure or treatment "bad" in this article sends the message that it really shouldn't be done. If Odom has certain fears and phobias about dental work, why not opt for general anesthesia? The stigma of a celebrity affording general anesthesia is also misplaced. Thousands of children, many of whom are covered under state medical and dental insurance, are treated in office based settings under general anesthesia at a nominal cost to the patient vs. a hospital surgery. -Jimmy
5. 

   Olga Monday - 13 / 08 / 2012 Reply

   Carolyn, I enjoyed your article and thought you made some excellent points. While general anesthesia is certainly necessary for patients with special needs, young children with rampant decay, and those with extreme phobias, I do feel that Lamar's phobia did not appear serious in the episode. There are many complications associated with general anesthesia, and his required treatment may have been much less extensive had he visited his dentist on a more frequent basis. I am a strong proponent of preventive dentistry, and by visiting the dentist regularly, you save money in the long run. It is important for patients to realize that your oral health has a strong impact on your systemic health, and is not something that should be put off for years at a time. I am glad that Lamar decided not to wait 6-7 years for his next appointment!
6. 

   Dentist Anesthesiologist Monday - 13 / 08 / 2012 Reply

   I agree with Jimmy & Brian. While Lamar Odom carries a higher profile, patients of all ages and dental needs undergo sedation and/or general anesthesia in dental offices throughout the country. The American Society of Dentist Anesthesiologists @ www.asdahq.org is an excellent resource to find a provider in your area.
7. 

   Brian Monday - 13 / 08 / 2012 Reply

   There was a reason why Odom didn't see a dentist for 6-7 years, with anesthesia, it made him want to go on a regular basis now. Of course, everybody wants preventative dentistry, but in reality it can not be done on every single patient. Unless, of course you are willing to pay him a visit every day to brush his teeth for him. As far as expense goes, I'm willing to bet lots of money the dentistry cost more than the anesthesia. In fact, I bet the anesthesia was only 10% of the total cost. To say this treatment is out of reach of "normal" people, that's not really true. Then to say there's many complications of General Anesthesia, is another myth. Odom was more likely to have died in a car accident getting to the office than from the anesthesia itself. If general anesthesia is killing people right and left in dental offices we would hear about it pretty fast. Yes, there was news reports of children dying from Oral Concious Sedation, but not general anesthesia. Why? I think there's more regulations that requires higher amount of training in providing general anesthesia than OCS.
8. 

   Zak Monday - 13 / 08 / 2012 Reply

   General anesthesia and sedation are viable options for the severely phobic patients and not just for the mentally challenged or children. There are 10's of thousands of patients who would never get their dental treatment done unless some anesthesia care is part of their management. While general anesthesia should never be taken lightly, it is still a safe alternatives for such patients who otherwise would never receive the care. Training/Education and the science and technoolgy of dental anesthesiology has continued to improve and develop over the years with a solid safety track. There are accredited residency programs that graduate dentists who focus their careers on the provision of anesthesia for dental and oral procedures both for adults and children. For more information log on to www.asdahq.org
9. 

   Michael Monday - 13 / 08 / 2012 Reply

   I find this discussion helpful for dentists who are on both sides of the issue. Just so I am clear as to which side of the issue I stand on, I am a Dentist Anesthesiologist and have been providing general anesthesia for other dentists for the past 18 years. My typical patient is not the celebrity in Beverly Hills but the fearful 3 year old child who is clinging to his mothers leg in the dental office. We have a disconnect between medicine and dentistry. In medicine, making patients comfortable is not seen as a luxury but rather the only humane way to treat someone. Take the 2 year old who needs PE Tubes, would your pediatrician suggest the child just sit still it will be over in 30 seconds? No way! They schedule her in the OR for general anesthesia. This procedure is frequently so quick it isn't even necessary to start an IV. Now take the same 2 year old who has 12, 8 or even just 4 carious lesions. How many would even think of providing general anesthesia for this child? Initially, probably none of us. Are PE tubes harder than a mouthful of caries? I'm not claiming that every child should be put under general anesthesia, but it is certainly an option for those who cannot cooperate. If this were your niece, would you want to strap her in a papoose board? Now for the skeptics that say, OK that is a child, but no adult would ever need general anesthesia. I had a chalzion in my upper eyelid. It is caused by a blocked oil duct. The excision would take less than a minute. One Ophthalmologist suggested removing it in the office under local, another scheduled the Operating Room under general anesthesia. Can you think of anything we do in dentistry that would be more invasive or take longer? I can. Pain and anxiety control should not be limited to local anesthesia. For patients who need it minimal, moderate or deep sedation, and general anesthesia should be an option.
10. 

