10 Commandments of Safe Sedation Dentistry
Complacency and safety do not mix.
The fact that more than 20 million Americans have been safely and effectively treated by specially trained general dentists using oral sedation is cause for celebration. That is even more true because so many of these anxious and fearful patients previously avoided the dentist altogether.
But the popularity and mainstreaming of sedation dentistry is also a compelling reminder that dentists and their team members must remain fully committed to patient safety as Job #1.
No "Top 10" list can encompass all the precautions and preparations that dentists must undertake to ensure patient safety and comfort. That is the role of basic and continuing education.
But this year's Sedation Safety Week seeks to reinforce the importance that these ten essential commandments play, among others, when it comes to practicing safe sedation dentistry.
We encourage dentists to review our list, share it with their entire team, and post the commandments where they will be visible every day of the year.
1. Above all other possible considerations, dentists and their team members must place patient safety first.
Adherence to all professional guidelines, regulatory requirements and state-of-the-art protocols is essential.
2. Dentists should never undertake a sedation treatment unless they have obtained a thorough and accurate medical history of their patient.
Always cross-reference the patient's medications, supplements, vitamins, and herbs with the sedative and anesthetic medications you plan to administer. If there are any doubts, confer with the patient's physician prior to treatment.
3. It is the nature of most dentists to want to help every patient, especially those who are experiencing significant pain or discomfort.
But some patients present with complex non-dental medical conditions, including chronic illnesses, which put them at greater risk for complications stemming from sedatives and anesthetic medications. It's important to refer these patients to other dentists who have received special training in treating high-risk individuals.
4. The protocols for maximizing patient safety are fluid.
Each year, if not more frequently, research and operatory experience generate improved methods for ensuring patient safety. It is vital for dentists and their team members to take regular refresher courses and to stay well informed about advances in the science of patient safety.
5. Most dentists who provide sedation treatments to their patients never face an emergency, especially if they adhere religiously to the first four commandments already mentioned.
Nonetheless, regular and varied emergency practice drills are compulsory in the effort to keep patients safe. This is a team-wide effort and everyone should participate. Regularly review the locations of all emergency drugs and equipment, as well as the procedures for contacting emergency service providers.
On an ongoing basis, be certain to make note of the expiration dates of all your oral sedation medications, emergency drug kit medications, AED pads and AED battery. At least once a week, check the oxygen levels in your emergency tanks and restore them, as needed, to full pressure. All other essential equipment, including your pulse oximeter and blood pressure monitor, should also be checked.
6. With advances in the science of safe sedation dentistry have come advances in the availability, affordability and efficacy of related equipment and tools that provide dentists an edge when it comes to emergency prevention and preparedness.
An excellent example is the growing prevalence of capnography as a means to obtain nearly instantaneous readings of a patient's expirations of carbon dioxide, permitting dentists to know immediately if the patient stops breathing.
Other equipment, such an intraosseous infusion system used to help run an IV line in an emergency, increase a dentist's ability to act quickly and effectively in the rate event that an emergency situation does arise.
7. Patients and their family (or friends) play an important role in sedation safety.
They need to understand fully the importance of making full disclosure of any existing health conditions that could pose a problem. Likewise, they need to provide you with an accurate list of all of the prescription drugs, over-the-counter remedies, and supplements they are taking. Of course, they must always bring with them a designated driver to escort them home after any sedation procedure. Encourage patients to ask any questions they have before, during, or after each procedure.
8. Many patients report that the only way they can overcome their fear of visiting a dentist is if they receive sedation treatments.
Nonetheless, sedation should only be administered where a patient's comfort and health necessitate it, and then only by providing the minimum dose necessary to reach therapeutic effect.
9. Dentists and their trained team members must work in tandem to make certain that patients are never left unattended and that a patient's vital signs are monitored at all times.
An especially crucial component of the safety protocols is monitoring respiration and protecting the patient's airway from foreign objects.
10. Many professionals who mean well, and a small group whose motives are less pure, have circulated a great deal of misinformation about sedation dentistry and what is — and is not — safe.
Dentists and their team members have an obligation to rely strictly on credible science and evidence-based research studies to determine the best ways to provide for the health, comfort, and safety of their patients.
