Wednesday, May 02, 2018

Become a Wizard with your Wand


Mother said we had change their lives!


From time to time I look back on some of my facebook posts.
You may find this story helpful...
"And this, in part, is why I do what I do it... 
"Yesterday we saw an 8 year old on referral from another practice about 8 miles away for the removal of a carious ULd,  with inhalation sedation.

Her parents were very anxious since their older daughter had had to have a GA last year for several extractions and the family found this to be a very traumatic experience.

We saw her for a trial run of the happy air last week and she was well behaved and cooperative.

So yesterday she attended for the extraction and as expected the whole procedure went very smoothly. She did not react at any time during the procedure including the palatal infiltration using The Wand and the extraction, despite the tooth having most of it's splayed roots intact.

She recovered beautifully and dad, who was of course witnessing everything, was bowled over.
Mother was concerned she would need to have a day off school today. We reassured her that her daughter would be fine.
Mother called the practice just now to say ...That we were right, her daughter could have gone to school today. She said her daughter had chatted happily all the way home unlike her sister who had cried for hours after her general anaesthetic to have teeth removed.
Mother said we had change their lives!"

So if you or your practice would like to be able to provide this level of care, please feel free to contact me. 


Learn about or re-visit the benefits of utilising The Wand® 







Friday, April 13, 2018

The Wand® Academy

Dr. Richard Charon BDS commenced work with Dental Sky Ltd as a 
Clinical Consultant for The Wand (STA) local anaesthetic system in Jan. 2018. 


 

This appointment was underpinned with 10 years of continuous use of The Wand from 2004 in my private dental practice in Newbury. I abandoned standard L.A. syringes within a week of my new acquisition! I used it as a stand-alone technique for all patients and of course as an an adjunct to inhalation sedation for anxious dental patients treated with "RA". 





 "The Wand Academy"

He is  currently involved in developing this programme with their Dental Sky team which will focus on new Wand Workshops which are now planned in England and Scotland throughout 2018 to cover the theory and practical to bring this revolution in local anaesthesia.

Dates have just been set for WAND training days in London, Manchester(Hale,Cheshire) and Bristol, monthly between now and the end of the year.
 
Relaxed posture using The Wand for an ID Block

Sat. June 2nd Hale, Cheshire 
Sat. June 23rd Bristol 
Fri. July 20th Londec centre  
Sat. Sept. 29th Hale, Cheshire 
October 5th & 6th London at the ExCeL Centre as part of the Dental Showcase, onboard The Sunborn yacht-hotel moored alongside the ExCeL. 
Thurs. October 18th Devonshire Place
Fri 7th December Londec centre

THE WAND IN USE FOR A STANDARD ID BLOCK
Mike Gow is looking after the workshops in Scotland. 
Please feel free to get in touch if any of these venues and dates are of interest. 

If you have a Wand unit which is under-utilised or if The Wand might be your next practice-building acquisition, these dates are not to be missed.

WARNING: USING OF THE WAND MAY GROW YOUR PRACTICE!


Dr Richard Charon BDS - Clinical Consultant  

richard.charon@dentalsky.com
Dental Sky Website
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Dental Sky Wholesaler Ltd, Unit A Foster Road, Ashford Business Park, Ashford, Kent, TN24 0SH
Telephone: 01233 502 605 | Mobile: | Fax: | Website: www.dentalsky.com










Tuesday, March 20, 2018

Dental and Needle Phobia - Managing the situation.



Here is a success story from yesterday I feel is worthy of sharing using combining standard Inhalation Sedation with Nitrous Oxide and Oxygen (IHS) & The Wand STA® to overcome a common problem.

I do declare an interest since I have recently been appointed as a clinical consultant by 
Sky Dental, the UK’s sole distributor/supplier of The Wand® and I do provide accredited eCPD courses in Inhalation Sedation.
However I would have used the same approach had this not been the case, since I had been a Wand user for almost 10 years prior to retiring as a GDP in 2014.

Case history

The patient: “A difficult 13 year old female patient who was “Dental & Needle phobic”.

