Is Sedation the Cure to Dental Anxiety?

By Vince Lymburn June 30, 2022

Dental anxiety is very common among people. According to the ADA and many sources, Dental anxiety afflicts anywhere from 20 to 50% of the US population – to the point they ignore going to the dentist resulting in compromising oral health. For that reason, we asked Dr. Michael Silverman to speak about the topic. Dr. Silverman is a general dentist with over four decades of experience, Dr. Silverman first began studying anesthesia and sedation after noticing how many of his patients exhibited dental fear and anxiety.

Utilizing his training, including a mini-residency in IV sedation at Montefiore Hospital in New York City, he began developing safe and effective sedation dentistry techniques and protocols. Seeing the tremendously positive impact sedation treatments had on his patients, and the incredible need throughout the U.S., he joined forces with Dr. Anthony S. Feck to found the Dental Organization for Conscious Sedation (now known as DOCS Education) in 1999.

As a faculty member and the President of DOCS Education, he has taught over 30,000 dental professionals how to safely implement sedation in their own practices.

Watch this interview with Dr. Silverman and learn how he educates other clinicians on how to help their patients with dental anxiety.


Rolando Mia: Hey, everybody, welcome. My name is Rolando Mia. This is Dental Voice with Zyris. Today, our guest is Dr. Michael Silverman. He’s a longtime friend and the founder of DOCS Education. Now, the topic that we’re going to cover today is all about conscious sedation in the dental practice. And there’s a lot of dialog around this. It’s an incredible technology that’s, I believe, underutilized. So Dr. Mike is going to sit down with us and share with us insights about and why and how this can be so important. Dr. Michael, Dr. Silverman, thank you so much for joining us.

Dr Michael Silverman: You’re welcome. This is fun. I’m glad we have a chance to actually chat again.

Rolando Mia: Oh, it’s oh, it’s been too long, but I’m happy that we are. So if you could please give us a little bit of background or a little bit of insight into who you are and kind of what you’ve done.

Dr Michael Silverman: Oh, sure. Well, I’m the president and founder of DOCS Education and we train dentists and dental team members on sedation and advanced medical training. And we’ve been doing this now for 22 years. We’ve trained about 34,000 dentists and team members in sedation, anywhere from nitrous oxide to I.V. sedation. And we’ve worked with just about every dental board in the country with regards to regulations and issues regarding providing sedation. And you know, what’s great is that the need for it is still out there, and dentists are embracing it. So.

Rolando Mia: So if you could define, you know, what actually is oral conscious sedation and how does this how does this tie in with like anesthesia needles, all that type of stuff? What’s what’s the context for that?

Dr Michael Silverman: Oh, yeah, sure. So what we’re talking about is we’re talking about creating a comfortable experience for the patient. So every dentist already knows that using local anesthetic provides that numbing ability for the patient to be able to have some invasive procedure done that normally would be painful. But when we’re talking about sedation, what we’re talking about more than dealing with the pain aspect, although it does have an effect with that. We’re talking about dealing with the anxiety or the feeling of being nervous, the feeling of being in a chair for too long. Those kinds of issues, especially when you’re dealing with surgeries such as implants, surgery, you know, wisdom tooth extractions, things where, you know, there’s going to be quite a bit of experiencing things that would be uncomfortable for the patient. They develop a lot of anxiety. And this is really dealing with that, those fears and reducing or eliminating those fears with different levels of sedation.

Rolando Mia: So there’s I read that I believe almost a third of the U.S. population has dental anxiety. Not only that, some people have it to the point that they forgo any kind of, you know, dental treatment because of that that kind of the fear. And because of that, oral health goes down the tubes, systemic health goes down deep. There’s a burden and all that type of stuff. How does this affect that or how do you see that potentially affecting that?

Dr Michael Silverman: Well, you’re right. Your statistics are just about perfect. 30% of the population avoids doing dentistry due to fear And what’s really fascinating, Rolando, is that when we do these larger events with dentists and dental team members, we’ll do a polling session with them and will ask them to them to rate their own personal level of anxiety about getting dentistry done. And we’re not talking about the general population. We’re talking about our professions.

Rolando Mia: Dentists, dental professionals and.

Dr Michael Silverman: And consistently. 67% of dental professionals have either mild to moderate fear of having dentistry done so. 30% not going to the dentist. Our own profession I know we get passed it, we get it done. But we also are experiencing anxiety going into getting those procedures done.

Rolando Mia: So even dental professionals have this fear. So when someone starts doing this, what do people have to be mindful of or what kind of what’s the process around it? Can I just start.