Moreover, it is important for dentists to defend the rights of all patients — present and future — to have access to safe, affordable sedation dentistry. Members of the public, dental regulators, delegates to professional trade groups, and the media must all be reminded of the strong science-based, empirical evidence supporting current sedation dentistry guidelines and regulations.
Get the Science of Sedation Dentistry
Introducing www.GetTheScience.com — Where Facts, Not Myths, Have the Final Word
The science that supports the safety of select oral sedative drugs to alleviate the pain and anxiety of dental treatments is not new. Nor are the protocols, guidelines, and regulations that govern the general dentists who provide oral sedation recent arrivals.
As early as the 1970s, if not earlier, general dentists were safely and successfully treating their fearful patients using mild oral sedatives.
"Our goal in dental practice is to maximize patient comfort and cooperation, while minimizing risk and costs."
Harald Löe, D.D.S., then the Director of the National Institute of Dental Research, wrote that statement 30 years ago in his preface to the book "Anesthesia and Sedation in the Dental Office," edited by Raymond A. Dionne, D.D.S., Ph.D. and Daniel M. Laskin, D.D.S., M.S.
The book presented the proceedings of a conference held at the National Institutes of Health in 1985, where the science of oral sedation — and the need for it — was a prominent topic.
That might surprise many of todayâ€™s oral health professionals given the ongoing debate — both in the profession and the media — about whether general dentists are qualified to administer minimal and moderate enteral sedation or whether they need significantly more training to ensure the public safety.
The evidence-based research on this question, aka "the science," is actually quite established. When practiced in accordance with the current American Dental Association (ADA) guidelines and state regulations, sedation dentistry has demonstrated an enviable safety record.
The science, moreover, is backed by overwhelming clinical evidence. More than 20 million otherwise fearful and anxious patients — many of whom avoided seeing a dentist for years, even decades — have been safely and effectively treated by general dentists administering oral sedatives, without incident.
One reason that so many practicing dentists are susceptible to the arguments of those who demand additional restrictions to the existing guidelines and regulations that govern the use of oral sedation is that they are unaware of the science. Truth be told, so are some of the well-intentioned dentists who are actively lobbying to tighten the rules governing sedation dentistry.
The current question before the ADA, which was debated in 2006, 2007, 2015, and will be again this year, stems less from ambiguity over the science and more from professional infighting and jockeying for influence. A few sensational news reports, highlighting tragic deaths caused by dentists who failed to adhere to current guidelines, protocols, and regulations, have provided fuel to those who seek to rewrite the guidelines to make them far more restrictive.
The question, however, does not merely impact the dental profession. The proposed changes to existing guidelines and regulations, now before the ADA, would have an enormous potential impact on dental patients. Should the latest proposals be adopted, the cost of general dentistry services aimed at fearful and anxious patients would rise, and the number of dentists qualified to offer such safe services would decline precipitously.
The science on this is unquestionable: When adults and children avoid seeing a dentist — either out of fear or because they can no longer afford dental care — they endanger not just their oral health, but their general health.
Myth, fear, ego, greed, and ignorance are insufficient reasons to upend a safe, patient-oriented, well-established method of dental sedation that has transformed the health and quality of life of tens of million of Americans.
Science, and science alone, should have the final word.
Please visit www.GetTheScience.com to review some of the hundreds of published and peer-reviewed articles that testify to the efficacy and safety of oral sedatives when administered by general dentists in keeping with current protocols, guidelines, and regulations.
The editors of GetTheScience.com invite the submission of additional published Journal articles that speak to the topic. Send the articles (as PDFs) or article references to: Editor@GetTheScience.com.
2016's Sedation Safety Dentist of the Year
In the age of the Internet and its many health review websites, patients can be harsh judges of any dentist who doesn't dedicate himself or herself to superior service and comfort.
Patients seldom know how much commitment it takes for their dentists to remain up-to-date on the latest safety protocols, guidelines, and regulations. All they know is that they expect each visit to their dentist to be painless and result in better oral health and a sparkling smile.
The 2016 Sedation Safety Dentist of the Year, Erica Polk, DDS, delivers consistently on her promise of treating all of her patients with the strongest commitment to their safety, needs, and comfort. Her nomination for this year's honor by her dentist peers — combined with her exceptional patient reviews — are a testament to the 18 years she's dedicated to our profession.