Her background:
This is the core of the e-mail I received from a practice manager just before Christmas:

“… we have a patient I’m hoping you can help us with. She is 13 years old and both dental and needle phobic, the latter is the worse of the two. She is due to have fixed orthodontic appliances but requires fillings beforehand.

She has had a session of private hypnotherapy which has not been successful. We have referred her to the community dental service but she is too old for them to treat her. A subsequent referral to our local NHS sedation clinic resulted in an ok consultation but she unfortunately panicked at the treatment appointment, became hysterical and they have refused to see her again.

Her mother has had to cancel her brace placement appointment, and is of the belief inhalation sedation is the way forward, but I have no idea who does this locally, hence me contacting X.
Mother cannot afford private sedation, which we could have provided, nor a referral to Toothbeary in Richmond for paediatric dentistry.

I am now at a loss! Are you able to help or advise in any way?  I look forward to hearing from you, and offer my thanks in advance.”

She had contacted a highly experienced IV sedationist who generally utilizes polypharmacy techniques on a peripatetic basis, someone I know well.

Knowing my own area of interest/expertise he gave the PM my name as a possible better option for the patient.  So she approached me to see if IHS could be the solution in Jan. The patient was not yet having pain with these teeth so we had some time in hand.

I no longer work in practice but I do offer a visiting sedation service from time to time to local GDPs.  Each appointment involved me in a 1 hour round trip plus loading and unloading and setting up/breaking down all of the equipment and gas cylinders.

However alarm bells rang in this case, as I teach that whilst IHS is excellent for many cases, if a patient is truly phobic, it is unlikely to work by itself.  Indeed I would often refer for hypnotherapy, for example, to be used alone or indeed in combination with sedation for true phobics.

 
My chosen approach:

I can only offer my sedation services on a private basis. I explained this at the outset and provided a step-by-step quote for the patient with the idea of proceeding no further at any stage if the patient refused to continue.
Her mother was happy to accept my private fee quote which included a mileage allowance.

I offered the patient’s mother to refer her daughter for a second attempt at CBT/hypnotherapy with a different practitioner who might have more success than the first.
As an alternative I could try to overcome her anxiety/phobia (not certain which at that stage) but it would have to be done on my terms.

The 3-step plan offered was simple enough but would require cooperation of the mother and daughter.

Step 1: Feb 14th: To meet & greet, assess, to explain my idea of how to move forward utilizing IHS with a full explanation and Q&A session to gain Montgomery consent to provide an “RA trial” at the next visit.

If accepted move to Step 2:
Outcome: Mother was very sensible and the patient, though evidently anxious was quite sensible too given her history and previous experiences.  They were prepared to move to step 2 of my plan.

Step 2: 8th March:  The visit was designed to assess the patient’s willingness to sit in the dental chair, and acceptance nasal mask (Porter-Brown) and all being well, to move onto an “RA trial”-(mouth closed & no Treatment).

The patient was also new to the GDP at this practice and he only had one BW radiograph and needed to take 2 new BWs for up-to-date information. The patient was quite cooperative for these and they were taken before we moved ahead with the “RA trial”.
The RA trial went very well, she was quite happy with the idea of using this “new technique” to help her at her next treatment appointment but it was clear that the patient’s main issue was having a local anaesthetic injection.

The rads. showed 2 grossly carious but potentially salvageable 6s at UR6 and LL6. That being the case, I did not want to risk the chance of either:
1       Refusing to accept sedation because she felt it was a cover-up as an injection would be used which would still upset her or
2      Achieving sedation with nitrous oxide and oxygen, (which although very effective, does allow patients some awareness of what is happening) and then just at the point the dentist raised the syringe to give the LA she might see it and still object/raise her hand or try to turn away. 
3    Reacting to a standard LA injection as it was being carried out because it was given too quickly (as I have seen more than once before!).

So my decision with agreement from the treating dentist was that
1        I would give the LA (to be sure of getting the timing just right too) but
2       That I would try to arrange for a one-off loan of The Wand® for me to use (as I no longer have one of my own). That way the patient would not see a syringe and the LA could be provided totally painlessly.

I contacted Daniel Pinder of Dental Sky who is their product specialist for The Wand® and he agreed to help me (and the patient).