Dr Michael Silverman: Well, hopefully not You know, historically speaking, you know, we’re talk about my company docs education just for a second. Not not in a in a way of promoting it, but as a way of describing it. So 22 years ago or so, the average dentist who was trying to dabble in oral sedation was using a medication called Diazepam or Valium. And it was it’s very, very safe. It’s been around for a long time. The Rolling Stones sang about it, you know, I mean, it’s one of those medications that’s very well known. The challenge is it’s not a very good medication for dental sedation. It has a long half life. It doesn’t have a high degree of amnesia effect. So it’s very hard to use. And Dennis, we’re having difficulty getting a consistent experience for the patient, a successful experience, which means that the patient was happy. So back then, we uncovered other methodologies and reducing some of the risks of the medication, not working the way you want, for instance, going without food or water for a certain period of time ahead of time, which allowed the medication to be absorbed more effectively. We eliminated the use of diazepam on the day of the appointment, and the result was we were able to increase the predict the predictability of doing sedation, oral sedation to a very, very high level. And that’s sort of how this whole thing got started. I have lost your sound. Rolando, can’t hear you.

Rolando Mia: There you go. Sorry. So it’s another set of drugs or medication that you utilize instead of what was there before. Is that correct?

Dr Michael Silverman: Yeah. I mean, moving moving away from what wasn’t working effectively. So that was that was really started the whole process. And then since then, you know, understanding what dentists are interested in doing, what they’re nervous about, you know, some people want to do nitrous oxide. Some people are concerned about some of the safety issues with nitrous oxide, especially with some of their dental team members in their offices. And then other people do some very extensive dentistry or invasive dentistry. And they wanted to be able to have a deeper level of sedation than than what oral sedation can provide. So we’ve expanded our curriculum to be able to cover more and more of that. What we don’t teach is deep sedation or general anesthesia that takes a residency of two to three years after dental school to be able to be qualified to be able to provide that in almost every state.

Rolando Mia: So now you just you just touch on something in some of the some of the feedback or things that I’ve been seeing. There’s a question that general dentists should not be performing this procedure What are what are your thoughts around that or what what kind of how or what commentary you have around that?

Dr Michael Silverman: Yeah, well, you know, I think it falls into a few categories. One, the first category would be the dentist that don’t understand how effective sedation can be for bringing in new patients and to get patients who are, quote, and don’t have the budget right now. But they’re really nervous, those patients, to accept treatment. So that’s sort of just becoming more aware of how to utilize sedation as a way to help those patients get the treatment they deserve and want to get past their fears. Then another category of dentist would be the dentist who has either tried it and failed and thought that, you know, it wasn’t a good idea. And the last category would be the offices that aren’t run very efficiently, the offices that you know, struggle to keep the dental records complete. You know, I don’t know how to say this in the best way, but you these are the offices you wouldn’t want to have and bring sedation in, because to be a sedation dentist, you need to be very meticulous about your record-keeping. You need to be very particular about how you maintain your medications in your office using a DEA compliant drug cabinet. You need to have the correct paperwork and the informed consent, everything that would make you safe and the patient safe, including pulse oximeter, blood pressure monitors, capnography, those other items that make the experience for the patient even more safe. And if you’re not somebody who wants to go through those kinds of details, that’s probably not the right place for you. Just stay stay with what you’re doing.

Rolando Mia: So I love the context around that. There’s a commitment that people have to make with regard to, I guess, any introducing any new technologies into the practice. Now, something that you mentioned, which, which I kind of connected to is this gives the practice, I guess access to a population of people who otherwise wouldn’t be coming in. Have you seen that with the with the with the clinicians that have joined you or, or that you’ve educate and all that type stuff? What’s kind of their experience around now?

Dr Michael Silverman: Well, I think the simplest and the fastest way to answer that question is to look at the top 5% of dental practices in the country. And almost to the tee, all of them are providing sedation to their patients.

Rolando Mia: Really?

Dr Michael Silverman: Yes.

Rolando Mia: And this is this is different sizes, different things.

Dr Michael Silverman: And this is different areas. Absolutely. I mean, of course, orthodontics orthodontist might be different because they don’t need it. But other than that, of the majority of those offices, the ones that are doing the best, the ones that are attracting the most number of patients, the ones that are reduce the amount of marketing they need to get new patients, the ones that are getting patients to accept treatment at the highest possible rate are the ones that are offering the safest and most comfortable experience and the confidence that they can provide those patients. That it’s going to be a good experience is is key to the process.

Rolando Mia: So what effect this has have on recall does it also affect recall for existing patients?

Dr Michael Silverman: I’m not sure. Tell me more about what you’re.

Rolando Mia: You know, I’m a patient. I go in, I freak out because that drill. But I had to go because I was in pain. I’m not going back because I’m really now even more freaked out. So have you seen that helping or affecting that, too?

