In the operating room, we need specialists who can work with the surgeon to help keep us safe during the procedures. Dentist Anesthesiologists do that with dental procedures. In this episode, Richard Marn, MD, sits down with Dentist Anesthesiologist Thomas Lenhart, DMD, to discuss how he is working to help keep patients safe. He also helps us understand what being a Dentist Anesthesiologist is like, what they do, and how to become one. Plus, Dr. Lenhart then shares some of the advantages and benefits of dentistry, how he maintains his work-life balance, and more.

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Did you know there are twelve different dental specialties recognized by the National Commission on Recognition of Dental Specialties and Certifying Boards? Some of them are well-recognized to you or well-known to orthodontics, pediatric dentists, periodontists, endodontists, oral surgeons. One of the newer specialties is that of dental anesthesiology. In this episode, we’re going to talk to a successful dental anesthesiologist out in California. In the US, there are only certain degrees that allow you to practice anesthesia. One is getting MD degree, a DO degree, getting a CRNA, a certification. The other is through a Dental degree whether it’s a DMD or DDS.

We’re going to talk with Dr. Thomas Lenhart who has a DMD degree. He first became a dentist. He first got his Bachelor of Arts Degree at the University of California San Diego in Microbiology then got his Doctor of Dental Medicine Degree at Boston University. He received his postdoctoral residency training in anesthesia at Loma Linda University in California. Dr. Lenhart has been practicing anesthesia for decades, mainly in California, both in the ambulatory setting, private practice model, as well as in the hospital setting.

Throughout the years, he’s been doing lectures, both local state and internationally to various organizations. He is also an active member of several dental-related and anesthesia-related societies. I consider Dr. Thomas Lenhart a good friend of mine. We keep in touch with each other over the last few years. We bounce ideas off each other even though we’re in totally different states and on the opposite sides of the country. He’s been a great resource for me. In this episode, he will be a great resource for you to talk about what he does on a day-to-day basis. Let’s jump into this conversation.

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Tom, thanks a lot for joining me. How are you?

I’m good. Thanks for having me on your show.

You and I go way back. I stayed at your home. We’ve had meals together. We’ve had road trips. We got to know each other. I’m glad you’re on the show because I want to understand what you do in your career. I’m hoping you can share that with us. Tell me what your profession is and what you do.

I’m a dentist anesthesiologist. It’s a dentist with a DDS or a DMD who undergoes three additional postdoctoral years of Intensive Anesthesia residency training for a specialty in Dental Anesthesiology and Dentistry.

What type of patients do you work with?

We usually see pediatric patients ages 10 months to 8 years old. That’s my typical patient. My average patient is about 2 to 5. These children who are ASA 1 healthy children with no diseases or children who are ASA 2, who would you have some type of a disease, but it’s stable and controlled. An office-based setting is a safe environment for them to have their sedation whether it be conscious or their general anesthesia being unconscious.

For your career, you’re a dentist who has anesthesia training and you take care of patients in a dental setting?

Correct. It does depend on what state you’re in. Dental anesthesiologists provide conscious sedation, sedation pain management, general anesthesia for physicians and dentists in offices, hospitals and accredited surgery centers.

Dentistry is an art because you get to create and rebuild. Click To Tweet

How exactly are you helping them? You answered that you provide different levels of sedation. You mentioned physicians so you’re saying certain states allow dental anesthesiologists to work with physicians?

In certain states, dentists who have DDSs or DMDs are chiefs of anesthesia in hospitals. Culturally, it has been a small niche. Dentists have been providing analgesia, sedation and general anesthesia for 100 and something years, since 1844 and 1846 with TG Morton and Horace Wells who were dentists. We have been doing office-based anesthesia since that time. In the ‘70s, we brought to the forefront office-based anesthesia, and that was dentists who were trained. We’ve been certainly trained in hospital settings since World War I, World War II, the Korean War, when there are shortages of physician anesthesiologists or DO anesthesiologists. Dentists have filled in those spots for hospitals and throughout the United States. Most people recognize an anesthesiologist as a medical doctor. In other words, to become an anesthesiologist, people envisioned that you have to go through medical school to become an anesthesiologist. You’re educating us telling us that you can become an anesthesiologist by going through dental school.

