Sedation in Dentisry: Luxury? Necessity? or BOTH?

February 3rd, 2016

By: Mel Hawkins, DDS, BScD AN, FADSA, DADBA

“It is no longer enough that dentistry be technically competent, it must be humanely presented”
Dr. Wm. Dover, dentist, dentist/anesthesiologist

Modern dentistry. With its biomaterials, advanced implant techniques, cosmetic emphasis, state of the art laboratory procedures, beauty, function, pain control, pharmacology, drugs, patient management, smiles, local anesthesia sophistication,  products,  adjuncts, medical wonder drugs …Is one any more important than the other? Yes. But it’s not in this list. We dentists, dental hygienists, expanded duties practitioners, dental assistants, office managers, registered nurses must never lose track of the fact that we are treating real people, not actors, as in TV commercials.

Dentists approach me at the podium, by email or at a reception and state something like:

  • “I’ve never needed to use sedation for my patients. I’m a gentle, patient, communicative person and use tender loving care (TLC) to get my patients through”

To get them through? Key phrase.

  • “I’ve only ever referred one difficult to manage child in 30 years of practice.”

That’s admirable. Sooner or later if an individual practices long enough, a patient has an indication for referral.

  • “I have a lot of senior citizens in my practice with a variety of heart problems, diabetes and physical and mental challenges. They just don’t need sedation”.

Stress of a dental appointment and myocardial compromise don’t go well together. Cardiac patients, high blood pressure individuals, and of course the apprehensive patient benefits from a reduced stress level.

I’m not here to sell sedation. I don’t need to. Some 85 million Americans avoid the dentist out of dread, according to the Journal of the American Dental Association (JADA).

The ADA has stated that a significant % of the population still avoids dental treatment due to fear. It’s ranked up there with public speaking, heights, flying, snakes, claustrophobia and crowds. As with any therapeutic treatment modality, patient management by sedative inhalational gases, oral or IV medications such as midazolam  (Versed®) will or could help the patient feel better towards dentistry, help the appointment time pass faster or provide memory gaps of points in the appointment which really don’t need to be remembered.

Dentists who use sedation say it may be the only way to get certain patients into the dental chair at all. Mom’s and Dad’s who parent uncooperative, caries ridden children say it may be the only way their child can be managed.

So how does a practitioner deal with the major disadvantages of oral sedation, namely “guessing” at a dose because titration is impossible and what if you’re wrong? How does one minimize the time of onset? Doesn’t waiting for it to work just exacerbate the already existing apprehension?


How do you choose a dose? The first appointment is in part a guessing game but the guesswork can be successfully reduced by employing a few practical (and rational) rules.

  1. Body weight: adult vs. child
  2. Age
  3. Level of apprehension.
  4. Drug experience, prescription drugs, OTC medications e.g. cough medication DM, tolerance, dependence, chronic prescribed medications (benzodiazepine history), liver enzymatic induction.
  5. Difficulty of dentistry and
  6. Time required (appointment length).

WHAT TO USE? Prototype: Triazolam – Halcion®

What do I mean “amnesia is conditional”? Isn’t that why a benzodiazepine is administered? Yes, but there are two overriding events that negate amnesia.

  1. Trauma / Pain
  2. Audio comments.

In other words, anything that stimulates a physical (pain) or emotional (anger, envy, insult) reaction from the patient, for example:

  1. Elevating a lower third molar which is not adequately anesthetized. “It’s just pressure, it’s just pressure”, while thinking, “they won’t remember it anyway”. Not. It hurts and they do.
  2. “Don’t you love my new Porsche? I’m going to Hawaii for a month”. Don’t say it!

There are many consents out there and sedation consent forms ( pardon the play on words) one more category. The first interview question should be, “Is English your first language?” or “Is English your preferred language of discussion?” If it’s not, it will be a very short appointment, ending now, for today. They must then arrange to bring an interpreter for the consultation and consent appointment. I have experienced occasions where during a consultation I believed that a patient while nodding “yes” at almost every point (as opposed to nodding off), ultimately had understood virtually nothing! Their first language was an East Asian dialect.

