Hi everyone. I'm Erica Spicer Mason with Becker's Healthcare.
Thank you so much for joining us today for the podcast.
We're thrilled to be joined today by Dr. Michael Silverman,
the c e o and co-founder of Strategic Dentistry,
who will discuss with us today how IV sedation can help grow dental practices
and dental service organizations. So, just a little bit about Dr.
Silverman. He's a globally recognized lecturer, educator, author,
and patients right advocate.
He's appeared in front of 28 dental boards to advocate for the right of dentists
to provide sedation in an environment of safe and reasonable regulations.
He lectures across the globe on methods, techniques,
and the power of sedation dentistry.
A graduate of the University of Pennsylvania School of Dental Medicine,
and a passionate believer in lifelong education,
he has changed the way tens of thousands of dentists practice.
He continues to impact dentistry as a champion of safe and effective,
minimal and moderate sedation.
As a faculty member and the president of the D O C S education,
he has taught over 30,000 dental professionals how to safely implement
sedation in their own practices. With that, Dr. Silverman,
thank you so much for joining us today.
Thank you so much for having me, Erica.
Great. Well, I think that bio alone speaks for itself.
You are quite the expert on this topic, so I'm really excited to dig in.
. Great.
So I'm wondering if you can just maybe start us out with saying a little bit
about IV sedation and who should add this technique to their services,
or I should say maybe this treatment to their services.
How would you describe it?
Yeah. I would add this service to their treatment regimen.
I think that when a dentist or a dental practice thinks about
implementing IV sedation,
it really fits beautifully with offices or
dentists who are performing longer,
more extensive treatment plans such as implant surgery,
implant dentistry, full mouth restorative, you know, wisdom teeth extractions,
um, extractions with full dentures, things that are pretty extensive.
IV sedation fits beautifully. It relaxes the patients.
It's also very well suited for those practices that have shorter appointments,
sort of like the, the two ends of the spectrum. Short,
very short appointments like when your endodontist and your periodontist whose
typical appointments are an hour or less. Um,
this is a way to using IV sedation to make the patient completely comfortable.
And because the medications wear off so quickly,
they can be released from the office in an efficient manner.
Another area that we see a lot of dental practices do very well with
IC IV sedation is where they happen to practice in a
community where it's difficult to find options for
patients to receive general dental care while sedated.
They can't go to an oral surgeon to have a tooth restored.
So if that community doesn't have other options, uh, a dentist that,
or a dental practice that incorporates sedation into that
community is very likely to get referrals from other general dentists for those
types of patients that require it.
One of the things just to think about IV sedation is that it's much more
efficient in the chair time as other places.
So high volume practices do very well with IV sedation as well.
Great. Thank you so much for sharing that.
It sounds like there are a lot of benefits upfront that I'm sensing already in
terms of, you know,
patient volume and being able to accommodate that efficiency and also making the
patient comfortable.
Yeah.
Um, so I'm wondering if you can speak to that a little bit more.
What patients do benefit the most from IV sedation?
Well,
patients that benefit the most from sedation and some specifically for IV
sedation.
So patients who have been without care for a long time often
come into dental practices due to the fact that the practice is providing
sedation and then they're going to have an extensive treatment plan.
And much of the dentistry can be done in fewer appointments when a
patient is sedated with IV sedation,
it's clear to most of the doctors and the managers listening that high fear
patients, anxious patients,
phobic patients are sort of the ideal candidates for this,
but also patients who just don't want repeat visits, um,
to come for an example, um,
if a patient arrives in the hygiene department and this patient
has some periodontal problems and is gonna require four quadrants of scaling and
replanning,
most offices due to insurance limitations are
strapped with four separate appointments because the insurance companies won't
pay for four quadrants to be done in one visit. However,
with IV sedation,
the insurance companies will pay for all four quadrants to be done at once,
which actually from a biological standpoint makes more sense anyway.
We all have had patients who have a,
a severe gag reflex or really a severe gag response
and IV sedation eliminates gag responses. Also,
we've had patients who are resistant to local anesthesia.
The redheads in our community supposedly have a higher
anesthesia, local anesthesia resistance, then the other population.
And by using IV sedation,
it lowers the pain threshold and therefore it allows the,
or raises the pain threshold and allows the patient to be completely
anesthetized. So I think that's probably Oh, yeah.
For diabetic patients, that's another consideration, Erica. Mm-hmm.
, um,
IV sedation is really better for a diabetic patient because you
really don't want a diabetic patient to go without food or water n P O for too
long because they could have a sugar crash in their system that could
create a serious medical problem.
And when we use IV sedation,
we're dripping with a dextrous solution that keeps the
diabetic patient's blood sugar level very level, very even.
