Specializing in your comfort

May 1, 2012

Some children and even adults with anxieties or special needs have trouble sitting still for a haircut. Can you imagine approaching them with dental instruments? Many otherwise healthy people are just plain afraid of going to the dentist. Medication — sedation — can help them relax enough for treatment. It was to help these patients that Dr. Glen Goleburn decided to take the extra training necessary to offer sedation dentistry. Now, Peninsula Dental Millsboro and Bear-Glasgow Dental Sedation Centers have grown to become the only dental practices in the state offering all levels of dental anesthesia and general dentistry in an office setting.

General Manager John T. Moore explained how this came about.

There are three forms of sedation: oral — medication in liquid or pill form with which the patient is still conscious but with little or no anxiety; IV (intravenous) — medication delivered via a needle in the arm, with which the patient is still conscious and able to respond to commands but likely not to remember any discomfort; and deep sedation — general anesthesia, administered by a board-certified anesthesiologist on site, with which the patient is unconscious but breathing on his or her own.

Starting with oral and IV sedation, Goleburn and his partner Dr. Neil Woloshin thought they might be able to attract patients who were otherwise healthy but had anxiety problems. As it happened, Moore said, many patients who came to them with anxiety concerns and had a great experience realized they had a relative with autism or a friend with a cognitive disability or other special needs who could use these services. They spread the word that their dentist could give medication to make treatment possible and comfortable.

The disabilities community began to seek them out. About 2003, the doctors began offering their services to the state of Delaware's Division of Developmental Disabilities Services. The doctors began to realize that, particularly for adult patients with profound disabilities, even IV sedation was not enough. These patients, even if they wanted to, were unable to cooperate. "There's not enough medicine in the office to help them calm down and be still," Moore said.

There was also a problem with informed consent, he explained. Who was the consenting party, the parent or the dependent adult? What could be done with the current regulations to allow dentists to have more capability outside the hospital?

A forum was organized in Newark in 2008 which attracted 150 stakeholders for a series of panel discussions. Jack Markell, then gubernatorial candidate, and other interested politicians attended, as did representatives of Chimes International, Easter Seals, Delaware Medicaid for children, and rehab and nursing groups. 

What came out of the forum was a change in regulations for the Board of Dentistry that enabled a general dentist to deliver dental care under deep sedation with an anesthesiologist onsite. It also cleared up some of the informed consent issues by creating forms we could all agree on using, Moore continued.

The decision resulted in the building of a first-of-its-kind sedation center in the Bear-Glasgow office in Newark. "We added four operatories (small operating rooms) and a recovery room." One day a week, the doctors worked with Anesthesiology Services PA, bringing in a board-certified anesthesiologist and a certified registered nurse anesthetist to allow them to do a deeper level of sedation. 

There was a real need for such a facility, Moore explained, because IV sedation is simply not safe for some who are severely disabled and already take a lot of medication. They have a high tolerance to sedative drugs. "With anesthesia and the equipment you would have in a hospital, you can treat them safely."

It is worthy of note that the cost of treatment in-office is about 15 percent of such treatment in a hospital setting. And, a hospital such as Nemours typically has a months-long waiting list for the operating room. "There's no facility fee, no billing by multiple providers. We're not a surgicenter, not a hospital clinic, simply a dental office that does all levels of anesthesia. There's one bill. That's it," Moore said.

The Bear-Glasgow operatories were so successful that in October 2009, the doctors opened an office in Millsboro with five operatories in 1,500 square feet. Dr. Judy Majul was added as a full-time associate dentist. She became a partner in the practice last summer.

In 2011, Peninsula Dental Millsboro took over the adjacent space and expanded to 4,000 square feet, adding four more operatories and a recovery room.

General anesthesia is offered in Millsboro on Mondays and in Newark on Wednesdays.

It is also a much needed service for children with anxiety or special needs. Moore called it a blessing, in fact, "because these children can go to the dentist and not have it be traumatic but fun."

Many special needs patients are taking medicines with side effects that dry out the mouth, so their oral health is already at risk. It's difficult for them to do, or have done for them, an adequate job of brushing and flossing. "That's a perfect storm for bad dental health," Moore said.

Goleburn has become a regional expert in special needs dentistry. He gave a keynote address at the 2011 meeting of the Special Care Dentistry Association in Chicago. More recently, he gave a continuing education lecture at the Millsboro office during the "Give the Kids a Smile Event" in February. The practice provided free dental care for 70 underprivileged children that day, many of whom had never been to a dentist before. Some spoke only Spanish, but that's not a problem since services are offered in English, Spanish and even American Sign Language (upon request).

Another big event is coming up in May. At an open house May 15, from 9 a.m. to 1 p.m., the public is invited to come see the office, enjoy refreshments and hear speakers including Gov. Markell and Alan Levin, director of the Delaware Economic Development office.

Markell and Levin played an important role in the opening of the Sussex County office, Moore said. "We wanted to be in Sussex County for some time, but the economy was really in the dumps after the 2008 meltdown. We thought we'd have to put our plans on hold.

"Alan and Jack cooked up the idea of how to get businesses to expand when banks won't lend," Moore continued. Under a program called LIFT — Limited Investment for Financial Traction — the state co-signs for loans so the borrower can use the state's AAA bond rating for low interest rates. The state pays the interest for two years, then the borrower pays it back.

The expectation was that in two years, the economy would be in better shape. It was a push to get businesses to do something and get the economy going.

Six people were hired in 2009 to run the new office; now there are 13 employees — 17 on sedation days. "They're living and working in Sussex County, paying taxes, buying hamburgers and gas ... We are the shining example of how Delaware is business friendly even in the worst of times."

The entire operation has eight doctors and 47 staff members statewide. Offering general dentistry for the whole family, Bear-Glasgow Dental is open six days a week and two evenings; Peninsula Dental is open Monday through Friday. For either site, the No. 1 goal is providing patient comfort in a professional, relaxed atmosphere. The doctors accept most insurance and offer interest-free payment plans. For more information, visit www.BearGlasgowDental.com or www.PeninsulaDentalMillsboro.com. For an appointment, call (302) 836-3750 in Newark or (302) 297-3750 in Millsboro.


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