The most important point after communication confidence has been established is for the patient to 100% understand:

  1. Not to drive a motor vehicle, operate machinery or use sharp objects (i.e. in the kitchen, for example ) and not to make any important decisions for 24 hours. Yes, they may go back to work but must sign off on the above!

The most important points for the dentist to adhere to are:

  1. Although the initial question and answer format can initially be conveyed in the printed word, consent must be discussed verbally with an adequate time allowed for questions and answers. Note that obtaining consent is not a single event but rather a process that occurs over time.
  2. An oral sedative cannot be administered and then consent endeavored to be obtained in the belief (true fact but not legal) that because the onset of the drug effects will not occur for a few minutes, “we may as well not waste time”. Why do all the consents and then administer the tablets/pills/capsules and then wait even longer? Answer: Because you must.
  3. Never change the treatment plan while the patient is under the influence, i.e. extract a tooth that you said you would initiate endodontic therapy on, see what happens, you find a crack, the tooth is obviously doomed and you take it out without permission, or with “permission” from the intraoperatively sedated patient, or just as bad, the spouse, which of course is not permission at all.

What is the criteria for assessing a professional fee for the reimbursement of a 25 cent tablet (or two or three)? Of course, this is not about the cost of the medication. It is very much about the education and expertise of the dentist, the time and money expended to do so, the responsibility of administering and monitoring the drugs involved, per-op and post-op, the ability to manage side effects including a medical crisis, the challenge of managing not only an uncooperative child but also a parent or guardian who may be equally as challenging, demanding or sceptical. In other words, “what’s it worth?”…or “should it be free as it simply allows the dentistry to be more efficient?”

Sedation is a wonderful adjunct to the practice and delivery of modern day dentistry. Not only is the apprehensive individual a prime indication for consideration, but also longer, more sophisticated and intricate procedures necessitate a cooperative and relaxed patient. The relaxed dentist and dental office environment form the third point of the treatment triangle and as a comprehensive treatment plan is extended to our patients, perhaps a comfortable, safe an time efficient consideration should be offered simultaneously.

Dr. Hawkins is board certified as a Diplomate of the American Dental Board of Anesthesiologists and is a Fellow of the American Dental Society of Anesthesiology. He has over 30 years of private practice experience in sedation dentistry in Toronto, Canada. Mel has been lecturing throughout the United States, Canada, Mexico, Europe and Asia for 40 years.

 Like what you read? Dr. Hawkins will be speaking as the 2016 Oregon Dental Conference!  Register today!

Encrypted Email – Friend or Foe?

December 7th, 2015

Encrypted Email has gotten a bad rap but it’s certainly your friend!

Picture a postcard. This mode of communication is perfect for documenting your latest trip laden with landmark pictures on the front and a simple “Wish you were here” written on the back. Anyone can flip over the postcard, read your sentiments. You’d never write anything too personal knowing this postcard can be an open book. No need to safeguard this innocent letter.
Now imagine it has your social security number written on the back under your name. Not so innocent anymore! This is exactly what an email is. A regular email is open for anyone to view while in transit to its recipient.
If you can think of a letter duct taped and carried by an armored van to the recipient – this is an encrypted email.

As a Covered Entity, you are responsible, by HIPAA law, for safeguarding your patient’s data. Anytime electronic Protected Health Information (ePHI) is being sent in an email, HIPAA recommends implementing procedures to ensure secure transmission and storage. The easiest way to do this is to utilize an encrypted email system.

Ideally, look for a provider that offers the option to send regular vs. encrypted mail. Aspida Mail, the ODA’s preferred Encrypted Email provider, is triggered by a keyword, encrypt in the subject or body of an email. If that keyword is omitted, all emails flow as usual.

Experience The Network Effect! Did you know email sent within our secure ecosystem (Aspida Client à Aspida Client) eliminates the login process for secure messages? That’s right! Encrypted emails will flow inbox to inbox like regular mail – no signing in!

