post your comments about sedation dentistry to our blog Read the oral conscious sedation press release.
In our most recent survey, we asked dentists if they offer their patients oral conscious sedation. Two out of three dentists reported that their dental practices offer OCS. A quarter of dentists don't feel comfortable offering sedation. And 8% said that they wished they were able to offer OCS, but regulations in their state made it too difficult to implement in their practice.
Read the dentists’ comments for more insight into their thoughts on referring patients out to orthodontists.
Click the graphs below for more data. Roll over to see exact percentages.
When it comes to sedation, urban dentists are the most conservative, and rural dentists the most liberal. Fully 70% of rural dentists offer sedation, while only 57% of urban and 63% of suburban dentists do.
In addition, urban dentists were more likely to wish they were able to offer oral conscious sedation. While 17% of urban dentists expressed this
preference, only 6% of suburban dentists felt the same, and no rural dentists did.
Gender differences were minimal, but still significant. Female dentists were more likely to feel uncomfortable offering OCS than their male colleagues. While 42% of women said they don't feel safe about offering sedation, only 28% of men did.
In addition, male dentists are more likely to offer OCS at their practices, with 64% of men reporting they offer the service, as compared to only 54% of women.
Specialists are more likely than general dentists to offer sedation dentistry. While 72% of specialists report offering OCS, only 61% of general dentists do.
Sedation is a valuable tool in dentistry
- “I love it and think it is very safe. Many of our patients use it and it helps them get the treatment that they need.” (Michigan dentist)
- “A wonderful service for our patients,” (Michigan dentist)
- “It is an excellent tool for the fearful patient that has not been to the dentist in years. It is a major part of my practice.” (New Jersey dentist)
Why are politics getting in the way of good dental care?
- “I think oral conscious sedation is a fantastic way to provide fearful patients a comfortable, safe way of getting their dental work done. When you weigh the negative aspects of dental pathology, conscious sedation provides an avenue of treatment for these otherwise untreatable patients… I believe regulations should be structured for the good of the people and not to prevent OCS for being provided. Currently OCS is surrounded by an entanglement of special interest groups. It is time we as dentists who have been certified be able to provide this safe and time-proven technique of patient care!” (California dentist)
There's value in them thar regulations!
- “I am very pleased that many states are starting to regulate this and have established minimum requirements to use OCS. License renewal is also important for dentists to stay current. I was wary when Arizona took this step due to increased regulation, but am now convinced it sound policy.” (Arizona periodontist)
- “I think the regulations are important.” (Puerto Rico pediatric dentist)
- “I feel the regulations are necessary for patient safety. It takes too much time for the procedures for me to be interested.” (Utah dentist)
- “regulation is needed to safeguard our patients.” (Texas dentist)
- “Excellent protection for the patient. States should continue to require a certificate or permit to deliver sedation.” (Illinois dentist)
Some of these regulations are over-the-top
- “Regulations on monitoring during sedation sessions are getting ridiculous. Some states don't even want the Dr to step outside the op to go to the lab or the bathroom AT ALL during the entire session even if the patient is still on the monitoring machines and the assistant is present. This is overkill.” (Minnesota dentist)
- “Regulations in Illinois are designed to protect dental anesthesiologists and oral surgeons not the public. In spite of safety record the state has determined than a sedation license for parental anesthesia is needed for use of safe doses of triazolom and similar drugs.” (General dentist)
- “The regulations are overly onerous. Each practitioner is ultimately responsible for the doses of the sedative agent and appropriate management pre, during and post treatment. More rules and regulations won't prevent irresponsible behavior–it will only prevent many compete tent practitioners from utilizing this modality.” (Maryland pediatric dentist)
- “The regulations have gotten tougher and I don't think it is warranted. We used to be able to titrate and now we cannot without an IV license. But it is still a great tool to have for the anxious.” (Florida dentist)
- “The regulations in Colorado are ridiculously strict. I am however more prepared to deal with complications as a result of them.” (Colorado dentist)
- “Too stringent.” (endodontist)
- “Should be allowed. Otherwise, next thing you know, I won't be able to write a prescription for penicillin because I'm not an internist. Having said that, I think some good short courses should be available. It's just like using an electrosurg. My training is good enough to know the benefits but the techniques need to be given.” (Mississippi dentist)
Don't forget that people can die as a result…
- “DANGEROUS!!!!!” (Oregon oral surgeon)
- “Due to the two adult oral sedation deaths in my area, I feel the ADA did not go far enough in its new guidelines.” (Missouri dentist)
- "Due to wide variations in patient responses, a certification NEEDS to be maintained. ACLS recommended and emergency training as well."(Illinois
Done properly, no one will die from OCS…
- “I am a big proponent of conscious sedation, when used safely. All studies show that, when the Academy of Pediatric Dentistry guidelines for case selection, monitoring, etc. are followed, there has never been a death of a patient from conscious sedation. It is a much better, safer, cheaper alternative than general anesthesia. I support those regulations that require the testing of providers, the requirement for CE and the inspection of offices. I do not support the blanket prohibition of conscious sedation when provided by trained, educated and peer tested providers.” (Pennsylvania pediatric dentist)
What about IV sedation?
