Can Sedation Dentistry Be Holistic?
An Interview with David Cutts, DDS
By Mike Bundrant

I’d never uttered the word holistic and the words Sedation Dentistry in close proximity. Therefore, I was surprised during my recent conversation with Dr. David Cutts when he claimed to practice such a thing. I wondered if it might be merely smart public relations, given the Healthy Times readership. With further investigation, I began to understand that this Temecula dentist is uncommonly committed to holistic principles, even when he needs to use Western Medicine.

I hope you enjoy Part One of the three-part interview series with Dr. David Cutts.

HT: When I think of Sedation Dentistry, drugs come to mind. In other words, it seems unhealthy to someone who is committed to living a natural lifestyle.  What do you have to say to that kind of claim?

Dr. Cutts:  I agree.  More than you can imagine.

HT: Why practice it, then?

Dr. Cutts:  I practice what I call Holistic Sedation Dentistry. 

HT: Okay, I’m all ears.

Dr. Cutts:  First of all, Holistic Sedation Dentistry understands that it’s not a good thing to put drugs, period, into the body.  It should only be done as a last resort. No other Sedation Dentist is going to tell you that.  I can guarantee you I will be the only one saying that.

I’m not saying that just to be different.  I firmly practice Holistic Sedation Dentistry.  That means I don’t do it if I can get the job done in any other way, because I don’t believe in drugs whether they are legal or street drugs. So, if I can talk to a little child and get that one little filling done and not have him go with full I.V. sedation just to take out one tooth, I’ll even say to the parents, “They have one little cavity bug.  The other doctor says he needs to be put out, blah, blah, blah, I disagree.  It’s not worth it. Let the little cavity bug go.” I say that everyday. 

I’m not interested in sedating two and three year olds for one little cavity.  There’d better be something worse, something very important that we are trying to fix using Sedation Dentistry.  And that is also true of adults.

I’m renowned for very, very careful injections.  Why?  I hate shots myself.  As a kid, I always used to climb a tree in my backyard when my mother, who was a nurse, would bring home tetanus shots. My older brothers had to treat me like a raccoon and shake me out of a fig tree in Napa Valley.  True story.  I hate shots.  I hate them!

So, I vowed that when I grew up and became a doctor, I would give very, very careful injections. And I treat a four year-old and an eighty-four year-old the same.  I’m going to do the most careful injections.  So, you don’t need to do Sedation Dentistry for fear of shots with me.  And if I see that fear of shots is the only issue, then we’ll just sit down and I’ll say, “You don’t need Sedation Dentistry.  Let’s don’t do it.”  Being careful and in touch with my patients and doing things slowly and thoughtfully - that’s Holistic Sedation Dentistry. 

HT:  I like that.  And I would add to it from a layman’s perspective.  You have a mouthful of cavities and developing gum disease and all these issues are compromising your health, compromising your immune system.  There are links from gum disease to heart disease and so forth, right?

Dr. Cutts:  Correct.

HT:  Because you’re afraid, you’re not going to go to the dentist.  From a holistic point of view – a perspective that asks what options are best given the totality of the issues, you can take your pick.  Allow your mouth to decay or go to the dentist, take some Western medicine to get it done and improve your over all health.  Given that those are the options, what do you do?  Well, you go to the dentist. 

Dr. Cutts:  Yeah, if I’ve got a severe kidney stone the size of a marble and I’m in pain where I need morphine, please, knock me out and take the thing out. If I’ve got appendicitis, remove it. Fine.  There are times for Western Medicine and there are times for Sedation Dentistry, but I don’t push Sedation Dentistry where it isn’t absolutely necessary.  If I do use Sedation Dentistry, I use a light amount of medication, the least amount of drugs possible.

Here’s the killer part - here’s the part that’s most important:  throughout history in operating rooms and surgical areas where people are sedated and thus in a hypnotic trance, there exists all kinds of jibber-jabber.  Surgeons are notorious for talking about their golf games, their wife, their second wife, their cars and babble, babble, babble with the nurses back and forth.  Guess what?  That is not holistic. That is not taking into account the whole being in front of you. You shouldn’t be saying a word and I feel very strongly about this. 