My understanding and doing this for many years is anesthesia providers or MDs, DOs, DDSs, DMDs, certified registered nurse anesthetists, in the United States, those people are allowed to practice. It is dependent on the hospital at times or the state laws at times. That’s who all can provide anesthesia. It’s not having an MD or DO. There are other routes you can go to be an anesthesia provider. It depends. You’re a specialist in pediatric anesthesia. I am a board-certified dentist anesthesiologist. I specialize in pediatrics. You and I do different things. We still have knowledge of that little teeny body, which is completely different than the anatomy and physiology of an adult.

Tom, let me ask you this. How does someone become a dentist anesthesiologist?

You have to have an undergraduate degree, a four-year degree, preferably in Science, Microbiology, Virology, Biochemistry, Molecular Biology would be the preference, even though there are dentists who have gone in and done English degrees or things like that. It’s more difficult, but more science-based is important. After your undergraduate degree, you need a 3 to 4-year doctoral program in Dental Surgery or Dental Medicine. That’s either on the West Coast, you get a DDS, or on the East Coast, you often get a DMD, which is that Doctorate of Dental Medicine. After that, most people have at least one year of postdoc and advanced general dentistry, or they’ll do other types of postdoctoral training in another ADA specialty, endo, prostho, pediatric dentistry, oral surgery, etc.

After that, it would be a three-year anesthesia residency that’s CODA accredited. That’s an accredited program from the Commission of Dental Accreditation. There are leaders in approximately 9 to 12 dental anesthesia residency programs in the nation. There are five in New York. There’s one in Chicago, Ohio, Pittsburgh and Toronto, Canada. We have a good relationship with the Canadians and dentist anesthesiologists in the United States and in Canada. New York is your hometown.

There are a lot of residency programs for dental anesthesiologists here.

You have NYU Langone Hospital in Brooklyn. You have Jacobi Medical Center in the Bronx. You have Saint Barnabas Hospital in the Bronx. You have Stony Brook University Medical Center in Stony Brook, New York. You have Wyckoff Heights Medical Center in Brooklyn, New York. You have five programs around you alone. It’s a lot of competition.

Why do you think dentistry is such a great field?

Dentistry is a better field than medicine. This is personal because we still have the ability to practice as a doctor. To make a diagnosis, to make a treatment that’s not based on an insurance company’s willingness to pay or not. We can decide to spend an hour with you personally inquiring, asking questions, being personable, letting you know that we care for you as a human being. You’re not this person coming in that’s getting a feeling that gets ten minutes of our time, one tooth at a time and reschedule. We also have many specialties in dentistry, the ability to do regular restorations, implants, cosmetics and veneers, to be an oral surgeon and to rebuild your face, to take a jaw that doesn’t fit your face and move it and slide it to do reconstruction.

You have the ability to do microscopic periodontal surgery, root canals with microscopes, cameras and little wires. You have toys, gadgets, lights. You have all things. We’re in medicine. I have a stethoscope, a blood pressure cuff and a patient monitor. There are many ways that you can effectively use your creativity, dentistry and medicine. They are both science and art. I say art for dentistry because you get to create. You get to rebuild. There are many ways to do it. As a physician, you also get to use your science, but you get to recreate the art of being a practitioner, to listen to people, to find the right diagnosis, to look outside the box. You’re limited in my perspective. Are you practicing for yourself? Are you working as an employee of the insurance company?

 

They won’t allow you to give them medicines that are required. They won’t allow you to do the things that you know should be done. If you do it, then they take their patients away. They say to you, “Richard, I’m sorry, but we’re going to take away the 1,000 patients we send to you for your anesthesia care. I’ll cut your group out completely.” In dentistry, you still have the opportunity to say, “If you don’t feel that access to care and the proper treatment of my patient is in the best of their interests.” We say, “We’re done. Bye. We don’t need you. We’ll go to another provider. We’ll find a way to help our patients.” We haven’t been restricted in that way. We can practice that art and science still now were sometimes in other healthcare fields, we’re finding ourselves not being the provider anymore. We’re an employee of insurance.

You feel there are more flexibility and freedom as a dentist compared to other healthcare providers.

As a healthcare provider providing dentistry oral and maxillofacial surgery, pediatrics, the list goes on. An anesthesiologist, you can practice sedation, pain management, anesthesia. It’s the best.

What’s your typical day like from start to finish?

