Correction to the previous sedation post

Just a small correction - In one section I indicated you need a class III permit for oral sedation.  In the next paragraph I show where the Utah law indicates you need a class II permit with additional training for oral sedation.  To clarify - you do not need a class III permit for oral sedation in Utah.  Thanks

What is sedation or "sleep" dentistry?

In this post I will try to quickly and clearly explain what sedation and anxiolysis mean in dentistry.  This is not designed to be a legal or complete explanation but hopefully will help people understand what they hear on those radio adds.

First some definitions -
     Anxiolysis - the process of decreasing a persons anxiety with medications.  This just takes the edge off so the person is a little more relaxed.
     Sedation -  Also called conscious sedation is a minimally depressed level of consciousness but the person can still breath on their own and respond to verbal commands (like open wider, turn this way, etc) and is produced by pharmacological (medications) means .
     Oral Sedation - same as sedation above but the person takes pills or has a pill dissolve under their tongue
     IV sedation - same as sedation above but the person has an IV and the medication is given directly through the IV.
     Deep sedation and General Anesthesia - Controlled state of depressed consciousness with partial (deep) or total (General) loss of protective reflexes (no gag reflex and you may not breath for yourself or respond to verbal or physical commands) caused by medications.

Now to the purpose - sedation dentistry allows the dentist to work more effectively because the patient is calm and comfortable with the use of medications given orally (swallow a pill) Sublingually (pill placed under the tongue) or through an IV.

Medications - there are a multitude of medications used but most are the benzodiazepine class such as Valium or halcion.  Other medications include antihistamines like hydroxyzine and insomnia medications like zaleplon.

Now to the laws in Utah - the exact laws can be found at

http://dopl.utah.gov/laws/R156-69.pdf which is the Utah department of professional licencing.  Here is a quick summary -

First a dentist must have the appropriate training. In Utah there are 4 anesthesia classes or permits. A class II permit is required for using nitrous oxide (laughing gas) and anxiolysis (lower dose of a medication taken the night before a procedure or one hour before a procedure to calm the person - but additional medications are not given)
Class III permit is required for Oral sedation - this often uses the same medication given for anxiolysis but in a higher dose, in repeated doses, or dissolved under the tongue (it absorbs faster than through the stomach) until you get the person more comfortable.
Class IV permit requires much more training and is needed for deeper sedation - often the dentist can bring in a nurse anesthetist or anesthesiologist for deeper sedation.

Most dentists can get a class II permit with their training in dental school and with the DEA licence to prescribe medications or to provide nitrous oxide and anxiolysis.  They can also give minimal sedation with a Class II permit if they can show 16 hours of training.

Utah just passed a law concerning oral sedation -
Effective February 7, 2011: Utah Administrative Code § R156-69-202 requires dentists to complete at least 16 hours of instructive classroom training with clinically-oriented experiences and obtain a Class 2 permit before providing their patients with minimal sedation using oral sedatives (with or without nitrous)*

A Class III permit requires 60 hours of additional training and at least 20 supervised cases for IV sedation. 
In any type of sedation the patient should be monitored with pulse, oxygen, and blood pressure during the procedure. 
All patients that take even an anxiolytic medication should have someone there to drive them after the procedure. 

At Bauman Endodontics we offer the full range of services with Dr Bauman providing nitrous oxide and anxiolytic medications if needed before a procedure.  Most patients who are anxious do very well with a pill one hour before the procedure.  We also have an anesthesiologist that can come to the office for someone who wants sedation or deeper sedation.  The sedation has additional costs but may be worth it for some patients.

Finally - what about the adds I hear that promote "sleep dentistry"!  The object of sedation dentistry is not to put the person to sleep or to make sure they are "out" - sometimes people relax enough to fall asleep but that is just very relaxed.  The goal is to sedate or relax a person.  To really put a person to "sleep" in the anesthesia realm requires a general or deep sedation.

Sorry this is a long post!  Hope it is informative.  If you have specific questions or want more information posted about this subject please e-mail you questions to baumanendo@gmail.com

If you want more details about Dr Bauman or endodontics (root canals) you can contact Bauman Endodontics at 801-590-8687 or visit the website at www.baumanendo.com.