"More than anything, I just wanted the ability to help my community with oral health and hygiene," Dr. Polk says in explaining why she chose the dental profession in the first place. Dentistry is a big part of health care and yet underrepresented in the national dialog about health."
Based in Memphis, TN, Dr. Polk provides her loyal patients a wide variety of services, including crowns, implants, root canals, bridges, and TMJ treatments. One of the ways she alleviates the fear and anxiety that keeps many patients away from the dental office is by administering safe, effective oral sedation, following guidelines set by the American Dental Association and in compliance with Tennessee dental regulations.
Sedation dentistry] is good for the patients because they're typically overcoming a serious fear," she explains. "They're furthering their health and typically can get long-standing issues resolved in [only] one or two appointments."
Dr. Polk took her initial DOCS Education oral sedation course more than a dozen years ago. Since then she has regularly attended advanced sedation and safety courses, as well as refresher classes.
The key to practicing sedation dentistry with the highest level of safety, Dr. Polk says, is always to pay attention to patients and keep the focus on them. "Listen to your patient and make sure you understand," she says. "That part's important. Not only are you instantly aware if something is wrong, you tend to forge relationships that are going to endure the test of time. It's not just about short-term relationships."
Dr. Polk attended dental school at University of Tennessee College of Dentistry and graduated in 1998. Her practice is staffed with friendly and experienced team members and draws patients not just from Memphis, but from surrounding communities as well.
You can trust your smile with us," Dr. Polk writes on her website. "Our promise to you is that the fillings, crowns, and bridges we create will look as good or better than the teeth nature gave you."
Relying on continuous training, development, and superior quality dental services, Dr. Polk aims to become "one of the leading dental practices" in Greater Memphis.
Based on the reviews of her peers and patients, she is well along the path. Writes one patient on a review site: "Best dentist I've ever been to. I hope she never closes. I don't know what I'll do.
Lucky for that patient, and all of Dr. Polk's other satisfied patients, she is not planning on going anywhere in the near future.
The type of dedication that Dr. Polk shows to her patients, their safety, and her ongoing education, make her an obvious choice for our 2016 Sedation Safety Dentist of the Year.
Congratulations Dr. Polk.
If You Won't Defend Your Rights, Don't Complain When You Lose Them
Today, we ask all dentists, team members, patients, and those who care about public health to take a few minutes to protect the rights of all Americans to receive safe, affordable, pain-free, anxiety-free, sedation dentistry.
Even after more than 45 years of scientific and clinical evidence showcasing the laudable safety record of oral sedation dentistry when provided by general dentists in accordance with the current ADA guidelines and state regulations, there are those who seek to rob patients of access to oral sedation care.
This is not the forum to discuss what the motives are of those who would severely restrict the ability of general dentists to continue to treat their fearful patients using minimal or moderate enteral sedation (the clinical terms for the administration of oral sedatives).
But it is a wake-up call and a reminder that the practice of oral sedation is under assault and needs to be defended in the public interest.
In 2015, members of the ADA's House of Delegates barely stopped a proposal that would have dramatically raised the cost of regular dental sedation treatments, while significantly reducing the number of general dentists who specialist members of the ADA deems qualified to offer their patients oral sedation.
In 2016, the ADA is once again taking up the issue, and the forces that hope to slap additional restrictions and costs on oral sedation dentists are mounting another well-funded campaign.
They cannot be allowed to prevail.
We are asking dentists and patients alike to voice their support for safe, effective, oral sedation dentistry that adheres to the existing ADA guidelines and state regulations. More than 20 million Americans have been safely and effectively treated without incident by specially trained general dentists. The evidence-based science on the issue is abundantly clear.
SHOW YOUR SUPPORT TODAY:
1. Like our "Save Sedation Dentistry" page on Facebook. Join the more than 2,100 other grassroots defenders of patients' rights. The page is located at www.Facebook.com/SaveSedationDentistry. While you're on our page, feel free to express your support in the comments section.
2. If you're a patient whose oral health and quality of life have been transformed thanks to safe oral sedation dentistry, please visit www.TellUsYourSedationStory.com and take a few minutes to share you story with other dental patients who might benefit from oral sedation dentistry.
Everyone who shares her or his story will be entitled to receive a free copy of "The Miracle of Sedation Dentistry" when the e-book is available later this year. In fact, we plan to incorporate some of the best patient stories we receive into the book itself.