This allows you to seamlessly send & receive encrypted emails to other Aspida Mail users within the ODA Community!

Additionally, if you are receiving ePHI to your email, verify you are implementing secure storage procedures. Typically, (free) Gmail, Aol & Yahoo Mail do not store securely.
Aspida Mail takes over your existing mail server – ensuring secure storage of ALL mail messages.

Do you completely understand what PHI is and how to protect it? What about the consequences for not taking steps to safeguard it?

Take our quiz to find out!


This post is brought to you by ODA Endorsed Program, Aspida. For more information on this and a complete list of ODA Benefits of Membership visit:

ODA Introduces New Endorsed Services as Additional Member Benefit

November 12th, 2015

ODA_Logo_horiz_RGB_ Endorsed Program

By: Conor McNulty, CAE, ODA Executive Director

In late 2014, the Oregon Dental Association (ODA) convened a task force to review  important benefits and offerings for ODA members. After getting feedback from members and approval from the Board of Trustees, ODA is happy to announce the following NEW  line-up of additional endorsed services for our members.

ODA and its endorsed service  program partners offer you the resources you need to help manage your dental practice…and your life.

Aspida –  Encrypted  e-mail service provider

Offers all ODA members an exclusive discount on their HIPAA compliant email encryption services

  • First three months at $1/each
  • 20% lifetime discount on all Aspida mail plans (after the 3 month trial)

OHSU Sterilization Monitoring Services  l   503-494-4641

  • 24 hour turn-around for test results
  • Emailed test results directly to you,
  • Is the test is not sterile you will also get a phone call to ensure the most rapid retesting options.

WEO Media – website and dental marketing services

Offers ODA members discounts on services:

  • Up to 25% on selected set-up fees
  • Up to 15% on selected service fees

Sofi – Student debt refinancing

ODA members get an additional .125% rate discount

  • Average savings for members is $39,000 for the life of a loan
  • Quick and user-friendly process for application and review

Dentists Benefit Corporation (DBC) – Disability insurance through Ameritas  l  503-952-5271

  • ODA members recieve a 15% discount on new individual disability insurance plans.

For a complete list of ODA Benefits of Membership visit:

New innovations in nanomedicine may be coming your way soon!

August 4th, 2015

By Dr. Kim Wright

It’s amazing the innovations happening in labs around the world right now.  Very soon we may have treatments for many more cancers that use nanoscale vehicles to deliver chemotherapy directly to tumors sparing healthy cells.  These drug vehicles are 200 times smaller than a red blood cell.  According to Scientific American’s April 2015 issue, labs at the University of Tokyo are researching several versions of nanodrug vehicles and are completing the final stages of clinical trials.  It is expected that research development speed will escalate in the next 5 years showing rapid growth in this exciting field.

The particles used to make up these drugs are cloaked in a variety of ways.  One way is they are made to “blend” in with the normal body tissues and therefore do not alert the immune system as a foreign body thus triggering their degradation.  They can also be constructed in a way to resist degradation by the bodies’ enzymes creating a longer life, thus allowing more of the chemotherapeutic agent to attack the cancer.  Some nanodrugs are created to be soft and flexibile allowing them to enter cancer tumors more readily and then degrade in the more acidic environment of the tumor where the chemotherapy drugs are released and are needed exclusively.  Other scientists are attaching cancer protein antibodies to these nanovehicles so that they are attracted to the cancer cells making delivery of their drugs very target specific.

This growing field of medicine could soon be the dominant way in which we fight cancer.  If you or someone you know is fighting cancer do your research and find out all the ways your cancer is being treated, your cancer may be the one where this therapy is being used!



It’s a Two-Way Street! Dental Practices and Patient Working Together For The Best Outcome

July 7th, 2015


By: Virginia Moore, Moore Practice Success

We’ve probably all been in the position of being a patient and been kept waiting past our appointed time. Frustrating, isn’t it? We’ve all had that experience of having to pay for something necessary when we’d really like to spend our money on something “fun”.  In both those situations, whether you are the provider of the service, or the recipient, you can work to make it as pleasant an experience as possible.