Being a mobile office-based anesthesiologist, my typical day starts at 4:00, 4:30 in the morning. I get up, shower, get dressed, drive 2 to 4 hours to a location, set up the operating room within an hour, go through algorithms and mnemonics to verify that everything is where it should be. Everything is in working order like walking a plane if you were a pilot. My patients come in. They’ve already been pre-op ahead of time. We do a review of systems, a physical exam, an airway evaluation, and risk assessment. At that point, I’ll pre sedate the child with medication that allows me to bring them back without any fear, anxiety, memory or discomfort. Once they’re back, lay them in their dental chair according to what they need to do and what position that chair needs to be in.

I’ll go ahead and place monitors and IV, put them on oxygen and do an induction to get them asleep. From there I prep and drape them, make sure that they have a secure and safe airway, or they have no pressure points. They’re wrapped, comfortable and warm in either a heating blanket or compression stockings or whatever those might be depending on the surgery and the length of time. My job is to maintain their hemostasis, heart rate, blood pressure, oxygen saturation, body temperature, fluid management, blood loss, all those things during the procedure and then wake them up, recover them and send them home to their mommy and daddy’s in better shape than they were when they came into the office prior to their surgery. I pack everything up, drive home 3 to 4 hours.

How many patients do you usually see a day on this typical day?

Depending on the speed of the surgeon, I see 2 to 4 patients per day, four days a week and then try to have a Friday or Monday off along with the weekend.

Besides the dentist, the dental assistants and office staff, are you often working by yourself?

In the beginning, I had built a huge group practice. There were five of us. At some point, I got tired of doing all the heavy lifting for everybody else. In 2013, I decided to come in and give everyone pink slips and say goodbye. I’m in private practice now by myself. I have a business office that does the scheduling, the finances. I’m the only anesthesia provider for my practice, which is Bay Area Anesthesia. In the surgery suite, it is the dental surgeon, myself, two staff members. You have a rotating nurse that rotates in and out.

There's a huge portion of our nation that's unaware that a dentist can even provide anesthesia. Click To Tweet

When I do recoveries, I bring an EMT, RN or an anesthesia assistant to assist in the recoveries. That means the patient doesn’t leave the OR until they’re stable, awake and responsive. They’re groggy. If you don’t bother them, they’ll doze back to sleep, but they’re not unconscious. We’ll take them into a recovery area and do the recovery until they’re safe to be discharged. For me, it’s touch your nose, wave goodbye and say you want to go home. No nausea or vomiting. Mom and dad are comfortable. They’re willing to go home. They asked to stay and I say, “No problem. You can hang out all day because I’m there all day.”

Tom, what misconceptions do people have about your profession and career?

It’s been held down in a pack through other specialty groups in dentistry. Many people don’t know what a dentist anesthesiologist is nor what they do on a regular basis. They’re unfamiliar with the training. They’re unfamiliar with the programs. Finally, after 175 years, dental anesthesiology as a specialty recognized by the American Dental Association. It’ll take some time for us to get better knowledge. For the physicians and anesthesiologists that train us and work with us, they treat us as brothers. They treat us with respect. They know what we can do. They know what we can’t do. We work together to provide the best care for children, for handicapped adults and children, for special needs adults and children. That’s what’s rewarding, but there’s a huge portion of our nation that’s unaware that a dentist can even provide anesthesia.

I’m glad you’re here on this episode to showcase your profession. As an anesthesiologist, I used to work in a hospital for many years. We used to work with dental anesthesiologists. Some of them were fantastic. A dental anesthesiologist can work both in the hospital setting and a mobile setting like you.

I worked with some good MD, DO anesthesiologists. There are some that are anyone else in any profession.

What is the most rewarding part of the job for you?

The most rewarding part is the mindset of I’m there to keep that child safe. We know that there can be bad outcomes in hospitals, accredited surgery centers and office-based settings. Office-based anesthesia has its own profession SAMBA. It’s been providing office-based anesthesia since the early ‘80s, mid-‘80s.

SAMBA is Society of Ambulatory Anesthesiology.

It is the fact that having a frightened cognitively, developmentally child who can’t control their feelings. They have all that fear. They have all that anxiety to have them come in to control that fear, take away any memory of what’s going to be done, having them come back and see you afterward and hug you and say, “Dr. Tom, you were my anesthesiologist. You put me to sleep.” Watching their smiles. An example of that is I had a three-year-old whose mother sent me a video and she said, “What do you think of Dr. Lenhart?” The little three-year-old says, “He’s funny. He is nice.”