3. If you're a dentist, dental team member, or public health advocate, you can support our efforts by ordering advance copies of "The Miracle of Sedation Dentistry" for yourself, your dental practice, and members of your community.
100% of the profits from the sale of the book will be used to defend the rights of general dentists to provide their patients safe, effective oral sedation dentistry without placing unnecessary restrictions and costs on them. For additional details and to order, visit www.OrderTheBook.org.
4. Members of the ADA must raise their voices. Contact your local ADA District Caucus leaders right now and let them know you oppose all efforts to make it more difficult and more costly for general dentists to treat their patients with safe, effective oral sedation. Point out that there is no evidence-based research or clinical record to support dramatically tightening the existing ADA guidelines.
A new website, www.GetTheScience.com is rich with scientific articles and other resources on the topic.
The four steps outlined above will take only a few minutes. But collectively, they will have a dramatic impact on the debate currently before the ADA. Today's dental patients — and tomorrow's — have the right to receive affordable, safe, effective oral sedation.
But that right must be defended or be forfeited. We're counting on you!
Introducing the Year of the Sedation Dentistry Patient
It is time that we in the dental health community join to salute our patients and their commitment to improving and maintaining their oral health.
In honor and celebration of the more than 20 million Americans who've successfully overcome their fear of visiting the dentist — thanks to safe, effective oral sedation — we proudly declare 2016-2017 the Year of the Sedation Dentistry Patient.
From March 2016 to March 2017, dental offices throughout the United States will be hosting "Year of the Sedation Dentistry Patient" open houses. These local celebrations will give patients whose lives, health and smiles have been transformed thanks to safe, effective, oral sedation dentistry an opportunity to share their good fortune with other fearful and anxious patients who have avoided the dentist for years, even decades.
"Many patients do wish for the opportunity to pass forward their good fortune to others, who like them, were once hesitant to visit the dentist," explains Dr. Michael Silverman, founder and national chairman of Sedation Safety Week. "In addition, nothing makes dentists and their team members happier than when they witness the profound difference their care has made in the lives of their patients."
As part of the Year of the Sedation Dentistry Patient celebrations, a new book will be published later in 2016, titled: "The Miracle of Sedation Dentistry — Transforming the Lives and Smiles of Millions of Americans."
The book, to be authored by Dean Rotbart, a Pulitzer Prize nominated journalist, will explain the science and vast clinical evidence supporting the safety of oral sedation. Rotbart will also showcase the inspiring stories of individual patients and detail what oral sedation has meant to their health and quality of life.
Patients and prospects attending the Year of the Sedation Dentistry Patient open houses will have the opportunity to share their success stories in the book and on the associated website.
"While some holdouts in the dental profession continue to deny the science of safe sedation dentistry, it is virtually impossible for anyone to dismiss the incalculable positive impact that oral sedation has had on the health and quality of life of so many individuals and their families," author Rotbart says. "Moreover, it's well-established that those adults and children who neglect their oral health are much more susceptible to serious general health illnesses."
Patients who wish to tell their stories and share them with other individuals who stand to benefit from safe, effective oral sedation, are encouraged to visit www.TellUsYourSedationStory.com.
Everyone who shares his or her story will be entitled to receive a free copy of "The Miracle of Sedation Dentistry" when the e-book becomes available later this year.
Dentists and their team members who wish to host a Year of the Sedation Dentistry Patient open house can order copies of "The Miracle of Sedation Dentistry" to distribute as "thank you" gifts for prospects and patients who attend their celebrations. Order details are available at www.OrderTheBook.org.
Dr. Silverman, who as co-founder of DOCS Education is a leading pioneer in the education of general dentists on sedation dentistry techniques and safety protocols, notes that the news media are quick to pick up on the very rare occasion when a patient has a bad experience at the dentist's office. That, in turn, helps fuel people's dental anxiety.
"Since the media don't often report on the tens of millions of Americans who have great dental experiences thanks to safe, effective oral sedation dentistry, we think it's time we let America know our patients' overwhelmingly positive story," Dr. Silverman says. "Oral sedation patients are among the happiest, most grateful, health care patients in the country. This is their year to be heard."
Sedation Safety Week was founded in 2009 by Dr. Silverman and has been hosted each year as a public service by DOCS Education. SSW programs and activities are always free and open to all oral health professionals and members of the public.