So interesting.
It sounds like IV sedation really solves for a lot of
issues. You know, just the patient anxiety like you mentioned, which by the way,
I completely relate to being in the dentist chair.
very anxiety inducing experience for some of us.
And then of course considering diabetics as well,
just with the prevalence of that chronic condition throughout patient
populations. Um.
Erica, it's fascinating to me that at our events we
poll our audience often not every 15 minutes we have a poll,
and one of the polls that we do,
we put out there is confidentially on basically
this scale. How fearful are you of having dentistry done?
And we do this with dentists and hygienist and dental assistants and practice
managers. We're asking people in the dental field that practice dentistry
how fearful they are. And you wouldn't believe it.
It's almost consistent across the board. At every event that we do,
67% of dentists and dental team members have a significant amount
of fear of getting their dentistry done. It doesn't mean they don't get it done,
but there is a significant amount of fear still out there.
Wow. That's a really significant percentage.
So I'm sure this would speak to many patients.
Mm-hmm. .
So we've talked about all these great features of IV
sedation and mm-hmm. ,
what it can do for both practices and the patient.
But I'm wondering if there's any disadvantages of this option and what
would be the best ways to minimize any disadvantages here?
Well, that's a complex question.
Maybe what we should do is start with some of the advantages of IV sedation over
other sedation,
and then I can talk about the disadvantages and how we can ameliorate some of
those disadvantages by combining oral sedatives with IV
sedatives. Sure.
So advantages IV sedation is titrateable,
which means that you can give very small amounts of the sedative to the patient
into their vein until you get to a desired result. It,
it's very quick in, it's very quick out. Um,
the ability to deliver both a sedative and an
analgesic medication really helps for those doctors
and practices that are doing surgery.
So you can actually provide pain relief during the IV
sedative. Um,
another advantage is these patients who we call hypo responds,
these are patients that just don't seem to be able to get sedated.
A lot of them are are heavy smokers and it's very difficult
to sedate a person who smokes a lot of cigarettes. It takes a lot of, um,
tobacco, um, and using IV sedation because it's tri titrateable,
you can make those patients completely comfortable. Um,
and then we've already talked a little bit about the diabetic patient. Now,
hypoglycemia or low blood sugar could be a problem for patients,
but since you're dripping a dextro solution, um,
these patients can go without food or water before they arrive at the office.
We can provide them, as I'll talk about in a minute, some oral medication,
and then when we put them on the iv,
we can make sure their blood sugar doesn't drop. Another advantage would be,
um, it, it avoids dehydration. So if they're without food or water, n p o,
they can get dehydrated, which isn't a great thing either. Right.
So as far as the disadvantages go,
cuz I think we need to be upfront about all those, you know,
the medication itself that we use, the safest medications we use,
which are in the benzodiazepine family are very short acting.
The duration is pretty quick.
So if you were just doing IV sedation and say you'd had a three or four hour
dental appointment,
you would need to redose that person multiple times during the appointment.
However,
by adding an oral preload of a
sedative before the patient is put into the
operatory, you can avoid the frequent dosing.
It actually extends the iv, uh,
sedation life and it turns this disadvantage into an
advantage. Another disadvantage, and this is someone every,
everybody should be very cautious with,
is the potency of the medications that we use are very powerful.
And when you do provide those medications,
you need to be super judicious because it's titrateable,
it gives you that i that opportunity to add infinitesimal amounts until you get
the result almost immediately as you're watching. So there is, you can,
you can handle that, but it is a disadvantage. Um,
another disadvantage, oh, patients who are afraid of the needle,
what I call needle phobics mm-hmm. .
So if they're afraid of the needle,
they're gonna get a needle in their arm and they're gonna go, wait a minute,
you know? But if you give them that oral medication ahead of time,
it sedates them, it pres sedates them,
it takes the anxiety level down and it makes it easier for them to accept that
needle in the arm. And most times,
because of the amnesic effect of these benzodiazepines,
even in the oral formula, the patient won't even remember getting a needle.
They'll be wake up with a bandaid on their arm and that'll be about it. Um,
and then I talked a little bit before too about the quadrants scaling replanting
and the disadvantage of IV sedation is, you know,
you have to have this set up, the monitors you have to pay for training,
um, and those kinds of things,
but that can be offset with less chair time in the o in the patient chair time
because it's fast in and fast out and you can do more dentistry and once in
fact,
a lot of these patients will ask if you could do more while they're sedated
rather than stretching it out to extra appointments.
I hope that answers the question.
Very much.
