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Dental Myths
28 Plays3 months ago
About the Hosts:
Dr. Savannah Craig and Dr. Ronnetta Sartor are notable figures in the field of dentistry, having successfully navigated the transition from academic learning to practical application post-graduation. Both doctors have acquired substantial experience and knowledge in treating medically complex dental patients. Their experiences during their residencies have armed them with insights critical to private practice dentistry. Their commitment to continuing education and collaboration with medical professionals underlines their dedication to patient care.
Episode Summary:
In this enlightening episode of Beyond Graduation, Dr. Savanah Craig and Dr. Ronnetta Sartor dive deep into the real-world application of dentistry post-academia. They debunk common myths taught in dental school regarding practices such as the use of septocaine and treatment of pregnant and cardiac patients. Their dialogue reveals a more nuanced approach to patient care, informed by their extensive experience and ongoing learning.
The conversation between the doctors opens with a discussion on the use of septocaine in anesthesia, a topic often met with caution among dental professionals. They explore the contrast between dental school cautionary teachings and practical realities discovered during their residencies. Additionally, the episode sensitively addresses the subtleties involved in treating pregnant patients, challenging the notion that they are to be excessively shielded from common dental procedures.
- Dental professionals often navigate the dichotomy between theoretical knowledge and clinical practice, requiring a balance between caution and effective treatment.
- The episode highlights the importance of evidence-based dentistry in decision-making regarding patient care, especially for medically complex cases.
- The doctors advocate for clear communication with patients and other healthcare providers, ensuring informed consent and multi-disciplinary collaboration for optimal outcomes.
Key Takeaways:
- Myths from dental school regarding anesthetics like septocaine can be debunked with evidence-based practice and further education, leading to more effective patient care.
- Treating pregnant patients in dentistry requires a personalized approach, considering the patient's comfort and medical condition, with an adherence to safety.
- The oft-repeated limit of two carpules of lidocaine with epinephrine for cardiac patients is not a hard rule but requires careful monitoring and patient-specific considerations.
- Enhanced patient outcomes are driven by a more nuanced understanding of the intersection between dental procedures and systemic health.
- Continuous professional development is crucial for staying current with practices that optimize patient safety and care quality.
Connect with Ronnetta Sartor: @dr_sartor
Connect with FutureDentists: @futuredentists
Connect with Future Dentists Beyond Graduation: @futuredentistsbeyondgraduation
Resources:
The Dental Residency Guide and the Beyond Graduation ebooks, which can be found at: https://ignitedds.com/ebooks/
Discover a world of dental insights that bridge the gap between academia and practice by tuning in to this episode of Beyond Graduation. Listen to the full conversation for a more comprehensive understanding and stay connected for more episodes that promise to enhance your dental practice with practical, real-world knowledge.
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Transcript
Introduction to Podcast
00:00:00
Speaker
Join Dr. Savannah Craig and Renetta Sartor as we navigate life beyond graduation. Real conversations about forging our own paths in our early years, in our careers. There's a reason it's called practicing dentistry.
Dental School Myths vs Real-World Practice
00:00:16
Speaker
All right, so today's topic is some of the myths or some of the things that you're taught in dental school that then once you're out in private practice, you realize either there's an easier way to do these things or, you know, a more more updated.
00:00:33
Speaker
way to do that. So I'll present you some of the topics that I find super interesting and then you let me know what your takes on them are. Sound good? Sounds great.
Controversial Use of Septicane
00:00:46
Speaker
So one of the biggest ones in residency we always talked about was like use of septicane in IAN blocks. What were you taught in dental school about septicane? Well, it depends on who it's teaching.
00:01:01
Speaker
Always, always. Yeah, I feel like the oral surgery people were just like, use whatever you can to get it. No.