 Staying on Schedule

Dental Practice:

  • As a dental team, agree on appropriate amount of time to allocate to different procedures. This gives you the best approach to staying on time.
  • Start your day on time. After the morning meeting, make sure patients are seated in the dental chair at their appointed time, not 5-10 minutes later.
  • If you routinely have 3 or more emergency patients each day, consider blocking time in the schedule. If less than, in the morning huddle have the clinical team determine best time for emergencies to be seen.


  • Honor your appointed time. Barring an emergency situation, keep your appointments. Your good oral health depends on it!
  • If you need to make an appointment change, give at least 48 hours notice. This allows the practice to accommodate another patient who has treatment needs.
  • Arriving early can give you the time to relax, check emails, and in many practices, have a refreshment. Relaxed is a great way to start your appointment!

Financial Agreements

Dental Practice:

  • Always discuss the financial aspect of treatment before providing treatment. No one likes a surprise, especially a financial surprise!
  • Consider partnering with a third-party finance company that can offer your patients a longer period of time to pay (and sometimes, for a very low/or no-interest rate).
  • Whenever possible, discuss financial matters in the most private setting. None of us like having to share our financial concerns with more people than necessary.


  •  Be upfront. Let the financial person know what you can commit to when discussing finances. None of us want to commit to something we can’t fulfill.  Ask about payment plans, savings for payment in full before treatment, or how treatment may be phased.
  •  Nothing’s for free! In over 25 years of consulting I’ve never seen a dentist’s fees that aren’t in keeping with their overhead. Most dental practices have significant overhead when you consider they are essentially a self-contained hospital; expenses of personnel, supplies, equipment, facility, lab, etc.
  •  If you are fortunate enough to have dental insurance, remember that it is not designed to cover all your dental needs. In fact, most annual dental benefit amounts are provided to maintain an already healthy situation. In other words, if you have dental needs that have been delayed, you will most likely have expense beyond your dental benefits.  When you think about it, it will be some of the best money you ever invest.  Your teeth and mouth work 24/7!

Working together is the key to the best outcome for all involved.

Here’s to the outcome of great dental health for all!


MooreMs. Moore has been bringing greater productivity and profitability to general dental and periodontal practices thru her consulting practice for the past 20 years. As a speaker, she has presented at the top dental meetings in the U.S. and has spoken at meetings in Canada, the Middle East and Asia. Ms. Moore is a contributor to ADA’s newest publication Expert Business Strategies, is a regular contributor to ADA’s Dental Practice Success, as well as authoring 2 books and co-authoring 8 books on practice management. Her passion is getting results that further the success of dental practices. Ms. Moore is a graduate of the ADA KEMP for dentists. She holds membership in the National Speaker’s Association and is a member and Past-President of Academy of Dental Management Consultants.


Tooth Taxi Stories from the Road – Veneta

June 1st, 2015


Tooth Taxi travels to Eastern Oregon cropped (2)

Veneta Elementary school Principal Olivia Johnson isn’t a math teacher but she figured out the perfect formula to help improve the oral health of children in her school.

DFO 3Olivia knew there were kids in her school that needed dental care and when her friend, Marquita Corliss with the Community Health Centers of Lane County, told her about the Tooth Taxi, Olivia got organized.  The school partnered with the Community Health Centers to conduct an initial dental screening so a list of students would be ready for the Tooth Taxi’s first visit.

Johnson got the staff involved early, and reached out to parents to let them know what the Tooth Taxi is, and that it was coming to town.  She used fliers, the school website and reader board, and plenty of phone calls to reach parents and recruit volunteers for the visit.  Johnson and school staffers worked with parents to complete necessary paper work for the children.  “It definitely takes a lot of effort on the schools part to reach out with parents,” Johnson says, adding she alone dedicated about 20 hour recruiting.  “I would do 200 hours if I knew it was going to pay off that way!”