This is a critical issue my practice. When patients do need to be sedated, I allow no talking, no babbling and nothing other than hand communication and whispering off in the corner.  Other than in an emergency if you have to say, ‘please grab that tube’ - fine.  But, other than that, I don’t want to hear anything in my patients’ surgical environment because it’s going to affect them unconsciously. 

I was talking to my long time assistant and she said, “Yeah, I know how to explain it.  When I put Mia, my three year old, down to sleep and everyone’s running around and arguing and blah, blah, blah - when she wakes up, she’s more upset.  But when it’s a quiet environment and nothing occurred around her, she wakes up and she’s much more peaceful. Likewise, we respect our patients’ space by remaining calm and quiet during their procedure. They wake up feeling much more at ease as a result. Typically, doctors pooh-pooh this idea, but it is very important to us.

HT: I know there are cases where people have remembered, under hypnosis, comments that had been made by hospital staff while they were under anesthesia that turned out to have a lasting effect on them.

Dr. Cutts:  That’s more understood than you might imagine.  Within the anesthesia profession, they don’t want to let that out.  They can’t control themselves from talking. They could just be quiet, but they don't want to. My anesthesiologist, he’s one of the top guys from Loma Linda University. He loves coming to our office because we are like a family after ten years, but he hates coming because this is the place he’s going to have to be quiet.  He’s a sociable guy and he hates sitting there for three hours and he wants to talk.  He wants to ask me how my horses are doing or my daughters.  You wouldn’t imagine what I have gone through to train that guy to be quiet.  But, he now is quiet.

I believe there was a study in the New England Journal of Medicine about eight to ten years ago that documented everything you said about people remembering because people do remember.  Even if they don’t it, still affects them significantly.

Dental Fear, Embarrassment and Avoidance: Is There a Solution?
An Interview with David Cutts, DDS
Part II

Estimates suggest that as much as 75% of the population has some degree of fear of visiting the dentist. For some, the fear creates a cycle of avoidance in which the lack of dental care and resulting tooth and gum issues create even more pressure to make that visit. This, in turn, exacerbates the fear. There is a percentage of the population that will only visit the dentist in cases of emergency involving extreme pain.

Avoiding regular check ups and dental care is a health risk with implications, not only for the teeth and gums, but for the entire body. Studies have shown the link between oral health and other conditions including heart disease, diabetes and general immune system functioning.

The fact that dental care is necessary does not seem relevant if you are afraid, however. The necessity is typically not as immediate and gripping as the fear. People who avoid the dentist do so in spite of the risks. Admittedly, I am one who tends to avoid the dentist, so I was curious to speak with Dr. Cutts about how he addresses this issue.

HT: If I am afraid to visit the dentist, what can I expect if I come in to see you for sedation dentistry?

Dr. Cutts:  Well, you can expect, first of all, that we can understand what your needs are.  If you take a look at our track record, twenty-five years in business and going on six thousand cases of sedation and anesthesia dentistry that I have personally done - it’s possibly the most done in California and perhaps the nation.  So, we are very, very appreciative.  We understand. We sit in the patient’s seat.

It starts with me because I’ve never been excited about having shots and various medical and dental treatments, especially when I was a kid.  So, it’s not hard for me to occupy the viewpoint or put myself in the shoes of the person in front of me.  Patients feel that difference too. 

To me, having sedation dentistry doesn’t mean you are a coward or chicken and all the clichés.  When you are talking about anyone having major dental treatment, it’s a lot to ask anyone to go through wisdom teeth, three implants in a row, two root canals, and five extractions, and so on.  That’s the kind of stuff we are doing on people.  I don’t know if I would ask anyone to go through that without some kind of sedation.

HT:  One of the things that bothers me about going to the dentist is the social anxiety of it.  Not just the fear of the pain, but the embarrassment of needing work done. I’m prone to social anxiety anyway and the thought that these people might think I don’t take good care of my teeth makes me uncomfortable. I get worried that way.  Do you find that’s a common thing for people?