00:01:11
Speaker
That's a great perspective. In not so many words, you know, but pretty much it was just like, you know, if you got to get it numb, you got to get it numb. But yeah, we definitely had a lot of professors that definitely were not on a septic pain train. And I think even when we took our general boards, there were stipulations on, you know, septic pain use and all that sort of stuff. What were you told? Because, you know, I went to dental school in South Carolina and
00:01:41
Speaker
You know, you went, where'd you go? Ohio. Yeah, in Ohio. So a little geographical difference. Geographical difference. I'm curious to hear what you were told. I mean, we were definitely told if you give a block with septo, you're gonna have paresthesia, you're gonna, you know, go directly to jail, do not pass go, do not collect your $200.
Residency Insights on Septicane Fears
00:02:05
Speaker
And then I got to residency and they're like,
00:02:10
Speaker
do you know what that fact was based on? And I was like, I thought research. And they're like, well, actually it was based on an advertisement against septicane and it's not actually based in a whole lot of logic.
00:02:33
Speaker
And I was like, this whole time I've been afraid to give a septo block and then you start doing it and it's so much faster. And I feel like it, you know, I can be a little more off on my blocks and people still get numb. So then when I got to private practice, I started doing that and people were like, what are you doing? Like people are gonna, you know, lose their whole mandible. And I'm like, guys, it's okay.
00:03:03
Speaker
So the myth has followed me forward. But do you give? Do you give septo blocks? When needed, yes.
00:03:14
Speaker
Yeah, we need it. So you'll still give a lido and then, okay. Then if they're not numb, what do you do? Do you give another lido or do you go back with septo? Whatever's indicated. Whatever is indicated. Whatever is indicated. But I say that to say that pretty much I am not like afraid to use septic pain. Yeah. It is something that I use every day. Yeah. Um, I think it just depends on the case. You know, you have some patients who
00:03:43
Speaker
when they sit in the chair, they tell you, Hey, I'm going to let you know right now. It's really hard for me to get numb. Yeah. And those patients are treated a little bit differently than the ones that I've seen already. And we haven't had any trouble in the past. Yeah, that's fair. For sure. Like it was the same thing. It was like, shell, you know, definitely shocked for real when I got into residency and they told me the same thing. It was just like, Oh, okay.
00:04:09
Speaker
Well, let's try it out. Luckily, there has not been any adverse reactions to it in the ways that we're told in dental school. That does not mean that there aren't some people out there that have experienced paresthesia and stuff. For sure. In my experience, I have not personally experienced it. You've not burned into flames from giving a septo block.
00:04:37
Speaker
No, no, no. What's next on your list?
Safe Treatment for Pregnant Patients
00:04:40
Speaker
I think the other interesting fact from like dental school was about treatment of pregnant patients and, you know, they can have nothing, you can do nothing for them. And then again, you go to residency and we had a attending whose wife was an OBGYN and she gave us lectures and basically was like,
00:05:04
Speaker
Yeah, we give them narcotics, we give them like, if you're in labor, and nothing bad happens. And so I think it was really eye opening to me of just like, I think poor pregnant people have not been like used in research for obvious reasons. But so we just treat them like they're so, so fragile. And what what has been your experience in your practice of
00:05:34
Speaker
So I'll start by saying a residency and it may be because we went to the same residency, the same person taught us the same things, but pretty much I'm just going to echo what you said. But I think when it comes to pregnant patients, I tend to put myself in their shoes. For sure. A whole lot.
00:06:01
Speaker
If, if I think, okay, well, if I was someone that was carrying, you know, another tiny human inside of me, I would err on the side of caution. Yes. So a lot of times I'm more conservative in what I do. I think it's been proven that the second trimester is the safest time to do
00:06:23
Speaker
things of dental nature. But a lot of times I, you know, talk to the expecting mom and let her know, Hey, this is what we found. This is what could maybe wait until after you delivered a baby. This is what we probably absolutely have to do now so that it does not affect affect your baby. Um, because you know,
00:06:49
Speaker
where we practice more now in terms of evidence-based dentistry and you know there are lots of things as it pertains to the mouth and oral health that could impact the baby and so I'm just very candid with mom about that and ultimately the decision is moms but it's no pressure for me. For sure.
00:07:11
Speaker
on treatment and that sort of thing. But I'd say that I'm still very cautious. But if a mom comes in and she's in pain and she has an infection, we definitely want to get that treated. Yeah.