Maybe not for you or other people, but it warms my heart. It makes me feel that in a world that sometimes is crazy that I have a tangible difference that I can make it’s visible. I can see it. I can feel it. I can go home and I can sleep at night. Prior to private practice, when I did eight years of anesthesia and trauma, there were many times I could never sleep. There were burdens and things I had to carry on my shoulder that I never got over. It’s nice to be able to select my patient, provide my service, sleep at night and go about my day smiling. I’m happy. It’s a wonderful profession.

Tom, is there a least favorite part of your job?

 

My patients are wonderful. Parents sometimes are difficult now because everybody’s a Google doctor. When they come in and they’re telling you what to do, how to do it without any foundation and knowledge, it makes it difficult. That’s it. Let me answer it another way. The worst part of my job is driving. It’s a double-edged sword.

You live in California and your offices are all over the place. You got to drive great distances sometimes.

They do. I would say that I have about a six-hour radius of driving there and back. It’s three hours out, three hours back in addition to a twelve-hour day. It’s a long haul. It wears on you as you get older, but it’s a double-edged sword. It gives me time to think, to decompress, to enjoy books on tape while I drive. It’s like long hours. I’m tired. Thank God my car drives for me into Tesla. The driving is a pain, but being able to work with different people and many different personalities every single day, that’s a big plus. You never feel like you’re in a rut or a routine.

Would you say your work-life balance is good?

I’d say in the past it did not balance well and that was because I thought of success as things that were possessions. I felt that being a successful man was an accumulation of things. Personal experience shows me that’s not the case. The thing that counts the most is your family, your friends, the closest people to you. In the event when there are issues, they scatter like cockroaches in the light. I lost my tangent.

We were talking about work-life balance and you started talking about your life.

That’s the work-life balance is I’m okay with working the 12 to 16-hour days for three weeks. I need to take at least 5 to 7 days off. That’s what we try to do. My wife is good at saying, “Tom, I’m sorry you have to work hard these three weeks, but I promise you we’ll go do something and get away for five days.” We left to do photography. We fly drones. We love to edit photos. We do things together as a team. It’s nice to have a best friend in this crazy journey.

That’s one thing I’d like to highlight, Tom, is that you are able to make your own schedule as a mobile dental anesthesiologist?

You can work in different modalities. There are many dental anesthesiologists who have an office like a regular dentist. They practice dentistry and they also practice anesthesia. Some of them practice as operator anesthetists. They’re surgeons under the anesthesiologist. A majority of them practice as only an anesthesiologist and provide no dental surgery at that time. For me, I chose to do nothing but anesthesia day in and day out, provide pain management, sedation, etc. I haven’t touched a handpiece as a general dentist since 1994, it’s been a long time. I have no regrets.

What do you think the future outlook is like for your profession?

It’s good. It’s a recognized specialty of the American Dental Association, more and more providers will be available. It’s about access to care. It boils down to that. The physicians in the United States can’t provide care in every avenue of health care. We fill a niche. We fill a need. We don’t want to tread on anyone’s space or their profession. We do enjoy the ability to provide safety and care for patients primarily in the dental field for me being here in California and doing those things to provide better care for everybody. Oral surgeons, on the other hand, can’t do everything either. That’s why we’re a specialty now is because after a long war, long fight. We all learn to work together. We all have the same care for our patients. We want the same safety and the same things for our patients regardless of who we are.

The thing that counts the most is your family, your friends, the closest people to you. Click To Tweet

Tom, do you recommend this career for students?

I do.

What students do you think are the best matching for this career?

Let me tell you what you need to be an anesthesiologist or a dentist anesthesiologist is you need courage and you need stamina. You have to have the ability to be in action even when you’re trembling in your boots. You have to be highly detailed oriented. You need to have empathy towards others and towards your patients, you have to have the ability to remain calm in calamity when the so-called plane is crashing. Most anesthesiologists, whether you’re a dentist, an MD, DO or a CRNA, they’ll tell you, “My job is routine 90% of the time, 95% of the time depending on what hospital you work at.