    Jimmy Monday - 13 / 08 / 2012 Reply

    I think the really cool thing was that after his general anesthesia appointment, Lamar is NOT afraid anymore!!! Indeed, what Carolyn brings up is the best outcome from the entire procedure! -Jimmy
11. 

    Michael Monday - 13 / 08 / 2012 Reply

    One more comment I think is missing from the discussion. Lamar was put under general anesthesia by a Dentist Anesthesiologist. General anesthesia is the practice of dentistry. - Michael
12. 

    Salman Monday - 13 / 08 / 2012 Reply

    Carolyn, first off thank you for bringing light to the issue of general anesthesia/sedation in a dental environment. I'm simply glad to see that dental students are being exposed to this modality of treatment in a dental office setting-- even if it's through media coverage of a celebrity undergoing extensive dental treatment. The fact of the matter is that dentistry has been at the forefront of anesthesia progress in both the medical and dental communities (look up Horace Wells and T. G. Morton and their contributions to the practice of anesthesia). Our profession has been using some form of anxiety control for over a century, whether that be hypnosis, oral sedation, IV conscious sedation or even general anesthesia. The trend seems to be tipping towards a greater involvement of sedation/general anesthesia in all aspects of dentistry. It's a shame that with all the advances in anesthesia dental schools are still ill equipped to teach their students even the basics of anxiety and pain control. In my opinion this is what has given our profession the stigma of the wholesalers of pain and torture. Imagine if each dental student graduated with sufficient knowledge in both medicine and anesthesia to make their patients more comfortable during procedures. Not only would the profession be graduating both skilled and knowledgeable clinicians, it would also be improving patient experience with dentistry; as a result, profoundly changing public perception of the practice of dentistry. Now, why would that be BAD?
13. 

    Kim Schneider Tuesday - 14 / 08 / 2012 Reply

    Thanks for reading, everyone! I want to be clear that ASDA Editor Carolyn Norton didn't mean that dental anesthesia is "bad" but rather that Lamar's visit was very atypical and may give viewers the wrong impression of a typical dental visit. Dental students stay up-to-date on areas such as dental anesthesia and recently wrote an article about it's pending acceptance as an ADA specialty in the August issue of ASDA News. You can read that article here: http://editiondigital.net/publication/?i=121178&p=1 Thanks again for reading Mouthing Off and sharing your insight with us! ~Kim Schneider, ASDA communications editor
14. 

    Jimmy Tuesday - 14 / 08 / 2012 Reply

    Thanks for the link Kim! Excellent article, but I wanted to point out that the ASDA is not looking to "regulate' anesthesia at all. Rather, the ASDA is aiming to ensure Dentistry will always have the privilege to administer anesthesia as it always has, and to make sure our patients are safe, informed, and receive the highest quality care in terms of sedation and anesthesia delivery. Again, thanks to you and Carolyn for bringing these issues to the forefront! -Jimmy
15. 

    Kim Schneider Tuesday - 14 / 08 / 2012 Reply

    For anyone new to this comment chain, I want to clarify that Mouthing Off is the blog of ASDA: the American Student Dental Association. The ASDA, the American Society of Dentist Anesthesiologists is the group advocating for dental anesthesiology to become an ADA recognized specialty.
16. 

    Sam Tuesday - 14 / 08 / 2012 Reply

    Just wanted to let all the readers know that the fear associated with Mr Odom's dental appointment was not a Hollywood act and although "atypical for a dental visit", dental anesthesia was much needed for his treatment. Dentist anesthesiologists all over the country help many patients from almost all dental specialties and walks of life to receive the proper care they need in a safe environment. Unfortunately, many of the dental students have very minimal exposure to the field of dental anesthesia. However, I would highly recommend visiting a training program or shadowing a dentist anesthesiologist to fully understand the level of contribution of dentist anesthesiologist to the betterment of dental health and patient care.
17. 

    Katie Sowa Wednesday - 15 / 08 / 2012 Reply

    Editor's note: Perhaps using the words "upside" and "downside" have clarified the point of this well-written post by Carolyn.