00:07:32
Speaker
But yeah, it does make me less anxious and nervous than I was in dental school because it was almost like, I was so scared in dental school. I don't know that I wanted
00:07:47
Speaker
to like treat any pregnant patients because they just made it out to be such a big ordeal sometimes. Agreed. Agreed. And it's like, you know, obviously every situation you're weighing risks and benefits and all of those things. But yeah, in residency, we had a couple of instances of, you know, patients in pain and infection and they're like, nobody will help me. Like,
00:08:14
Speaker
you know, I can't live like this for another however many months until this baby comes. And then I think we've, we had also seen a lot of people who sort of had to put off or chose to put off treatment. And then now they have a baby and they don't have the time to come in for, you know, the care that we deferred. So I think it's like you said, it's really a conversation with mom of like,
00:08:42
Speaker
As far as we know, these things are safe. These are the biggest concerns, but we're willing to help you. And I think a lot of people are just looking for someone that's confident that they're going to be okay if treatment needs to be rendered.
00:09:01
Speaker
Yeah, for sure. No one wants to go to someone that they deem to be an expert and the expert's nervous. Right. That does not help the patient to be not anxious about treatment if you're anxious about it, you know? Yeah. Yeah. Yeah. I think another interesting point on this topic was having, they recommended in residency asking them
00:09:29
Speaker
how the pregnancy is going, because I think all of our brains try to make like connections between things. And so if you can be like, you know, if there's already some complications or concerns about the pregnancy, and then you do treatment and something goes on, unfortunately, people tend to make that connection of like, oh, well, I had
00:09:56
Speaker
you know, this treatment. And so I think that's something I think about a lot is just making sure you know the lay of the land and and let you know there are potential complications with any any health care procedure. We're not immune from that in dentistry, but I think it helps to make that decision a little more more of an informed decision for you and the patient.
00:10:20
Speaker
Right. And it goes back to like what we've all learned is that you never treat a stranger. So you need a thorough medical history on anyone that you're doing treatment on and, you know, pregnancy and the details and, you know, whether there's been any complications with it is one of those things that's on that list. For sure.
Epinephrine Use in Cardiac Patients
00:10:43
Speaker
I think that's a good segue into my, my other topic of ideas is
00:10:48
Speaker
cardiac patients and the the myth alleged myth that we were taught in dental school that then residency was like is only allowed to carpeoles of anesthetic with epinephrine in cardiac patients. What's your thoughts about this topic? Well, I guess tell myself in the audience what you were told in terms of that. So
00:11:16
Speaker
Um, so in dental school, basically if your patient has any sort of cardiac condition, previous heart attack, they're on, you know, uncontrolled hypertension, stents, any of that stuff, that patient is allowed two carpells of lidocaine with epinephrine and that is it. If they're still not numb, we're deferring care today.
00:11:41
Speaker
And then in residency, they were like, it's, you know, epinephrine does not last a whole long time. Your body actually produces more endogenous epinephrine from being anxious that you're at the dentist than necessarily the two carps are gonna
00:12:02
Speaker
you know, increase the body's epi. And so their recommendation was, you know, don't give 10 carbs in a row, but give to monitor the patient. If heart rate is stable and they're feeling okay and no chest pain and they're still not numb, you can give a third. You know what I mean? Like it's not, it's not as an exact maximum as we were portrayed it to be in dental school. Okay.
00:12:31
Speaker
Yeah. So same along the same lines. Um, and I, again, we were taught by the same people, but you know, that definitely has worked for me. And I will say that if there is a patient that has lots of cardiac issues and, um, I definitely get that they're all
00:12:54
Speaker
medical history in terms of like what cardiac issues they have and use my judgment in terms of whether I deem that I'm comfortable treating that patient for sure in my office or whether I think it would be best due to their medical history that they're seen by specialists. Sometimes that is the case and you know I explain to the patient why I feel that way you know
00:13:24
Speaker
And obviously, full mouth extractions versus an occlusal filling. It's wildly different. I think on that one, it's one of those things where it's a double-edged sword, right? Because if something is to happen and your notes are subpoenaed,
00:13:54
Speaker
and you have an air date you just like slammed them with tin carbs you know like you're in trouble yeah it's not gonna look very good for you so i think part of it is you know a lot of what yeah a lot of what it's like we're we live in a completely different time now and we're like
00:14:18
Speaker
Yes. If an adverse reaction were to happen, we're more likely to be sued than say 30 or 50 years ago. Yeah. So it's one of those things where, you know, because dental schools teach it and that sort of thing is like, if something happens there, you know, you want to make sure that you're covered and you're doing, you know, doing no harm, if that makes sense.