So I really appreciate that thorough explanation and also the way that you kind
of framed how there are some disadvantages,
but they're navigatable and they can actually be flipped into advantages
Correct. For this option. So yeah. Yeah. Um,
I think that's a really helpful thing for our listeners to hear.
And this question that I wanna ask ne next,
I was planning to ask a little further into our conversation,
but I think it ties so nicely into what you were just saying. Um, you know,
if anyone's listening to this and they're thinking this might be an option for
their practice, they're probably wondering, okay,
to navigate these advantages or potential disadvantages or, you know,
the workarounds will their dental teams need special training to administer this
kind of treatment.
Yes, yes, yes, yes, yes, yes. Very important. So,
uh, when I, when, when,
maybe I'll get a chance to describe in one of your next questions more about our
program,
but our program requires our doctor participants
to bring at least one team member to the program
mm-hmm. and the team member being a dental assistant particularly,
it could be a hygienist, but a dental assistant would be best because, you know,
the dental team needs to be trained on how to monitor an
IV sedation patient. And after the patient has,
you know, is dismissed from the office appropriately,
which they need to know how to do as well,
they need to know how to transfer the data that's been stored on
this very sophisticated monitor that captures pulse and oxygen
and blood pressure and carbon dioxide and all these parameters
needs to be transferred to, uh, uh, the patient's chart.
And you don't want the doctor to be spending time d use,
manipulating that aspect. And on top of all that,
the dental team always frees up the doctor to do more dentistry. So we really,
really want them to get that kind of training as well as they get a chance to
practice with the physician,
with the doctors in this training session on how to prepare
for the unlikely event of a medical emergency.
Absolutely. It sounds like training is essential in this case,
um, for safety and, and all of that good stuff.
So thank you for sharing of.
That. We, we even have doctors who send their team members,
extra team members in after they've been trained for us to train them as well,
um, because, um, they want everybody to be on the same page.
Absolutely. And so I wanna shift a little bit to,
we're kind of going in that direction,
but the benefits to the dental practice or the organization.
So in using IV sedation,
is there potential for return on investment? How, how does that work?
Oh, absolutely. Well, let's, let's look at it slightly differently,
but same question, potential for return.
If you look at the statistics of the, in the United States,
of the top 5% highest producing dental offices,
almost all of them,
I would say 19 outta 20 of them are IV sedation practices.
And that's not a coincidence.
So clearly providing that service brings in
a, a changes the way the practice is run,
as well as brings in the type of patients that really require significant amount
of dentistry. Um, as I talked about before,
there's more than one way for a dentist to invest in
acquiring an IV permit or an IV certificate.
Each state calls it something slightly differently. Um,
the tra more traditional way was to be out of the office for two weeks of time
where you spend time in the classroom every day,
and then eventually you treat 20 patients with
IV sedation and do dentistry on those patients.
And that's pretty much the standard of requirement
guideline throughout the country.
The second way to do this is with a hybrid course like our program
where the majority of the didactic information is provided
as pre-course material where you meet with our faculty member on four
separate occasions on Zoom after you've done study.
And then you review that study four in four sessions,
and then you only have a four day clinical experience where you get to treat
those patients,
prepare for medical emergencies and then treat 20 patients individually with a
one-to-one faculty to doctor student ratio.
So they really get a lot of hands-on work doing that. Um,
cost-wise, I mean, I can just put out numbers if you'd like, if that helps.
Sure. I think that would be really helpful.
Yeah. So the, the tuition is around $23,000 for our program.
Um, you'll spend a minimum of $6,000 in equipment,
probably $2,000 in travel,
which is a lot less than a 12 day or 14 day program.
And then you can charge for your IV sedation treatments
and you'll break even pretty quickly. I, you know, most people,
if all they did was charge for the IV and didn't do anything else in their
practices, they would break even within a couple or probably three months.
But the truth is, is that once they start providing this service,
they're gonna start to do wisdom teeth learn,
learn to or already know how to do wisdom teeth extractions more effectively.
You're gonna attract more high value patients.
And our graduates claim that within one month they've more than made back their
investment in time and energy and money and now they feel really great about
what they're doing. Most importantly,
not people just don't wanna spend a lot of time outta the office. I think.
Of course. And I really wanna highlight too,
it seems like there's such an emphasis on education here,
and I know research shows, I can't cite the study off the top of my head,
but I know that we know through research of clinical staff that they're kind of
itching for more education opportunities and to grow their skills.
And so I think that, you know, this does sound like a viable option for that.
Erica, you made a very good point,
especially today with this shrinking
population of employee pools for our, for us dentists mm-hmm. ,
we wanna give our team members, our staff, you know,
more, uh, responsibility, more growth, uh,
more acknowledgement for what they do and bringing them to a program
like this,
asking them for their help to be able to implement all the bits and pieces of
this really does help to cement them in your particular program.
