Some top tips for great bleaching trays.pdf

Just wrote this for the staff here as we make our own bleaching trays. Am working on a handbook for all dental staff as part of a course we are planning here. Please feel free to enjoy
Some top tips for great bleaching trays.pdf

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Testimonials from our latest course

Many thanks to all who attended and for the lovely comments!

“Fab facilities”
“Excellent, good environment”
“Nice course room, excellent environment”
“Great venue, I’m really jealous!”
“Lovely modern practice with excellent facilities, lovely lunch too!”
“Really enjoyed the day, found it very interesting and helpful. Very clean tidy venue”
“Very pleasant setting / surrounding with good refreshments”
“Great facilities”

Dr Rob Endicott BDSRestorative, Implant and Sedation Dentist

Www.phobiadentist.com
Www.stratforddental.co.uk

Stratford Dental
Aintree Road
Stratford upon Avon CV37 9FL
01789 292398

Relative Analgesia in Practice Part Four

Dental treatment for those who don’t feel they require being “knocked out”

This is something I come across a lot. A patient who is obviously nervous, really isn’t looking forward to a procedure but has decided to go through it anyway. Maybe the patient feels that they “should” be brave, it’s what’s expected of them as a patient.

Dare I say, I’ve been in a position myself when I’ve been in hospital, about to have an unpleasant procedure and feeling guilty asking for anaesthesia. I’ve had dental treatment before where I’ve asked for sedation and I’ve been told “ahh, you don’t need that”.

I am a great believer in healthcare guilt and have written about it many times before. Patients often feel guilty that they have let their oral health slide. They feel guilty asking for help, asking for pain relief. They feel like they are going to get a bollocking from their dentist or hygienist. (By the way, if you think that your team doesn’t think like that, how many times have you heard a team member say “how could Mrs X let her teeth get that bad! It happens in my practice sometimes)

If the culture in the practice changes, great things can be acheived for patient comfort. For example, rather than offering sedation as an option for implants, simply saying “we tend to use sedation for this procedure” makes the patient feel like their comfort is very much caterered for and not something that they have to opt in to.

RA is great for this. For the patient who is to undergo an extraction for example, saying “we often give happy air for extractions as it makes it much comfortable” rather than the standard line “we offer sedation for nervous people”

Dr Rob Endicott is a General Dentist and Sedationist based in Stratford upon Avon, carrying out dentistry for patients under sedation almost every day.
Http://Www.phobiadentist.com

Saturday March 23rd sees the training centre at Stratford Dental (www.stratforddental.co.uk) hosting an RA training day with Dr Richard Charon, the RA Coach (www.the-RA-coach.co.uk) for the whole dental team.

Relative Analgesia in Practice Part three

Treating Children without setting up a damaging future phobia.

Young people who need dental treatment present a difficult challenge. There are so many adults out there who have neglected their oral health because of the memory of atrocious dental treatment when they were younger. Patients we come across everyday in practice.

It makes me feel much more responsible that not only are we trying to sort out any dental issues right now but what we do may set a tone for compliance in the future. I don’t want to be the one that gets blamed for putting someone off great dentistry in the future.

This is where RA fits in beautifully. Treating children becomes a lot easier when there anxiousness levels are reduced and their analgesic levels are increased. Giving a local becomes almost in-perceivable to the patient and the RA helps a better depth of general analgesia, making for a more comfortable experience.

Dr Rob Endicott is a General Dentist and Sedationist based in Stratford upon Avon, carrying out dentistry for patients under sedation almost every day.
Http://Www.phobiadentist.com

Saturday March 23rd sees the training centre at Stratford Dental (www.stratforddental.co.uk) hosting an RA training day with Dr Richard Charon, the RA Coach (www.the-RA-coach.co.uk) for the whole dental team.

Relative Analgesia in Practice, part two

Patients losing a day

With IV sedation there’s no way a patient is trying to make it home on their own afterwards. I did have a case once of a late teenage boy who brought his mum with him, they had both signed the appropriate consent forms, including the escort instructions, I took a tooth out under sedation and unbeknownst to us, she had changed her mind and left. The young lad waited in the waiting room, phoned her and then discharged himself, tried to walk home and ended up asleep on a bank round the corner from the practice!

Even with verbal and signed written consent in advance to bring an escort, patients can arrive for an appointment and say “I’ll just order a taxi”. Of course we then refuse to treat them.

With “Happy Air” nitrous oxide, it’s quite different. The patient is still fully consented but they don’t need to being someone with them. They can even drive to their appointment and return to work afterwards.

This means that life starts to get simpler for all of us! We can consent and treat at the same visit which means we can use it opportunistically.

I love the effect nitrous oxide has on the gag reflex. I have treated the most crazy of gag reflexes using RA. I love the fact that for a while after the RA the gag reflex is still reduced.

Two patients we saw last week.
Patient A was a chap who needs a bridge but we need to plan it first using a wax up. He’s got a pretty bad gag reflex so impression taking was going to be interesting.
After 5 minutes of RA at 40% NO2, I took a lower alginate. nothing! We took the mask off so I could get better access anteriorly. Upper alginate – nothing!