00:14:47
Speaker
I think the other thing on this topic that I like flip back and forth between is the balance of
00:15:00
Speaker
my patient not being profoundly numb and that strain on their heart and their body versus giving one more peripheral of anesthetic, you know what I mean? And there's no right answer there, but I think that's like the debate I have in my own brain. And then the other part that you kind of brought up and they brought up when we were in residency, just the basic fight or flight response. Right. You know, how much epinephrine is the body pumping out?
00:15:30
Speaker
You know because they're in my chair Because they're hanging out with me Yeah, so I think and I think that's my favorite part of Residency was like we had the chance to see such sick people and I mean that's not Special to residency, you know what I mean? Like there are people in private practice who are
00:16:00
Speaker
going through it and have a lot of medical diagnoses. But I think it makes me more confident because we saw such medically complex people in the hospital or coming to our clinic or in the emergency room that I'm like, okay, if, you know, Mr. Jones from residency had an LVAD, you know, and we gave him some Lido with Epi and he was okay.
00:16:30
Speaker
you know, misses whoever in my private practice who, you know, is on some blood thinners, she'll be all right.
Consultation with Medical Professionals
00:16:39
Speaker
And I do think just brings up a good point to like, if you have any question about it, you can always have a consultation with the their cardiologist, you can always going back to, you know, pregnancy, always have a consultation with their OBGYN. Like, I think
00:16:59
Speaker
industry sometimes we feel like we're on an island but every cardiologist I've ever talked to every OBGYN every primary care physician I've ever talked to none of them have like shooed me away we have the same goal we want our patient to be healthy and it's been welcomed every time that I've tried to reach out yeah to make sure that we're doing right by our patient yes
00:17:26
Speaker
And I do think that was another point that I learned a lot in residency was, you know, we're all on the same team here. Um, and also a lot of medical providers don't really know the extent of what we do. Um, and so I've tried to like speak with them in person or in email and explain, you know,
00:17:52
Speaker
This is a full mouth extraction. It's going to involve a flap across their maxilla and some significant bone reduction. This is major surgery. That's a different conversation than we're taking out one perio-involved tooth.
00:18:17
Speaker
It's a specific balance of you don't want to insult anybody's intelligence or their experience of dentistry, but being very clear of what you need to do and how extensive it can be so that they, you know, just they have all the information that they need to help advise you, I think is tricky sometimes.
00:18:41
Speaker
for sure. Because they're just like, Oh, they're going to the dentist. They're fine. You're like, this is going to be a lot. Are they going to be okay?
Continued Education in Dental Practice
00:18:52
Speaker
I think this topic leads back to one of our past episodes, which was continuing education. So we both talking about residency in education that were received after we graduated in the importance of it and how we've learned to practice and
00:19:11
Speaker
how we've learned to better serve our patients because of it. And dentistry is all connected and that's what makes it such a beautiful profession to be in. Awesome. What a great way to wrap it all up. Thank you for joining us for this episode of Beyond Graduation. If you enjoyed this week's episode, be sure to share it with a friend. Connect with us on social media at
00:19:40
Speaker
Savannah Craig, DDS, and at Dr. Underscore Sartor. And remember, you are not alone on this journey. This episode was sponsored by the Dental Residency Guide and the Beyond Graduation eBooks. These eBooks can be found at IgniteDDS.com slash eBooks. Thank you so much for listening to Beyond Graduation brought to you by Ignite DDS and Future Dentists.