Right, absolutely. Well,
thank you so much for sharing that. And I'm wondering if you could also,
I, I'm just thinking about this topic and um,
how many benefits there are and the education opportunities,
and it sounds like there are a lot of practices adopting IV sedation,
so mm-hmm.
for any of those practices that might be on the fence or
might have misconceptions about this therapy,
what do you say to them?
How do you clear up any misconceptions if there are any?
Well, you know, it's fun because we,
we hear after the graduation from the program,
our program requires after the clinical session,
they need to take a final examination. And after the final examination,
we have a chit chat with them and they, many of them will share with us.
Before I came to this program, I had these misconceptions. Right. And the,
the number one misconception that that scares people off is they think their
malpractice insurance will go up. I mean, that's kind of fearful.
Sure. But the truth is, it will not go up. In fact,
we've only found one malpractice company in the country
that only had a slight increase in their premium if you were to
provide IV sedation. So what does that tell you?
Do you think the insurance companies are giving a big discount?
Do you think that they're ignoring it? Probably not. Right? Mm-hmm.
,
it's more likely that these insurance companies haven't had claims and no claims
means no additional liability.
No additional liability means no additional premium. So that's a,
that's probably the number one. Number two misconception is it's dangerous,
you know,
and doing it the right way is not only not
dangerous,
it's actually safer for medically complex patients
because those patients when in your chair for a long period of time and
all of their anxiety and all of their fears, and they,
their heart and their blood pressure is raised, whereas on IV sedation,
they're relaxed and they're less,
less likely to have a cardiac event if they're sedated.
Which feels so important given how many, um,
patients we see nowadays with multiple chronic conditions.
And the ones that need the most amount of dentistry, right. Are those patients.
So it's really, yeah, it's,
it's ideal for those type of patients and you need to do a very careful
screening cuz some of those patients should not be treated in a dental office.
Some of those patients need to be treated in a more hospital setting or need to
have a medical anesthesiologist, you know, um, for instance,
patients who have severe C O P D should not be treated with IV sedation.
I mean, we have a whole list of these of course, but, but the,
the standard medically complex patient, the one that's on, you know,
four different medications, those are patients that are actually,
are safer treated with IV sedation.
Of course. Uh.
Another one was that this hard to learn, you know,
we've been teaching sedation now 23 years.
We've kind of figured out the best way for people to retain the information,
to learn the most important things, how to repeat and practice what's necessary.
It it,
the one thing that scares doctors is how do I give a needle in the
arm? Or how do I access a vein?
And I can tell the doctors who are listening,
it's easier to access a vein in the
arm than it is to give an inferior avelar nerve block .
So if you can do that and you do that every day without even thinking,
you can learn how to do, uh, vena puncture.
Another one misconception would be poor return on investment.
But I think we've already busted that myth.
. Absolutely. We have .
Too much downtime is another one I'm thinking about. Whereas, you know,
that's one of the reasons that we designed our program for only four days out.
But they will need to study in the evenings and on weekends. Uh,
but they can do that in their own timeline.
They don't have to be forced to anything particularly except for four sessions
for one hour sessions with our faculty beforehand. And the last one,
which is, which I'm told is very, very,
very challenging for doctors is the application process
for permits.
So when you have to fill out all those complex forms and everything and submit
it to the dental board, it's very nerve-wracking.
And it's one of the reasons that we have a full-time regulatory attorney
that helps each individual doctor with their permit process and screens
and makes sure that their application has all the i's dotted and ts
crossed before it's submitted in. Because the truth is,
is I hate paperwork too. .
I think a lot of folks are with you on that one. .
Yeah. Yeah.
Great. Well thank you so much for clearing up those misconceptions.
I think our listeners are leaving not only with so much,
so many rich insights on IV sedation, but also,
you know,
really tangible ways to get involved in this kind of treatment option if they
haven't explored it already. Yeah. So thank you. Thank you so much Dr.
Silverman. We really, really appreciate you joining us today.
And if, if, um,
the doctors and the managers and people would like to learn more,
they can just go to our website, docs education.com/iv.
We have quite a bit of information on that. And if you'd like to,
you can email me at my email address,
which is Dr MDs docs education or I'm sorry,
docs edu.com. Um, and if you email me,
I'll send you a special coupon, uh,
for $500 off the IV program if you're interested.
Great. Thank you so much for adding that helpful contact info and that offer.
Appreciate Silverman.
It's a pleasure. My pleasure.
Wonderful. Well, it's been a pleasure speaking with you too.
And I'd also like to thank our sponsor today, strategic Dentistry.
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