For many patients with severe anxiety, phobias and developmental disabilities, sedation dentistry is the only path to dental care. While many dentists are well-trained and prepared for any emergency that could arise from sedation procedures, other dentists lack training in performing conscious or moderate sedation, popular procedures that involve oral or intravenous drugs to relax the patient who remains awake and responsive to verbal commands.
Concerns about sedation dentistry, including several alarming deaths of disabled children, are fueling a debate as to how tougher standards should be imposed on dentists who practice sedation dentistry. Some experts call for the states to do more to regulate the practice. But patients cannot always look to the states to take the lead. For example, Michigan has not updated state laws to comply with national standards, set by the American Dental Association (ADA) in 2007, that recommend more training of doctors performing sedation. In fact, Michigan is one of only two states that does not require a permit for health care providers who offer sedation. Although Michigan’s Board of Dentistry is working to strengthen sedation regulations, most experts agree that legislative changes will be necessary to address recommendations, such as mandatory permits and annual office inspections.
If you are contemplating a procedure that requires sedation, ask these five questions of your dentist before you try sedation:
What training have you had specific to the use of sedatives?
The ADA recommends that a dentist, offering conscious (awake) sedation, have at least 60 hours of classroom training and an additional 20 hours of working with patients in a supervised environment. Michigan law requires only 20 hours of classroom training and 40 hours of work on 20 patients.
How are a patient’s vital signs monitored during sedation?
Is emergency rescue equipment available in the room where the procedures are performed?
Ask to see the machines that monitor heart rate, pulse and levels of oxygen in the blood, called tidal-end CO2 monitors. Oxygen and suction equipment, intubation equipment and a defibrillator are essential to have on hand whenever a patient is sedated.
Is the staff properly trained in the use of the rescue equipment and have opportunities to practice with the equipment?
If there is an emergency, a dentist has only several minutes to recognize the problem, assess options and implement measures to prevent brain damage from inadequate oxygen levels in the patient’s blood. The staff must be familiar with how the equipment works in order to efficiently and effectively administer emergency treatment.
How long do you monitor a patient before they are able to go home?
A patient should be monitored at least 30-60 minutes for short-acting sedatives and perhaps longer, depending on the drug. If you are given a so-call “wake-up” pill, you should be monitored for 2 hours, 3 hours if you are given an additional pill.