There is that moment that there’s nothing to do except muscle memory and training to save your patient. You have to have the ability to function effectively in that calamity. You need to have excellent decision-making skills and management abilities. You should be able to communicate and interpersonal skills. From going to high school to undergrad to a doctorate program to a postdoctoral program, your foundation is built on layers. What I know I wasn’t born with it took hours and hours. I’ve repeated practice to sit here many years later and to be able to safely provide anesthesia care. Don’t be afraid of anything, have courage and stamina. Get in there and get done what needs to be done and do your best 120% all the time.

Let me shift gears a little bit. What were you like when you were younger? You talked about your trajectory, how you went from high school up through graduate school and training. When you were in high school or even in college, were you thinking about becoming a dentist? You said you wanted to be a dentist when you were eight years old. What were you thinking?

I came from your typical American family, divorced parents. I was hyperactive. In second grade, I spent most of the year outside sitting because I couldn’t sit still until the teacher figured out, “I need to give Tom a task so he has stuff to do because he rips through things fast and he gets bored.” When I was eight years old or around eight, I had a great dentist. His name was Edward Wing C. Houser. He was in Ball Road in Anaheim. He seemed to be this guy who was a superhero. He was this German guy with a big, giant forehead like Frankenstein. I’d come to the office. He’d grab me by the head and picked me up.

He would say, “Tommy, sit in the chair, don’t move, be a good boy. I’ll give you back to your mom. The longer you make me sit here with you because you’re Mr. Wiggly, then the longer it’s going to be before you go home so help me out here.” It was my plan ever since that, “This guy likes me. He cares about me. I want to be a dentist.” Like the cartoon, the Christmas one or the little reindeer that wants to be a dentist. I worked my whole life in school to study hard. I was also a musician so I played the trumpet. I was a percussionist. I learned that practice, perfection, practice. It’s okay. I don’t have to get the first-place ribbon the first time I try something. It takes work. Tenacity, perseverance, the fortitude never to give up, never surrender. It was a model that I kept, a movie quote, “Never give up, never surrender.” That’s how I’ve lived my life. If you tell me no, I’m going to bite my nose off to spite my face and show you that I’m going to do it. They call that defiance disorder.

After college, you went straight into dental school?

When I graduated from UC San Diego, I worked for a year as a waiter. I went to Boston University in New England for four years. What made me like medicine was I received a DMD and that was a Doctorate in Dental Medicine. A gentleman, who the school was named by Henry M. Goldman, his thought was look, “Dentistry is a subspecialty of medicine.” When you come to Boston University Dental School, you’re going to do two years of medicine with the medical students along with your first two years of dental school. When they go off to clinical medicine, you’ll go off to clinical dentistry.

That’s what I did is I had fourteen classes the first two years while the med students had 4 or 5, but I had 14 because I had a medical curriculum and I had a dental curriculum. When I got out, I had a good background in medicine. I still want to be a dentist, but doing dentistry for four years as a hospital staff general dentist, I was a little bored and I needed something else. I liked the plastics. I liked faces and I wanted to be a plastic surgeon. In 1993, I applied for a dual degree program. That was the three years of Medicine, three years of Oral and Maxillofacial Surgery, then a year internship. It would be Plastics.

 

The Plastics at that time was a three-year program. How many years were that, 7, 8 years? In the midst of that, I ended up doing an anesthesia residency. They loved me and they said, “Be the chief anesthesia resident.” In my second year, I got to do that. I have a crazy way of doing it. People have asked me, “What is it? How do you think of yourself when you’re doing anesthesia?” I tell people, “I become omnipresent. I sit in a space that’s the past, the present and the future.” The past is my monitors. When you look at your monitors, “That happened so it’s your past.” It gives you a graphic. It gives you a path that you’ve taken that you can look at and say, “I was here and then I can be in the present.” I can be in the present by using my precordial where I can hear the heart, the carotid arteries, the respirations. I can use my eyes, ears, nose, and hands. Touch using your senses puts me on the same times that I’m in the past into the present.

My brain gives me the future. It gives me this quantum ability to look at multiple possibilities of what’s going to happen at that point because we know that’s what we prepare for. We prepare for the multiplicity of things that are going to happen are possibly going to happen. It’s trying to hold an explosion in place, anything that changes in that operating room, from the temperature to the body position, to what the surgeon says, what the feelings are, it impacts the patient and impacts everything around you and its outcomes. Whether you feel that way or not, that’s how I can tell you the feeling of providing anesthesia is for me.