Dr Michael Silverman: Yeah. So I think there’s two things about about that. I’d like to mention. One is it absolutely brings patients in a sedation dental practice that is used to dealing with patients who are fearful will provide a different kind of hygiene experience than a practice that doesn’t understand this. So if you are a super high fear patient and the only way you’ll get your dentistry done is if you’re sedated, we can sedate you for even your hygiene appointments. Oh, so so that you will have never have an experience or even a memory of having anything going on in your mouth because of the incredible amnesic effect that that this provides us.

Rolando Mia: So let me ask you this. For clinicians or dentists practices that are kind of on the edge and they’re they’re considering but they haven’t haven’t added it. I mean, the idea that they’re able to improve dramatically, you know, new patient recall that. What what advice would you give them or what what would you have them consider to, you know, to think through to kind of help them through that process?

Dr Michael Silverman: Well, I think it depends on, you know, their goals. I always look at that when I talk to talk to dentists about what what they’re interested in doing. You know, a dental practice may be running OK, but the dentist, he or she may feel like I really want more implant patients. I really want more full restorative patients. I really want more quadrant dentistry. Patients or perio patients or whatever that is, or endo patients. And and you have to start with what they really want more of and less of because we’ve taken dental practices, you know, that are literally running on a hamster wheel, right where they’re seeing 20 patients a day, one doctor seeing 20 patients a day, you know, once one every 20 minutes. And we’ve taken those offices and we slowly move them into a more relaxed state where they’re seeing patients for longer appointments. And they’re getting a much different experience, not just economically, but that’s a multiple economically, but also emotionally because they’re getting the incredible gratitude from these high fear patients that are now being treated for the first time. The number of flowers, the number of home baked goods that arrive in the office right afterwards is off the charts. You know, it’s just it’s it’s a great feeling. And then the team members also, I should mention this too, I hope I don’t go too long on this, but to mention this, too, is that the team members become more a part of the experience than they normally do. So they feel more engaged. They feel more involved and invested in the dental practice so they’re less likely to leave the practice. They feel more fulfilled in their job duties because they’re also getting these great thank you’s in these hugs and these happy patients.

Rolando Mia: Right.

Dr Michael Silverman: Happy patients, happy dental team, happy dentists, reduces the stress. There’s a lot of there’s a lot of advantages to it. And, you know, and I do put that caveat out there, you need to be properly educated, you know, wherever you get your education it has to at least meet the dental board’s requirements.

Rolando Mia: Right. Right.

Dr Michael Silverman: But it should really meet the standard of the national standard of care, which oftentimes is above the dental board requirements. So that would keep you safe and the patient safe.

Rolando Mia: So the practice has to make sure that they’re kind of, in their minds, committed to the program, that they understand that this is not just a one and done. This is something that they’re investing time resources and most importantly, education around. But the benefits are huge because of the what I’m going to call this, the overall experience that their patients get as well as their team becomes incredible. And this just kind of raises everything. Is that is that kind of what I heard you say?

Dr Michael Silverman: Yeah, no, that’s exactly right. Yes.

Rolando Mia: So let me ask you this. You know, we are I was using the term post-COVID. I don’t know if it’s post-COVID or not because COVID is so well around. How does this affect that or is there you do you see do you see COVID and all that? Because there’s enough anxiety about going into the dental practice. Now you’ve got this other thing there. How do you see this playing this or does it well?

Dr Michael Silverman: Well, let’s talk about the anxiety issue. I mean, because, you know, you can’t literally open a newspaper or open your email for the newspaper, please. Or go online, right? Without reading about the burnout, without reading about the increasing anxiety out there about our children, you know, and how this house covered affected the the mental health of so many people. And and this increase levels of anxieties is just one piece gets on top of another, on top of another. And if you can eliminate the anxiety to the dentist, story, you’re helping that patient experience a better life, a better lifestyle, because that at least takes one of those anxiety issues away as far as COVID goes, I think it’s important also to mention, since we are in the middle of this, that if a patient has experienced and contracted COVID, that as far as sedation goes, you should wait a minimum of four weeks post infection.

Rolando Mia: Continue or.

Dr Michael Silverman: Considering sedating them. And you should also be careful if with now we’re not getting as much pulmonary damage as we did with the original COVID, you know, the new be a virus is the variants are not causing the whole damage to the lungs. You know, that ground glass effect on x ray that we all saw in the beginning, we’re not seeing that anymore. But you still should be very cautious and make sure that their pulmonary function is back to normal. Before ever doing any sedation because one of the side effects of sedation could be a depression in respiration. So normally a little depression in my respiration is not going to do anything. But if I’m already partially damaged because of being post-COVID or having a really congested chest, it could be an issue.