DFO 2During the first visit, the Tooth Taxi screened 44 students and 84 percent needed treatment. Tooth Taxi staff led classroom oral health presentation for 159 students during that visit, and the dental team provided $26,596 in free dental services.

“That just made a huge difference and had such an impact,” Johnson says.

Since the Tooth Taxi has been visiting Veneta Elementary, Johnson has seen firsthand the impact of its services, including improved attendance and classroom participation by children. “I’ve seen kids who are actually happier. I’ve seen kids who are more on task. I’ve seen parents who are grateful for the support and the help, and the kids are excited to go to the Tooth Taxi,” she says.

DFO 4Carrie Peterson, the Tooth Taxi’s program manager, says the commitment of Johnson and other school staff, as well as engaged parents and volunteers, are among the qualities that make Veneta Elementary a model site for the Tooth Taxi.

During its most recent visit, the Tooth Taxi completed treatment on all of the children identified during the initial screening.  In total, visits by the Tooth Taxi have provided 133 students with dental screenings (identifying some serious health issues), 289 students received oral hygiene presentations in their classroom, and 150 children received preventive and restorative dental care on the van.  The total value of the donated dental services is conservatively estimated at $89,855.  More importantly, results show that the combination of committed school partners, parent involvement, oral health treatment and education, and repeat visits make a real difference for children.  It’s a winning formula for children who are not getting into see a dentist.



Are e-Cigarettes Safe??

May 5th, 2015


 Dr. Kim Wright

According to the May 2014 Scientific American online article e-cigarettes generally contain 3 ingredients, nicotine, propylene glycol and flavorings.  Nicotine is a highly addictive stimulant and now there is new science suggesting that it may also impair the immune system.  Propylene glycol is used to keep products moist.  When it is eaten or applied to the skin the FDA has given it a “generally recognized as safe” designation.  However, there is not much human scientific research on the effects when this substance is vaporized and inhaled into the lungs.

E-cigarettes utilize heating coils to vaporize the ingredients.  Metals from the coils and solder joints could potentially dislodge from the apparatus and particulates accumulate in the lungs.  Tin, chromium and nickel are among the majority of metals used in the coils but other heavy metals could be used since there is little regulation of these products.

The concerns are that the children appealing flavorings such as chocolate and bubble gum has contributed to the doubling of the U.S. high school student use from 4.7% in 2011 to 10% in 2012, as reported from the CDC.

The e-cigarette industry has used the “substantially similar” argument to prevent the FDA from stringent regulation of e-cigarettes as drug delivery devices but the same legislative laws that protect target marketing youngsters with regular tobacco cigarettes does not apply to e-cigarettes, a dichotomy that is unbelievable.

In summary, more controlled non-e-cigarette industry supported research must be conducted before declaring e-cigarettes as safe.


wrightDr. Wright is a general dentist practicing in West Linn, Oregon. Dr. Wright earned the prestigious Masters Award from the Academy of General Dentistry (AGD) in 2011. She has actively served professional associations in leadership roles, such as the past president of the Oregon AGD and past trustee for the Oregon Dental Association (ODA).

Dental Practice Employment Law Update: After Measure 91, is Marijuana Just Another Legal Drug?

April 6th, 2015

By Randall Sutton, Saalfeld Griggs PC

Reliable and productive staff is the backbone of every dental practice. It is well known that substance abuse problems can interfere with work. Unreliable attendance, lack of focus, and poor decision making are common outcomes of staff substance abuse. For these reasons, many dental practices find it critical to maintain a drug-free workplace.

With that in mind, it should come as no surprise that the legalization of marijuana for recreational use poses new challenges for dental employers. If the experiences of Colorado and Washington are any indication, Oregon is likely to see a significant increase in the number of employees testing positive for marijuana.  In the year following legalization in both states, positive tests increased by over 20% according to a recent study by a national testing lab.  Moreover, the decriminalization of marijuana and resulting drop in prices, combined with tightened controls on prescription drugs, has led to a surge in the manufacture and importation of heroin into the United States from Mexico.  Given the level of dependability, skill and professionalism required of dental staff, these developments make an enforceable drug and alcohol policy and testing program more important than ever.