Dr. Cutts:  It’s interesting that you say that.  This is more common than you can imagine. All I can say there is when you are a dental practice that specializes in taking care of people who need to have significant amounts of dentistry done (I call it a backlog in maintenance, you know?) you naturally feel compassion for people. It doesn’t make any sense to judge people who are coming to you for help. It’s like taking your car to the car wash and having them complain about how dirty it is.

 HT:  Right. The last thing I want is to be uncomfortable with the people who are supposed to be helping me. It’s almost like I want somebody to go out of their way to address the issue and tell me it’s okay. 

Dr. Cutts:  Mike, I don’t know how you are going to write this, but there is a vibe in our office, you know what I mean by a vibe?  There is a feeling.  The number one thing patients say when they come into our office to have a consultation is, “Okay, good.  This is what I’ve been looking for.”  

A person is either judgmental or they are not. You can’t fake being non-judgmental.
We just aren’t.  That has a lot to do with being real people and putting ourselves in the shoes of the other person.  I don’t know what else to say.  Why would you be judgmental of a person trying to handle a problem?  It just doesn’t make sense to me.   I don’t know if I have some analytically correct answer to that, ‘hey, we aren’t judgmental, believe me, because we read a book or something.’ We’re just not.

HT:  That may help people feel safe and more comfortable, which I think is important when you put yourself into a vulnerable situation.

Dr. Cutts:  I actually take special pleasure in the fact that my patients know that I am a real person who understands their dilemma. You wouldn’t believe how many new mothers come in crying - I’m not joking, crying - because they were told they were bad mothers because their kids have baby bottle decay - two to three year olds. 

Hello?  Baby bottle decay occurs whether you are a millionaire and live in Bear Creek or whether you are on welfare.  It occurs because teeth are genetically soft and, sure, with a lot of sugar…but this same mother will have another two children with no decay at all.  Why is that dental office saying that they are bad mothers?  Were they a bad mother with the other kid?  No, they weren’t.  That story I see time and time again. 

The adult version of that story is I know I haven’t had a cleaning in five years and the hygienist pointed the finger, you know, “bad boy” tsk, tsk, tsk…

HT:  Shame, shame, shame.

Dr. Cutts:  Shame, shame, shame.  Why professionals think they need to do that in order to help people is beyond me. We see everything in our practice and the number one thing people say when they come to our office is, “This is different.” 

HT: So, with Sedation Dentistry, give me a profile of the person who needs it.  Someone, for whatever reason, hasn’t gone to the dentist in a while.  They have a backlog of maintenance work that needs to be done and you just sort of knock them out so they don’t have to be present for it.  Is that it?

Dr. Cutts:  There are two main profiles and they are totally different people.  One is the person who is seriously freaked out about going into the dental office. They are not going to go unless they are sedated, even if it’s for a cleaning.

The other category is the person who is basically okay with dental work and they’ve had dental work done, but they need so much work to catch up on that backlog maintenance  that they need to be in the chair for four hours.  It’s a lot easier on them and on me to have them sedated. For them the four hours passes like it’s thirty minutes and then they are home and they don’t even remember what happened.  I can do more extensive work like implants and it seems effortless that way.

There are your two different type people.  One person isn’t particularly afraid, but they have so much work to be done that it is better for them to be sedated. And the others are generally terrified, basically.

HT:  What kind of sedation do you use?

Dr. Cutts:  I don’t give nitrous oxide at all because it’s unpredictable in its results.  I do general anesthesia, I.V. sedation with the anesthesiologist that works for me. Or I do basically Valium - it’s a beefier form of Valium, a sleeping pill.  To give you a statistic on that, roughly thirteen of fourteen cases do just fine with the pills.  For one in fourteen I need my anesthesiologist. 

As a final note, one in five dentists practices sedation dentistry, but that doesn’t mean that one in five are sedation dentists.  In other words, doing five or six thousand cases and managing thousands and thousands of full mouth reconstructions is an entirely different thing than saying I give people Valium whenever they are a little bit edgy.  We do a full range of sedation anesthesia dentistry with heart monitors and medical evaluations.  We are really experienced in doing this.

To contact Dr. Cutts, call his office in Temecula, CA at 951-296-0166.