Rolando Mia: Wow. Good to know. You know, it’s interesting. I guess COVID is here and it does affect and kind of touch everything. So that’s I wasn’t aware of that. And it’s good to understand for people who want to pursue or want to look for information about this, where would you send them or what would be the best way for them to start getting a better understanding of one? What’s involved with this then two like instruments or things that they need in the practice? Where would they go to find that out?

Dr Michael Silverman: Well, of course, you know, our organization Docs Education has a great website docs education dot com that they can go to and do a lot of research on the site itself. Thank you for doing that. Steve has a lot of information on there by itself. There’s also a category on there about regulations that gives sort of a brief outline of each then each state’s regulatory issues. And and also we have very detailed reference sheets on each states regulation that tells specifically what the state requirement is for equipment and what the standard of care is. Sometimes one’s above the other, you know what I’m saying? But you want to whichever ones are the highest, you want to meet that standard, whether it’s the standard of care or the regulation and the best way to do that is by going to the website, maybe calling our offices are our course advisors are very well crafted in understanding this and can share with the doctor the specifics of their individual state requirements and what the standard of care is would be.So that would help on that call.

Rolando Mia: So let me ask this. If you were to summarize for viewers or people who will see this, you know, kind of what how would you sum up what they need to know and understand and then kind of how they would approach that? What what advice would you give people with regard to that?

Dr Michael Silverman: Well, you reminded me of a of a sort of a of a saying, you know, be the cure, not the disease. Right. Be the cure, not the disease. The disease is dental anxiety. And, you know, we try everything we can to make a dental appointment comfortable but due to the fact that many of us had childhood negative experiences, those fears are not going to disappear. I mean, you could sit on the couch with, you know, Sigmund Freud for a couple of years and maybe get most of it out, or you could take a pill, you know, so I’m thinking, you know, it’s probably not a good idea to to to pooh pooh the idea of dealing with fear on a on a psychological basis, which I think is important, especially today. But as far as dentistry goes, be the cure, you know, be able to give them an experience that they’ll have little to no memory of the appointment and have their dentistry done beautifully. The other thing I did mention was a sedated patient is sort of like that mannequin you used in dental school. Does it move it doesn’t complain. It just you can do your very best dentistry on that. Right, exactly. Exactly. So as far as giving advice goes, I would say, you know, balance this out in your own mind. You know, what is it that you want for your practice? Do you want to grow your practice with patients like this? Are you happy where you are? Do you feel like there’s a need for this in your area, which I guarantee there is? Do you want to set yourself apart from other dentists? Is that something that’s important to you? And what about the quality of the relationships you have with your patients and your team members? Can you improve that? And if you’re interested in that, I think this is a wonderful avenue for you to take that’s safe, been proven and quite effective.

Rolando Mia: Awesome. Thank you so much for that. If people wanted to ask you or follow up with you, ask you more questions, what would be the best way for them to do that?

Dr Michael Silverman: Yeah, let me it would just to email me should I type it into those.

Rolando Mia: Just what if what what email would that be?

Dr Michael Silverman: The email would be a DRM Silverman ad docs education dot com DRM as in Michael Silverman at DOCS education dot com. You can just email me directly. I’ll be happy to to chat with some of your people. I do want to mention since we’re on this together, that one of the best ideas while being a sedation dentist because you need to protect the airway really well is the use of isolate and we’ve been recommending isolate. I know you told me not to say this, but I’m doing it anyway. We’ve been recommending isolate for like 20 years at our, at our off and on our lectures because it gives a very a beautiful way to get great lighting it gives the isolation and it gives airway protection that you need to have when you’re doing sedation. So if you’re not an isolate, you should be getting your isolates now.

Rolando Mia: And I’ll appreciate that and thank you for that. But first of all, really appreciate the insight, kind of the context around it. I appreciate the advice around what people need to understand and why. I think it’s it’s a really powerful technology that a lot of people don’t have. I was not aware that what is it? The top 5% of the most successful practices out there all employ sedation, dentistry. And because of that, they’re able to kind of calm down and help their patients. So this is all awesome. If if we at some point here later on, you’ll be up for following up with us and kind of sharing further and see how things are going would you like to join us again to to share?

Dr Michael Silverman: Well, this has been fun. I love it. Great. Awesome.

Rolando Mia: Well, thank you for joining us. Really appreciate it. Hey, folks, if you like this content, please reach out to Dr. Silverman. Ask him if you’re considering this. It’s a phenomenal way to learn a lot about things. Docs is all about education, and I’ve had the opportunity to participate in it. It is almost you know, it’s incredible the the level of expertize and information you’ll find there.

Rolando Mia: Share this. Dr. Silverman, thank you so much. For joining us. Appreciate it. Have a wonderful rest of your day. Have a wonderful week and great weekend you do to take care of everyone.