The recent change in the law has also brought changes to perceptions and expectations about marijuana use, particularly on the question of whether the drug should be subject to looser regulation by Oregon employers. As of July 1 of this year, marijuana will join alcohol as the only legal intoxicants that can be used recreationally. Given the significant change in the you’re your staff may erroneously anticipate that marijuana use will be treated the same as alcohol use. Under Oregon law, a dental practice cannot test for alcohol use unless a trained individual determines that the staff member is presently (and visibly) under the influence. Similarly, staff may believe that after July 1, 2015, they may use recreational marijuana away from work so long as they do not appear to be under its influence while at work.

However, testing protocols and Oregon employment laws treat marijuana very differently than alcohol, and the new law allowing recreational use does nothing to change that.  Marijuana is fairly unique among the drugs typically included in an employment-related test panel.  Unlike other drugs, which leave one’s system in a matter of hours or days, THC (the active ingredient in marijuana) is stored in fat cells in the body and tests may be positive even weeks or months after the staff member’s last use.  Second-hand smoke can also trigger positive results, but testing cutoff protocols are intended to screen out results that arise solely from spending time around pot-smoking friends or colleagues.  In any event, marijuana is unlike alcohol because there is no recognized test to determine whether your staff member is presently impaired by marijuana.

Not only are testing protocols different for alcohol and marijuana use, but Oregon laws treat them differently—even after legalization of recreational marijuana. Since Prohibition ended in the 1930s, alcohol has been legal at the federal level.  In contrast, marijuana continues to be illegal under federal law.  For employers, this distinction is critical.  Given that federal law continues to identify marijuana as a Schedule I controlled substance with no accepted medical use, the Oregon Supreme Court held in a 2010 decision that Oregon employers can enforce zero tolerance policies, even against authorized medical marijuana users. Measure 91 does little to change that holding, as the new law specifically does not “amend or affect in any way any state or federal law pertaining to employment matters.”

In other words, Measure 91 does not require that you abandon zero tolerance drug and alcohol policies or make significant changes to testing protocols. But, in light of changing perceptions about the drug, we recommend that our dental clients update their policies to address the issue of recreational marijuana use and make it clear that the drug is still illegal under federal law and prohibited under the practice’s drug and alcohol policy.

This is also a good time to ensure that your drug and alcohol policy strictly complies with the myriad of complex drug testing legal requirements.  In Oregon, there are restrictive regulations governing whether or not a termination resulting from a positive drug test affects the staff member’s ability to collect unemployment benefits, and it can be challenging to win unemployment appeals if the practice’s policy is not sound and all regulations are not followed. For these reasons, dental practices should work with employment counsel to review and update their drug and alcohol policies before recreational marijuana is decriminalized on July 1st.


Randall Sutton_Saalfeld GriggsSaalfeld Griggs PC is a law firm serving dental practices throughout Oregon and Washington. Randall Sutton is the partner in charge of the firm’s Employment Law and Litigation Practice Group.  He advises dentists on a wide variety of employment matters and represents dental practices in litigation.


February 2nd, 2015

By Mark M. Storer, DDS

The terms “substance abuse” and “addiction” have always had negative connotations, and most people associate these terms with a moral failing or weakness. It is very difficult for people unaffected by  addiction to view the entire process as a disease.

The AMA first classified addiction as a disease in 1953.  It is defined as “ a primary, chronic, and neurobiological  disease with genetic, psycho-social, and environmental factors influencing its development”.  Addiction is characterized by impaired control over drug use, continued use despite harm, and craving the use of the drug when unavailable.