More examples of failing root canals because of missed canals

This is an addition to the last post.  Once again, it is easy to put successful images up but sometimes it is not possible to find additional canals because they are so small and often calcified.  I will address calcification in another post.  I am adding this post to show that there are other teeth that can have missed canals.  Upper first molars are probably the ones I see the most but almost any tooth can have an unusual anatomy. 

This one is similar to the previous picture. The same root on the right called MB2 has an additional canal.  This is an upper first molar.

This one is a bottom tooth.  The really white part you see is the metal foundation of the crown.  You can see the root on the left side in the second image has an additional canal treated which solved the pain problem for this patient.

This last one is tooth #19 and it is a little less common.  In the first image you see three canals treated.  Most often there are 3 or 4 canals for this tooth.  However, when there are 4 there are usually 2 in the mesial or front root (the one toward the midline of the mouth) and 2 is the distal or back root.  As you can see in the second film this one has 3 canals in the mesial roots (left root as you look at the picture).  This canal is called the middle mesial canal (because it is between the other mesial canals).  This is the type of canal that can lead to a tooth with 5 or 6 canals.  This is not very common but can often be the cause for a root canal that is not working. 

Why do I need my root canal retreated? - Answer 1

Pre retreatment picture - notice the white filling on the right

Post retreatment image - see the additional canal treated on the right

There are many reasons why your root canal needs to be redone and with this post I will address one reason.  Probably the most common reason I encounter is an extra missed canal.  Before I begin I want to make it very clear that these are not always easy to find or treat.  Sometimes I know there is one there and I drill down a root trying to treat the canal.  Eventually I have to weigh the risks of drilling down a root with the risks of leaving the canal untreated.  Luckily root canals are very successful and most of the time they work well even if we can't get down the root, but I love to find and treat these extra canals.  It is challenging and fun. 
Now onto the images above.  This is a radiograph (or x-ray) of a tooth with a root canal.  The first image was how it presented.  The patient had an abscess or pimple on the gums next to the tooth.  This is simply a path for infection to drain from the root tip out of the bone.  If you look at the first image you can see 3 canals that were treated.  The canal on the right is inside a root we call the MB root.  MB stands for mesial buccal or toward the midline and toward the cheek because this root is oriented toward the midline of the teeth and toward the cheek relative to the entire tooth.  This is the root that tends to have more than one canal.  We call the canals MB1 and MB2 because they are both located in the MB root.  In the second image you can see after we retreated the tooth and located the second canal or MB2.  The pimple healed and the tooth has felt better since cleaning the bacteria out of the second MB canal.
So does your tooth have an "extra" canal.  It is hard to say because there is so much variability with teeth.  Some upper molars have one canal, some two, most have three or four and occasionally they can have more than four.  So I always look for four and expect to find four or more.   If you have a question concerning your upper molar or root canal visit our website www.baumanendo.com or call our office at 801-793-8822 for more information.

Bauman Endodontics Blog

Welcome to the Bauman Endodontics Blog!  I (Rich Bauman) am very excited about the opportunity to share some information about myself, my patient care philosophy, and more importantly about endodontics or root canals.  I am married to Meredith and have two children.  We are thrilled to be living in Utah and love the outdoors, family, and fun available here.  I studied at the University of Utah for my undergraduate degree, the University of Kentucky for dental school, the VA hospital for a general practice residency and the University of Louisville for my endodontic specialty training and masters degree.  Thank you for visiting the blog and I hope you enjoy the information available through this blog.

With time I will be answering some of the most common questions I am asked like -

                   why do I need a root canal?

                   why do I need to have my root canal redone?

                   why did my dentist refer me for this root canal?

I would also love to respond to questions you may have.  Please send me questions by e-mail at baumanendo@gmail.com.  For more information on Bauman Endodontics located in Murray Utah you can also visit our website  www.baumanendo.com or call 801-590-8687.

Thank you for your interest in Bauman Endodontics.