Dental Anesthesia Q&A With Dr. Rachelle Kim

If I had a nickel for every time I’ve heard… “I’m sorry, but I HATE the dentist” my student loans would probably look a lot less pathetic. Really what patients are usually referring to is the discomfort (pain) associated with injections, fear of sitting in the chair for long hours, and the uncomfortably loud drilling noises in most dental offices. 

Providing comfortable anesthesia is often an overlooked service in our profession. I wanted do a Q&A to shed some light on Dentist Anesthesiologist.

Our Special Guest:

Dr. Rachelle Kim is part of a mobile concierge dentist anesthesia group in Southern California. She is a colleague/friend, and was gracious enough to take time out of her busy schedule to answer some questions for us. 

Happy Scaling! 

(Photo by Bliss Anesthesia Group)

Dr. Yvette Carrillo:

Dental Anesthesia is as of 2019 a recognized specialty by the ADA, how did you and your colleagues feel about this?

Dr. Rachelle Kim:

For more than half a century, we have been specialists in practice, as governed by our advanced training and licensing requirements. Due to the intricacies of politics at the organizational level in dentistry however, it took 5 applications to finally be recognized as a specialty, with each application coming with significant financial contribution and sacrifices in time and effort from many American Society of Dentist Anesthesiologists members. These predecessors have paved the way for the new generation of dentist anesthesiologists and we are forever indebted to the efforts of those that fought for the future of our profession and patient safety, even in the midst of fierce opposition and resistance. 

 YC:

That’s wonderful that after all the sacrifices, persistence, and efforts put forward, anesthesiologists finally got the recognition they deserved for so long. 

 RK:

It was a historic and emotional moment for many, and we were all very grateful that we could finally be recognized in name. It was also liberating to move on to continue our mission in prioritizing access to safe sedation and general anesthesia for all dental patients, as well as commence on new responsibilities such as educating, producing legislation, analyzing regulatory concerns, and tracking anesthesia outcomes. 

Photo courtesy of Bliss Anesthesia Group

 YC: 

You and I have discussed patient safety concerns in patients undergoing dental anesthesia in the past. It’s great that as a governing body, you can now focus on patient safety. 

 RK:

Yes, now the role of our organization is to expand to new horizons as we continue the good fight for advocacy of patient safety.

YC:

Dr. Kim, it’s so inspirational to hear about the persistence and force behind the American Society of Dentist Anesthesiologists. Could you please tell the PerioPocket readers about your specialty, and the services you provide?

RK:

Sure, dental anesthesiology is unique in that it is a specialty that is a supportive adjunct for other specialties in dentistry. We provide sedation and general anesthesia in a safe, relaxed atmosphere for the patient and operative dentist, decreasing barriers to care that can be challenging to overcome without our services. 

YC:

So usually you’re going into other doctor’s offices for the day, and take all of your equipment, medications, and materials you use with you, correct?  What are some challenges you face as a traveling anesthesiologist ?

 RK:

The commute is often the biggest challenge that traveling dentist anesthesiologists face. Depending on where the need is in relation to where you live, as well as the traffic conditions and time that you finish are all part of the logistics of our job. Also, when we go to a new office we are always looking for the nearest electrical outlet and figuring out how we can occupy the space efficiently, especially if the operatory room is small. 

 YC:

So many patients are terrified of going to the dentist, utilizing a dentist anesthesiologist can make that experience so much more tolerable. What type of patients do you usually see in your day-to-day ?

 RK:

We are particularly experienced in treating special needs patients because we understand the unique dispositions and challenges they present due to their physical and mental abilities to cope in the dental office. A subset of the population that we often treat are patients with special needs such as Autism, ADHD, Down Syndrome, Intellectual Disabilities, Cerebral Palsy, etc. This population is diverse with their needs for anesthesia just as multifactorial since going to the dentist can be a disorientating and confusing time for these patients. 

We also work closely with pediatric dentists to treat patients that are of pre-cooperative or uncooperative age that have rampant childhood caries. The unfamiliar aspects of a dental office and anticipation of pain can lead to fear that can be traumatic and debilitating for a child, especially when there are extensive treatment plans involved. 

