Timely care isn’t only a matter of convenience and profit. In working with pediatric dental patients, I see kids who are hurting, and I feel an ethical obligation to meet their needs by providing safe and timely care. As healthcare providers, if we can’t serve them as quickly as they need, it’s our responsibility to refer them to someone who can.
Thanks to the introduction of mobile anesthesia at my practice, I can provide timely care to my patients. Being able to treat trauma, decay, or other causes of oral pain in my own office space has empowered me to treat more children, more quickly.
Unique Needs of Pediatric Patients
Access to timely care is a matter of concern for all patients, no matter their age or ability. But several factors go into making timely care an especially important issue for younger patients.
Children aren’t capable of giving an accurate symptom history. So often, a parent will provide a report of symptoms, and a child will look up from the chair and say, “No, that’s not right. I feel fine,” when in reality, they were awake because of pain all night. By the time a child can consistently report that they are in pain, something is very wrong.
Because of that, parents are the de facto advocate and communicator for what the child is experiencing. Unfortunately, and usually through no ill intention, the average guardian isn’t able to fully appreciate the child’s symptoms. Adults will brush complaints off until it becomes a bigger problem. Sometimes, by that point, I see children who are at risk of being overdosed on over-the-counter analgesics.
By the time a child comes to my office for treatment, their issue is already urgent. Even before COVID-19, we would have to schedule some procedures that needed anesthesia far in advance because of hospital wait times. When we’re dealing with urgent matters all day long, I couldn’t, in good conscience, make my patients wait an additional six months for treatment.
A child in need of urgent dental care could be suffering from any number of issues. An emergent need for care could be pain, infection, or trauma. There are also instances where parts of the population I serve aren’t able to access preventative care.
Some children are only in my office because the school required a dental exam prior to enrollment, or their school nurse sent them because they already have cavities that are causing them pain. It’s surprisingly frequent that a mouth full of gross decay in a child goes undetected until it’s a major problem.
Adults can cope on their own. They can communicate their symptoms and their medical histories, and they can even find another dentist if their current one can’t fit their needs. But children require adult intervention to help them access care. And in many markets, there are very few specially trained pediatric care providers, as well as limited ways to treat a child.
The Risks of Waiting
In addition to prolonging the pain that a child is in, delaying care can often worsen the problem itself. Cavities grow, symptoms increase, and teeth can become infected. What could have been a small and simple procedural fix can turn into a much more invasive and complex procedure if the disease progresses.
The effects then ripple out into other areas of a child’s life. They can cause difficulty at school or more days home from school. Eating, playing, learning, and socializing all are impeded when a child is in pain. And sadly, it’s all too common. Behind asthma, dental decay is the second most common chronic disease in childhood.
Aside from urgent healthcare needs, we also treat special needs patients who require sedation for any procedure, even routine cleanings. It felt unreasonable to me to schedule every child who needs sedation for preventative care in the operating room.
Availability of OR time in the hospital can be a challenge to come by. Aside from the extremely high cost and stress to the family, the long wait times that usually exist for the OR can delay preventative or restorative care, which can inevitably lead to the problems getting worse.
Using Mobile Anesthesia to Speed Up Access to Care
It’s simply a matter of fact and necessity that hospitals don’t prioritize dental cases in the same way they do other cases. If mobile anesthesia is an option, then it becomes a non-issue because most of my dental patients don’t need to be treated in a hospital.
But if a hospital is the only option, consistent timely care is almost impossible. The hospital OR is for the patients who are the sickest or in the most dire of situations. They have life or death cases, and when the hospital compares a dental surgery with a time-sensitive heart surgery, it’s obvious which one will take precedence.
In addition to the difficulty of scheduling an OR timeslot or the high risk of getting bumped for an emergency surgery, there are so many hurdles to getting an operation scheduled, and each step along the way is an opportunity for another delay. It has to go through the scheduler, an RN, an anesthesiologist, insurance, and more. Any person along that chain could miss a call or have to pause the process for some reason.
And now with hospitals requiring COVID-19 tests a day in advance of the surgery, there’s another potentially long drive into the mix. The entire process presents so many obstacles that some families can’t or won’t be able to keep up.
This isn’t to say that hospitals need to change course. They do what they do for a reason. But the introduction of mobile anesthesia presents another way for us, as dentists, to do what we need to do. Hospitals have life and death decisions to make, but I am the one who has to look a parent in the face and break the news that the procedure that their child has already been waiting months for is getting pushed even further back.
Bringing patients into the dental office for their procedure eliminates many of the external factors that could push or delay treatment. Instead of having to work around a hospital schedule, I can make room in my own office and my own schedule for an anesthesiologist to come in and help me treat a child.
It’s important to note that I’m not speaking hypothetically. Before we started incorporating mobile anesthesia through SmileMD, we would be able to get one or two days in the main OR every six months, and on that day we’d be able to schedule about six kids. But at any given time, we’d have about 30 kids in line needing surgery in the main OR. It just wasn’t possible to serve every patient I had in a timely manner. Unfortunately, so many families would take themselves off the list or stop returning our calls.
And though other surgery centers within our hospital system allow dental cases, such as the dental surgery center, the ambulatory surgery center, and the procedure center, the cases that can be seen in these locations are not always interchangeable. It’s also true that surgery time in these locations can be easier to come by than that of the main OR.
But sometimes, for seemingly silly reasons, patients would need to be scheduled in one location or another, creating a scheduling nightmare for our surgery coordinator and confusion for our other staff members who help with surgeries.
Now, by doing most of our procedures in-house with SmileMD, we can do dozens of patients a week because they work around my schedule, allowing me to see many more patients. We’ve been able to expand the list of patients we can help. We even expanded our office and hired new staff to keep up with the need that was already there.
Mobile anesthesia is not a replacement for hospital anesthesia, and not all patients should be sedated in the office. There will always be a need for OR time in the hospital. Many patients simply do not qualify medically for in-office sedation, and some parents are more comfortable having their child sedated in the hospital. But for most patients, mobile anesthesia is a great alternative.
With the pause on elective surgeries that COVID-19 has caused, the delay in care would have been insurmountable. But even during this difficult year, mobile anesthesia allowed us to stay afloat and meet our patients’ needs. I encourage you to consider adding mobile anesthesia services to your practice to be able to serve even more pediatric patients, more efficiently.
Dr. Draney earned his BS degree at Utah State University, attended dental school at The Ohio State University, and completed his pediatric residency at Nationwide Children’s Hospital and The Ohio State University Wexner Medical Center. Upon completing his residency in 2013, he opened a practice in Lancaster, Ohio. SmileMD is a mobile anesthesia services company that was founded by anesthesiologists. SmileMD provides anesthesia to pediatric and adult dental patients in office settings, increasing access to care for thousands of patients each year.
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