The patient reported that he thought he could feel a gag reflex trying to start but it wouldn’t properly appear. There wasn’t any nausea at all.
He’s now asked to have Happy Air for everything! No problem!

The second chap has the most incredible sounding gag reflex. You know how some people just make slight retching sounds? This guy is can be heard outside the building, even when a mirror touches the side of his tongue.

Everyone in the practice knows about this chap, but in a nice way. He’s a great guy (beats me at table football though) and is really easy to get on with. I think though that over the years, previous dentists have been dreading the thought of ever doing posterior restorations on him.

He comes in one day with a lingual cusp fracture on a lower right posterior amalgam filled tooth. Colleagues said “good luck trying to sort this tooth out!”

I did an opportunistic 10min Happy Air trial session with him, 5 minutes at again 40%NO2 and the gag went completely.

We then saw him a few days later, uses the same dose, put in an ID block, he was able to communicate how numb it was and how comfy he was. Good skin peripheral analgesia, it’s a very nice sensation.

We did the composite restoration for him totally without event. Afterwards he said “would have loved to have seen you try that without Nitrous!”

He drank coffee in the waiting room for about half and hour and then drive back to work.

I’d had my RA machine for years but had got so tied up in IV, I had neglected to realise the potential. So i got to spend some time with Richard Charon in Newbury.

Richard is a great proponent of RA and lectures all over the world. He trains many dentists hygienists and therapists every year to practically allow them the next day to introduce RA to their practices, to start making a huge difference to their patients.

Dr Rob Endicott is a General Dentist and Sedationist based in Stratford upon Avon, carrying out dentistry for patients under sedation almost every day.
Http://Www.phobiadentist.com

Saturday March 23rd sees the training centre at Stratford Dental (www.stratforddental.co.uk) hosting an RA training day with Dr Richard Charon, the RA Coach (www.the-RA-coach.co.uk) for the whole dental team.

Relative Analgesia in Practice Part One

My Relative Analgesia “Happy Air” experience in General Practice
bart-scared

I am delighted to help host the Richard Charon Inhalation Sedation training event on Saturday 27th March 2013 in our modern training facility in Stratford upon Avon. I can highly recommend Richards approach to handling nervous patients and its great to do a day like this and go away fully prepared to start using these techniques.

I have been involved in IV sedation for quite a few years, carrying out over 1000 sedation dental procedures. I am used to it, I like the technique, I like how it makes people feel and I know that even the most phobic patients, those who haven’t been for 20 years, can be treated with the minimum of fuss, pain free and anxiety free.

However, there are quite a few problems and barriers I have come across on my Dental Sedation Journey. I’ll run through them over the coming articles and then explain how Relative Analgesia with Nitrous Oxide has helped me and my patients overcome them. Hopefully you’ll get to see how much more it is possible to become a “Hero” to our patients!

Richard has helped me to understand that IV is not the “be all and end all” and having an “armamentarium” of sedation techniques means we can help the most people with the widest range of comfort levels and dental needs.

The topics I am going to cover are:

Easing Patients expense, making sedation more affordable

Patient having to lose a whole day

Treating Children more easily, so helping to prevent future phobias

Those who don’t feel that things are bad enough to require “knocking out”

Hygienists and therapists making patients lives easier on a day to day basis.

Lets talk about Patient Expense.

In my private practice, I allow generally an hour for an IV sedation session. Once I have consented the patient again, confirm the treatment plan and gone through aftercare, cannulated, induced, reached end point, I am ready to start dentistry. This may be 15-20minutes into the session already.

I can then do about 30 minutes dentistry, take out a few teeth, do lots of root surface debridement or maybe a few fillings.

Then the patient recovers and is ready to go 50 or so minutes after they came in.

This is fine, I enjoy working like that but it does mean that what could be a simple extraction ends up being unaffordable for a lot of people.

I could finish the procedure, get the patient out of the chair, into a wheelchair and out into a recovery facility with a recovery nurse but I always feel I’ve got part of my brain in with them. I’m also conscious that as its just me doing IV, if the sedation was complex or difficult and my attention is required, I have to leave another potentially sedated patient. One thing at a time for me…..

Since my coaching with Richard, I have been able to do more RA procedures in half the time with patients feeling very relaxed and with really great analgesia from the nitrous. They recover in the chair in two minutes and are on their way home in 15 or so. This makes safety even better and allows me better control over my working situation.

So the patients who want “oblivion” get the IV, those who want to make it pleasant and really comfortable, I can use RA. It actually opens up my market of patients to those who are on more of a budget whilst still providing a chargeable service to my patients.

The next thing I will talk about is patients having to lose a whole day because if dentistry. Thanks for reading!

Dr Rob Endicott is a General Dentist and Sedationist based in Stratford upon Avon, carrying out dentistry for patients under sedation almost every day.
Http://Www.phobiadentist.com

Saturday March 23rd sees the training centre at Stratford Dental (www.stratforddental.co.uk) hosting an RA training day with Dr Richard Charon, the RA Coach (www.the-RA-coach.co.uk) for the whole dental team.