RK:

Also, we provide our services for patients undergoing more invasive or long surgical procedures such as extractions, implant placements i.e. All-On-Four implant supported prosthesis procedures, sinus lifts, bone grafts and more. Patients that have unique medical conditions such as severe dental apprehension, gag reflexes, and local anesthetic tolerance can benefit from dental anesthesia as well.

Utilizing a dentist anesthesiologist in your practice can drastically increase efficiency and provide a safe, comfortable environment for all parties involved, right in the comfort of your dental office. 

YC:

I would say majority of dentists if not all have one of these patients in their office. What would you say to the dentist who feels like they can’t afford to bring in an anesthesiologist, or to the patient who is worried about the cost of anesthesia with dental work? 

 RK: 

We understand that people are cost conscious and for that reason, we have a fee schedule that is reasonable and fair. Anesthesia is often just a fraction of what the total dental treatment costs, yet anesthesiologists take on the most risk and liability. We do try to work with patients and providers that have limited resources, but we also know the value of our time and the services that we provide. Patients entrust their lives into our hands every day, and with that, comes great privilege and responsibility.

YC:

You’re very passionate about dental anesthesia and providing the best patient care possible. If you could pick just one thing, what would you say is the best part of your profession ? 

RK:

I would say, our relationships with our referring doctors [and patients] is the best part of the job. We are so grateful for our working relationships with dentists. They love indulging in our services because the time to suction the mouth is reduced and the reflexes of the tongue are eliminated when the patient is under anesthesia. They can work more efficiently and completely focus on the procedure at hand, while we provide the reassurance that the patient is being properly monitored and safe. We all work together as a team to deliver results that could not have been achieved otherwise without everyone’s help
YC:

That’s amazing, I agree working with other docs is always fun (and patients of course). I was temping at an office that regularly used an anesthesiologist and it was definitely a treat. 

So Dr. Kim what about some of the challenges you face as an anesthesiologist, can you talk about that?

RK:

Sure! Treating special needs patients and pediatric patients come with the nuances of uncontrolled or inadvertent movements. We are preventing potential traumatic experiences for children and special needs patients, while also providing less harmful situations for the people treating them. 

 Providing more access to care for patients that may be marginalized in society and in dentistry makes our job meaningful. We also provide a significantly more comfortable and satisfying experience for the patient with complex treatment plans so they do not have to open their mouth for hours, hear unpleasant sounds, or deal with the stinging pain of local anesthetic injections. 

 When we can provide a convenient and blissful experience for our patients and referring doctors, we feel fulfillment in a job well done. 

 YC: 

A Blissful experience, I get it. Is that how your group came up with the name Bliss ?

RK:

It’s a play on words we came up with after the fact but we picked Bliss because it was short and easy to remember. 

YC:

It’s catchy, yet professional, I like it. Tell me, what is one thing that you want other dentists to know about you ?

RK:

Bliss Anesthesia Group

We all went to the same residency training program at similar time frames, which forged a close-knit relationship. Our values align with our training so we adhere to the highest standards of care. Collegiality and relationships are so important in dentistry because it provides an honest environment for people to learn from each other’s indiscretions and successes. We have a platform where we can refer to each other for help, ask for advice without judgment, and come up with ingenious ways to move our practice and profession forward. 

YC: Thank you, that’s amazing. Thank you so much for taking time to answer questions for the PerioPocket readers. I have one last question for you. What is one thing that dentists and referrals can do to facilitate your workflow to provide the best patient care and experience ?

 RK:

Having a History and Physical and medical history, along with other pertinent information such as labs, medication lists, EKG, ECHO, etc. on file really facilitates the process for us. We usually have to track down this information from the patient’s physicians. However, when referring offices ask for complete medical records along with their medical clearance forms, it really streamlines the process for the patient. If the office doesn’t have this information already, giving us ample time to obtain patient’s medical records is much appreciated.

 ___

 YC:

I’m seeing a trend in more offices to provide some type of sedation in office. We should all strive to be advocates for patient comfort as well as patient safety.  I hope everyone learned something new about dental anesthesia.

 Thank you again Dr. Kim. 

To learn more about Dr. Rachelle Kim and Bliss Anesthesia Group visit their website: 

https://blissanesthesia.com