Originally posted by captaintripps
Dr. Jeff,
I noticed your comment about a dental anesthesiologist. I have recently heard of this specialty and would like to find out more information. Could you shed some light on what the job entails; training, opportunities etc.
Thanks.
I'll tell you what I know about that branch of dentistry. First off, it has its own specific residency, which often runs along with a medical anesthesiology program to a very similar extent. I know that very few schools offer this type of residency currently.
As for what the job entails. Here is how it goes when the dental anesthelogist(DA) comes to my office. After I've identified a patient whom I feel that needs conscious sedation for his/her treatment. My office calls up the DA's office, and due to the demand for him in my area, a date gets scheduled about 2 to 3 months down the road(read as a very strong opportunity for DA's out there).
When the treatment day arrives(in the mean time, the DA has contacted my patient and obtained his own medical history/ past anesthesia records if appropriate/ ordered any lab tests above and beyond what I may order(often when I'm usig a DA I'll be doing multiple extractions on medically compromised patients on multiple meds)). The DA arrrives at my office with all the anesthesia meds/monitors/resusitation equipment that may be needed about 45 minutes before the scheduled start of the procedure. After he's set everything up, he'll discuss what I'm planning on doing that day, and my impressions of the patient to help gauge how long a procedure it may be and how much/ what type of anesthesia may be best for the patient(this is just him double checking since I tell him when I'm scheduling the anticipated procedures/treatment times and in his Med Hx that he takes he's talked with the patient about their apprehension levels).
Once the patient has arrived and is seated, and he and I have greeted them, the DA will then set up all the monitors and make his assessment if the patient is medically able to tolerate the procedure that day(the only time I've had a procedure canceled is when the patient who was suppossed to be NPO(nothing by mouth from midnight the night before on to reduced the risk of aspiration if vomiting occurs under anesthesia) ate a full breakfast before coming to the office prior to the 9AM scheduled time
). The DA will then begin to administer the sedation, and will then get the patient numb for me.
Then I goto work, all the while the DA is monitoring the patient and maintaining adequate sedation levels. When I'm done, the DA monitors the patient while they're "waking up" and then he'll discharge the patient to an escort when the appriopriate sedation discharge guidelines have been met.
The vast majority of the time, the anesthesia cost(and it's often $1500 to $2000 for a 1/2 days treatment) can be covered under medical insurance if not under dental insurance.
The DA provides a great service for those few patients that need them. Given the nature of what they do though, the only drawback can be the much higher malpractice insurance rates that they have compared to a general dentist. For example my malpractice yearly premium is just under $1250(yes thats the correct # and as you can see its WAY LESS than what our medical colleagues pay) for a 1,000,000/3,000,000 policy. My DA's yearly amount is about $12,000(I actually asked him about this when he was last in the office in October) for a 3,000,000/5,000,000 policy. Other than that it has a low overhead(you don't need your own office if you have a cell phone and a palm pilot, and all the equipment you need can fit in the trunk of that sporty Mercedes or BMW that you want) and flexible hours.
. Occasionally, in large extraction cases on the phobic, the patient will feel more comfortable with my personality than the OMFS's and ask if I can do the ext's, and thats when I'll get the DA involved(I've only had 1 such of these cases in the last 5 years).
), he'd probably send them to the prosthodontist FIRST, not the implant surgeon.