One thing I love about talking with you, Tom, especially when we talk about anesthesia, since we’re both in the anesthesia business, is that you’re able to put in words what you are doing and you frame it in a way in a concept that can be understood by laypeople. You can also teach it to other professionals too. I’ve seen how you talk to patients, other professionals. That last few minutes where you’re talking about how you conceive your way of practicing medicine and anesthesia, I still like, “That’s another way to look at it that I never have thought about before.” That’s why I appreciate you. I appreciate how you look at that. At one point you were thinking about being an oral surgeon, but were you thinking about any other careers along your paths?

Not an oral surgeon. I wanted to practice plastics. I want to go into plastic surgery in an indirect way since I didn’t have the opportunity to go in through medical school, but now I have the experience that I’d take a backtrack way. I have a Dental degree and an Anesthesia degree or a Dental degree. I would have a medical degree finishing a three-year program. It was a backdoor approach to something that I’d love to do. I still love faces. I’m telling you.

I had a guest called Sherrill Fay. People understand that you can get an MD degree after a Dental degree. You get this MD degree through the residency training after that Dental degree is earned. You can earn that Medical degree if you choose, but it’s a niche market for that it sounds like.

I want to be an actor. When you grow up in the volcano when your world is crazy, you want to be everything, but who you are because you don’t know who you are because it’s crazy. I thought maybe being an actor. When I retire, I want to be a barista. I want to serve coffee and become anonymous. They’re going to call me Dr. Coffee or becoming a flight attendant would be super fun. They’ve got great benefits.

Reflecting back, what would you have done differently?

Nothing. It’s been a fantastic journey. It has ups and downs, excitement, sadness, all realms or all avenues of feeling. I don’t think I’d want to miss anything. There was a more direct approach. Time-space isn’t always linear. By the end of my career or the end of my life, it’s not going to be where I went from point A to point B. It’s what happened to me along the journey. It’s all those experiences that make me a good provider. If I didn’t have those experiences, I wouldn’t be a good doctor, a good father, a good husband and a good friend. I don’t think I do anything. I could shortcut some things, but I would’ve missed out on a lot of learning at that point.

Tom, I want to move to a fun segment. I like to call Dr. Marn Lightning Round. You may have heard about this before. Favorite city in the US besides the one you live in?

Boston.

Favorite junk food?

Dentists prepare for the multiplicity of things that are going to happen. It’s about trying to hold an explosion in place. Click To Tweet

McDonald’s fries.

If you were 80 years old, what would you tell your children about life and about the business that would be the most important thing for them to know to get ahead start?

My quote from Galaxy Quest, the movie, “Never give up, never surrender. Always give 110% and laugh every day. Love your life.” That’s it.

What cheers you up?

Laughter, smile, a kiss.

How would you hope you are described by people when you’re not around?

Kind, empathetic, a listener.

Final question, can you say something about yourself that most people at your workplace would not know about you?

I’m more funny than serious. I’m not the same person at work as I am at home with my friends. It’s a different hat. I wear different hats. I wear a different hat as a dad. I wear a different hat at home. I wear a different hat at work.

Tom, that’s it. I appreciate you coming on this episode. You provided a lot of content, depth, interesting stories and understanding about what you do. Thank you. I apologize to the readers if this was a boring episode. Thank you for coming on board, Tom.

Thank you, Dr. Marn. It was a pleasure. If there’s no contact after you edit everything out, I’d be glad to come back and try it again.

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That’s our show. Thanks for reading. To learn more about ‘s guests or other past guests, check out my website, HealthCareersWithDrMarn.com or HCWithDrMarn.com. If you like what you heard in this show, then please go to my website, add your name and email to my email list. That way you can get the latest announcements and news as they arise. You can also find me on Instagram @DrRichardMarn. Thank you for reading. Catch you in the next episode.

 Important Links:

• Dr. Thomas Lenhart – LinkedIn
• Commission of Dental Accreditation
• Bay Area Anesthesia
• SAMBA
• Sherrill Fay – Previous Episode
• @DrRichardMarn – Instagram
• BayAreaAnesthesia@Gmail.com

About Thomas Lenhart,DMD