Step 3 The plan was to treat one tooth under IHS and to assess the patient’s acceptance.
The decision was to tackle UR6 first. Yesterday Daniel very helpfully delivered and set up a unit at the practice shortly before I arrived and then returned 2 hours later to collect it.

Technique details
We proceeded to re-gain patient consent and moving to the treatment room then very smoothly and without any fuss of any kind, proceeded (while mother quietly watched) to sedate her using IHS. Next as the patient’s sedation began and with her knowledge a fine brush was used to apply topical anaesthetic gel into the gingival crevice buccally.

The Wand® was used in it’s STA mode and a short “handpiece/wand”.
Starting at the disto-buccal aspect of UR6, I obtained a positive feedback (Green zone LED display) from The Wand® Dynamic Pressure Sensing® technology feature, giving assurance of correct delivery of LA in the correct place (½ cartridge Lignocaine 2% with adrenaline).

Moving to the mesio-buccal aspect, the feedback from the Wand was less positive (indicating operator error!) and so to be certain at this point of fully anaesthetizing this tooth with a very deep cavity, I chose to change to the mid-length (Brown colour-coded) Wand, turn off the STA mode and deliver a standard Bucc. Infiltration over UR6.  The patient was unaware of any of the above.
  
The initial STA site disto-buccally (possibly in addition to the analgesic added effect of nitrous oxide) meant that on testing the palatal gingiva with a BPE probe she reported feeling nothing.

I then stepped back and the GDP took over, applying a rubber dam without hindrance and proceeded to prepping the deep cavity and restoring it very nicely with composite.

Dr. Hitesh Chandegra of Gipsy Lane Advanced Dental Centre, Reading



-->
Note the combination of Inhalation Sedation,, personal music & Dental Dam. 
Complete relaxation and detachment from procedures following injection with The Wand® for a "needle and dental phobic" patient. The patient remained responsive to verbal communication at all times.
Sedationist: Richard Charon BDS


Patient Feedback 
The Sedation recovery was fast and uneventful and the patient feedback was excellent.

The session took 54 mins to complete including sedation & recovery and the patient remained in verbal contact throughout.

She said "It seemed very quick","... remembered very little,", "... very happy" " .. will do this again next time".  She was quite happy to go ahead and book the next appointment which has been done.

Other equipment
I use an MDM RA flowmeter on a mobile stand with Miniscav unit from RA Medical Services and Porter-Brown active scavenging nasal masks (my preferred option by a margin).

Discussion:
There could of course have been other avenues to explore to overcome this patient’s needle phobia and indeed my first preference, given her history, was to try once again with a non-pharmacological method. However this was not acceptable to the patient/her mother.

As the potential sedationist at the early stage, it was for me to take over the full management and not just arrive on the day and go ahead and “gas” the patient.
This approach with a patient who has never met me and with whom I have not had a chance to develop any meaningful rapport or insight, though not doomed to failure, will increase the chances of failure in my experience.

Would it have been possible to achieve the same result using a tell, show, do approach and the Wand only? Quite possibly/probably but there would always have been the chance that if the patient had a deep needle-phobia she might have reacted negatively to any suggestion of an injection, however small the needle and however  the method had been “dressed-up”. There is no knowing for sure but I wanted to avoid any failures at any step which would then have been more difficult to recover from.

Concusion
In this case the combination of

1)    The promise of doing everything “quite differently” from her previous dental experiences and
2)    The detachment and analgesia provided by the inhalation sedation and
3)    The absence of a shiny, threatening metal syringe and ability to provide a totally painless and non-threatening LA experience using the Wand
succeeded in overcoming all of the patient’s anxiety/phobia and allowing her to receive the treatment needed in a relaxed and straightforward manner.

If you, your practice and your patients might benefit from using either Inhalation Sedation and/or The Wand®, please do get in touch to find out more about the accredited training (for IHS) and practical training for The Wand® that I am able to provide.

