Meet Our 10th Annual ‘Safe Sedation Dentist of the Year’ Honoree
(EDITOR’S NOTE: The theme of this year’s 10th Annual Sedation Safety Week is “Awareness.” Dr. Michael D. Silverman, founder and national chairman of the annual event, believes that it is incumbent upon sedation dentists to spread the message that oral sedation – when practiced in accordance with all national guidelines and state-mandated regulations – is safe, effective, and of great value to the estimated 92 million Americans who exhibit dental anxiety.
“Selected by a jury of his peers, Dr. Chiang is an exemplary model of professionalism and dedication,” Dr. Silverman says. “He does our profession honor, and we hope this recognition will encourage other dentists to emulate him and his strong commitment to patient safety.”)
Meet Dr. Peter C.J. Chiang – 2018’s Safe Sedation Dentist of the Year
When Peter C.J. Chiang, DDS, isn’t treating kids from the mostly rural, blue-collar area surrounding his Salinas, California office, you might find him powering through a team roping event at a local rodeo, where he and a partner race on horseback to rope a calf in the fastest possible time.
Though team roping and pediatric dentistry may seem worlds apart, Dr. Chiang sees a common thread. In both undertakings, he has found ways to avoid pitfalls, maximize safety, and use the best possible equipment.
His practice, Central Coast Pediatric Dental Group (CCPDG), located about an hour south of San Jose, has three locations and some 130 employees, including six pediatric dentists, six general dentists, and one dual degree MD,DDS.
“Sedation and hospital dentistry is an important part of our practice,” Dr. Chiang says. It comprises at least one-third of CCPDG’s overall business and takes more than 90% of Dr. Chiang’s time.
Dr. Chiang is originally from Seattle but went to the University of California at Los Angeles for his undergraduate studies, and completed a residency in pediatric dentistry at the UCLA Medical Center. He is now a UCLA faculty member, spending one day a month helping to train future pediatric dentists.
Dr. Chiang always wanted to live in a rural area, so when he was recruited upon graduation from dental school to go to an established Salinas practice by his business mentor, Dr. Roger Sanger, and his clinical mentor, Dr. Ray Stewart of the University of California at San Francisco, he jumped at the opportunity.
It was a good fit.
Dr. Chiang has been with CCPDG for 27 years, developing an approach that evolved into a mission statement. The vision of his practice group, Dr. Chiang explains, is to “treat all kids in our community with the same compassion and care; addressing their needs equally.” CCPDG not only sees to the dental needs of its patients but also holds year-round community events, including reading and sports contests.
An essential component of the practice is safety in pediatric sedation. The core of Dr. Chiang’s approach is to stay abreast of developments in his field and always go beyond the minimum standard of care.
“We have a strict sedation protocol that not only adheres to our academy’s safety guidelines, but we practice protocols above and beyond the minimum levels,” he says. “We require all our sedation doctors to have continuing education.” Training extends to his staff in both the front and clinical offices. The clinic holds emergency drills and protocol rehearsals on a regular basis, covering topics including PALS medications, complications of anesthesia, and rescue concepts.
“Not knowing what you don’t know is a scary thing versus knowing what you don’t know. You need to be careful with oral sedation and pediatric dentistry. Knowing the danger and the margin of safety is what is going to keep a patient safe in a sedation environment.”
CCPDG utilizes a “surgicenter,” which Dr. Chiang designed to handle the practice’s sedation dentistry patients. He describes it as a “facility within a facility.” The idea came to him when he noticed that friends of his who were ENT doctors (ear, nose & throat) were beginning to handle some procedures in the office.
As outpatient surgery centers became more common, “that idea morphed in my mind, to establish a section of the office dedicated to oral conscious sedation and in-office IV sedation. We concentrate all our resources in terms of monitors, chairs, and back-up systems so that our sedations are done with minimal disruption to the normal flow.”
Dr. Chiang has instituted other important procedures at the practice, including the use of monitoring devices.
“In our oral conscious sedation monitoring protocol, we started using capnography in 1997,” he says, “and now, 21 years later, it’s required in some offices. But I would like to think that our contribution to oral conscious sedation is having patients’ safety as our utmost goal.”
Safety and education go hand in hand in Dr. Chiang’s experience.
“Not knowing what you don’t know is a scary thing versus knowing what you don’t know. You need to be careful with oral sedation and pediatric dentistry. Knowing the danger and the margin of safety is what is going to keep a patient safe in a sedation environment,” he explains.
Like so many quality pediatric sedation dentists who are devastated when they read news reports of pediatric deaths in dental offices, Dr. Chiang knows such tragedies – though tiny in number – are preventable, and should never occur.
Kids who are seriously injured or die at the dentist’s office represent a lack of quality assurance and experience; what Dr. Chiang deems the “ultimate failure.”
‘It’s just an absolute tragedy, and my heart goes out to the families and all the people who are involved,” he says. “We are still addressing the lack of understanding, the lack of education, and the lack of attention to patient safety that resulted in these tragic cases. Education is key.”
For dentists who may be considering using sedation, particularly in places where medical services are few and far between, Dr. Chiang emphasizes preparation.
“For general dentists in underserved areas, in a rural area in which there are few backups – EMS or hospitals not readily at hand – education and never compromising patient safety is of primary importance. I think it’s important that dentists who are new to sedation pair themselves with a good mentor who is a fit, so they can have good equipment and have a safe philosophy.”
Mentors – such as Dr. Sanger and Dr. Stewart – have been instrumental to Dr. Chiang, even when it comes to recreation.
He rode horses as a child and got interested in rodeo as an adult, when he had the chance to hang out with some professional cowboys. “I started roping, and had the opportunity to team up with some of the best people in the profession. I had great mentors who steered me to good equipment, allowed me to learn quickly, and steered me away from danger. They helped me be good at what I like to do.”
Dr. Chiang excelled at rodeo from the start.
“I’ve been fortunate,” he says, “I was able to win in my division quickly.” He keeps his many awards in a separate room in the house, kitted out with special tables, a wall stand, and even a wagon wheel to hold the trophies, buckles, and the particularly prestigious saddles. His fastest roping time was an incredible 6.1 seconds at an event in Maui (under ten seconds is considered ideal in team roping), but, he still says, “My best event ever is the next one.”
Looking ahead, Dr. Chiang sees a bright future for pediatric dentistry.
“We anticipate growth. We’re still having kids, and kids aren’t very good brushers. It allows me to discuss growth and development; it allows me to see my patients grow from young kids to young adults leaving the practice, and then coming back with their own kids.”
Dr. Chiang’s successful career and life have been characterized by always doing more than the minimum, and taking every precaution to avoid unnecessary risk.
Does his work in pediatric dentistry fulfill him? “It has exceeded my expectations both financially and personally,” he says. “I have been rewarded by the profession, by my patients, and by my community in ways I never expected.”
(This article was reported and written by Nancy LeBrun, a regular contributor to Incisor, the free biweekly cutting-edge dental news and features newsletter. To subscribe to Incisor, click here.)