Dentists should be concerned about addiction because there are alarming statistics that show a tremendous increase in the amount of drugs, including alcohol, that are being abused by the general population:

  • the most widely abused drugs are oxycodone, valium, xanax, and adderall; opioids, CNS depressants, and CNS stimulants
  • non-medical use of prescription drugs occurs by seven million Americans per month, which is greater than the number abusing cocaine, heroin, hallucinogens, and inhalants
  • the number of drug overdoses from prescription narcotics has exceeded deaths from heroin or cocaine overdoses.
  • drug overdoses have become the ninth leading cause of death in the United States, exceeding the number of deaths caused by auto accidents.
  • adults between the ages of 18 and 25 years make up the highest percentage of non medical use of prescription drugs.

With these statistics in mind, it becomes evident that as dentists, we are very likely to treat patients who are abusing drugs, have employees with substance abuse issues, or deal directly with addiction through our own abuse, or that of a family member or friend.


StorerDr. Storer, a 1976 graduate of the University of Notre Dame, obtained his Doctorate of Dental Surgery from Loyola University in 1980.  Upon graduation, he completed a Residency Program in Hospital Dentistry at Illinois Masonic Medical Center in 1981. Dr. Storer was an Assistant Clinical Professor in the Department of Oral Diagnosis at Loyola University School of Dentistry, and for the past 32 years has been a member of the Attending  Medical  Staff at Resurrection Medical Center, where he is currently the Chairman of the Department Dental Services and a member of both  the Credentials and the Bylaws Committees. Dr. Storer is also a clinical instructor and attending dentist in the Residency Program of Emergency Medicine at Resurrection, and is a guest lecturer for the Department of  Family Practice. Dr. Storer and his wife Katie have five children, Jeanette, Tim, Chris, Courtney, and Corey, and they reside in Wilmette‘ Illinois.

Global Diagnosis In Dentistry

January 12th, 2015

By William Robbins, DDS, MA

With the increased emphasis on interdisciplinary treatment in recent years, the deficiencies associated with traditional methods of diagnosis and treatment planning have become more evident and problematic. Many years ago when I was in dental school, I learned to gather a lot of information about the patient and then sit down and make a treatment plan. Dentistry was much simpler in those days. In a complex patient, the treatment plan was primarily dictated by information provided by study casts which were mounted on a sophisticated articulator in centric relation. At that time in history, the primary tools available for treating the complex restorative patient were functional crown lengthening surgery and increasing the vertical dimension of occlusion. The treatment plan was simply based on restorative space, anterior tooth coupling and resistance and retention form of the final preparations, with no focus on placing the teeth in the correct position in the face.  Practitioners did not have access to advanced periodontal, orthodontic, orthognathic surgery and plastic surgery tools that are currently available. With the advent and common usage of these new treatment modalities, the historical method of diagnosis and treatment planning is no longer adequately serving our profession. This style of treatment planning is only effective when prescribing single tooth dentistry. When the case becomes more complex, the old style of treatment planning doesn’t tell the dentist where the teeth and supporting structures fit into the patient’s face.

Global Diagnosis is a treatment planning strategy that guides the dentist through the process of diagnosing and sequencing an interdisciplinary treatment plan. It provides a systematic approach to diagnosis and treatment planning the complex interdisciplinary dental patient with a common language that may be used by the orthodontist, periodontist, and oral and maxillofacial surgeon, as well as the restorative dentist.


Robbins photoDr.  Robbins maintains a full-time private practice and is Clinical Professor in the Department of Comprehensive Dentistry at the University of Texas Health Science Center at San Antonio Dental School.  He graduated from the University of Tennessee Dental School in 1973.  He completed a rotating internship at the Veterans Administration Hospital in Leavenworth, Kansas and a 2-year General Practice Residency at the V.A. Hospital in San Diego, California.  Dr. Robbins has published over 80 articles, abstracts, and chapters on a wide range of dental subjects. He coauthored a textbook, Fundamentals of Operative Dentistry – A Contemporary Approach.  He is a diplomat of the Federal Services Board of General Dentistry and the American Board of General Dentistry. He is past president of the American Board of General Dentistry, the Academy of Operative Dentistry, the Southwest Academy of Restorative Dentistry, and is currently president of the American Academy of Restorative Dentistry.