Accredited Inhalation Sedation training for “new starters” (GDPs and DCPs):

For The Wand® information and training opportunities:

Full consent given to use photos












Tuesday, January 02, 2018

Inhalation Sedation Update Day

 Happy New Year to you All

We are now booking our next
Inhalation Sedation Update Day
in Newbury
on
Sat. March 17th 2018.
Fully compatible with new GDC eCPD regs.
   7 hours certificated eCPD hours



offer ends in
4 weeks on Feb.3rd

Remember ALL members of the team involved
must undertake regular updates.
12 hours every 5 years.


Inline image



Whilst writing, don't forget your required annual ILS + PILS training.
This trainer in Banbury is offering a course on January 31st.
I have no financial interest.
Please contact Lynn directly if this is of interest

"See what others have said about ushere
Lynn Fox RGN - EPALS/GIC/ALS/ILS (Resuscitation Co.UK Instructor)
First Aid Instructor (FAIB, HSE, SkillBase and OFQUAL)
Ofsted|Sure Start|Qualsafe Awards
ResusPlus Training
01280 704014 or 0770 250 9967


I look forward to hearing from you soon to indicate your intentions.

e-mail: richard@the-ra-coach.co.uk

Saturday, December 30, 2017

Training and Introducing an Inhalation Sedation Service with Richard Charon BDS

Introducing an Inhalation Sedation (IHS) is a committent both to training, equipping as well ongoing
servicing of the equipment, updating yourself and your team from time to time and undertaking the required ILS + PILS training annually.  
In addition Standards and Guidelines introduced in 2015 and 2017 respectively require more of us but none of this is impossible - it just takes some organisation and systems to run smoothly whilst complying. All aspects of these requirements are covered in the course but it is the individual's responsibility to read these documents.
I found that the technique and indeed the equipment lasted me a lifetime (let's say 35+years) in GDP, using it on a daily basis. It is a question of setting a proper fee level to cover all costs and leaving some over for your trouble!  Naturally for those in the NHS salaried services these considerations do not apply.

Almost any treatment can be achieved

This is a 3-day courses for beginners or those returning to this technique include, Day 1 of Theory and practical demonstrations followed by 2 days of individual one-to-one "Work-based Assessments" at your own practice.




This 3-day course is accepted as being equivalent to a University-based module on this subject.
This course is suitable for dentists, including specialists and DCPs in the UK 
and for dentists only in the Irish Republic.

Course Fees

These fees are not being increased during 2018.
The final fee must include costs which will vary according to the location of the practice to my home base in Newbury. It is a question of geography.
Once a practitioner decides to commit, I will spend the time needed to work out the logistics/ costs of travel, hotel stays , taxi transfers or car hire for visits to Scotland or Ireland usually plus mileage allowance if applicable and subsistence allowances.
These fees do not include your own costs of travel to day 1 of the accredited course which is class-based training and may involve 1 or 2 nights night hotel stay depending on where you are travelling from and the timing of flights/trains etc.

Application
You can download an application form to be printed off, completed, scanned and e-mailed back to me as well as the educational aims and objectives.

My role and ongoing support

My role is to teach practitioners with no previous experience to administer Inhalation Sedation with nitrous oxide & oxygen, successfully and safely, taking full cognisance of the requirements of the current Standards and Guidelines of the IACSD and SDCEP respectively in the UK and where these might differ, of the Dental Council in Ireland.
In addition I act as a mentor before, during and after your training, as well as having the dual-role as an assessor. 


Dr. Suresh Govind, Nottingham receives his competency certificate

This would mean that IF I felt that after the course and spending 2 full days with the candidate, overseeing their first 10 cases plus 5 case assessments, I still assess that that person was not yet ready to go it alone, it would be my duty to say so.
Saying that, this has never happened yet, so hopefully that says something positive about my courses.

If you do decide to book, you will receive further e-mails with attachments or links to resources well ahead of the course date. Please remember at least one of your RDNs should attend with you for day 1 to understand how to assist during the 2 days of WBAs.

You will also need to show evidence of having completed both ILS & PILS training in the previous 12 months before we book days 2 & 3. We can discuss further if you wish.

There is a great deal of information if you navigate the left hand column of my website but some of these case histories may be of interest which are less easily found!


In addition you should find many of my Linkedin articles and posts of interest.

Here are 3 to start with:-

Please e-mail me to book places or for any additional information .