- “I am taking an IV sedation course, because I see the writing on the wall.” (California dentist)
- “But I am trying to move to IV sedation.” (Argentina dentist)
- “I do IV sedation and some oral sedation. I think that the regulations for oral and IV sedation are fine.” (Pennsylvania dentist)
- “I have a permit to do IV sedation in addition to oral sedation, which does not work for at least 50% of patients. If work is started, then abandonment
becomes an issue unless IV sedation is done.” (California dentist)
OCS demands special training
- “I need to take a refresher course and it is very expensive. My liability will go up of course.” (Texas dentist)
- “However, each patient is so different. Some are zonked with 0.25 mg Triazolam whereas others are still going after 1.0 mg. If you are on a tight schedule, then the second group really throws you off. I find it inconsistent with our training that some states allow you to give one pill, but not another an
hour later. Stupid politics.” (Canada dentist)
Plenty of praise for DOCS
- “I believe the DOCS classes should be enough training and probably mandatory for anyone wishing to do oral conscious sedation. I do not believe ACLS or IV training is necessary.” (Kentucky dentist)
- “My experience has been that by following the DOCS protocol and training, monitoring with Criticare unit, and just being cautious with case selection,
conscious sedation is extremely safe and a treatment godsend for anxious patients!” (general dentist)
- “Very useful. I think the training provided by DOCS is both adequate and excellent. I oppose the new regulations proposed by the ADA.” (Michigan
- “Must be offered as option to all dental patients. Regulations are vague and if we let schools get involved in the education and certification, they will do the same death wish as they have for dental assisting. Mandating more classroom work and courses with little application. DOCS is our most valuable asset.” (California dentist)
- “I am a member of DOCS (Dental Organization of Conscious Sedation) and the education this organization provides is top notch. We receive
extensive training in pharmacology, medical emergencies, patient management and medical legal issues. Still to date, there has not been one patient die from oral conscious sedation and it remains to be the safest way to sedate an anxious patient. I do not know what will happen with many of the patients I treat if the proposed regulations are instated. There will not be a place for thousands of fearful and anxious patients to receive general dental care. Oral Surgeons do not do dentistry, and the patients I treat I do dentistry on, not oral surgery. I fear this dilemma is merely a turf war,
and not an issue of safety; there are no issues of safety when compared to IV sedation… If oral conscious sedation is taken away from dentistry, patients will not get the dentistry they need. There will be no place for them to go. I promise, the oral surgeons in our town don't do endodontics, restorative dentistry, crowns and bridges.” (Idaho dentist)
Frustration with the ADA over OCS
- “It is a needed treatment modality if used in the correct manner. The recent rules changes advocated by the ADA are ridiculous.” (Oregon dentist)
- “OCS is definitely needed for many patients. However, I attended one of the 2 day courses and most of the time was spent on marketing and selling the
procedure. I do think some clinical education should be required but the ADA is going overboard thanks to the oral surgeons.” (Kentucky dentist)
- “We need regulations, but not the knee-jerk, specialist-protectionist, overreaction that is being fabricated by the ADA. Just another reason I haven't paid ADA dues for 20 years.” (South Carolina dentist)
Oral surgeons and specialists are ruining it for the rest of us…
- "Oral Surgeons and others are increasingly obstructive in their efforts to block sedation in any form by non specialists. They ignore the safety record established by general practitioners who have provided many thousands of sedations over the last 12 years." (Delaware Special Care Dentistry)
- “Regulation is good to an extent….but do not make it so it is so restrictive to make the oral surgeons feel like they own the place…..” (Florida dentist)
- “Safety comes first, but there seems to be a growing movement by the vocal minority to regulate it so strictly as to minimize its use by dentists.” (Missouri dentist)
Are the laws changing? Dentists need to know!
- “We need a clear understanding of the new laws regarding what type of training/certification we will need to continue to offer oral conscious sedation
in our practice.” (North Carolina dentist)
- “Wisconsin is trying to come up with some standard for conscious sedation. The rumor is that we will need even more hours (possibly 60 hours) of continuing education than we have now (40 hours). I have recently taken two days on conscious sedation training at Marquette, and one day of airway management at Marquette university. This is in addition to DOCs training I had about 5 years ago, and supplemented by 20 years of in-office use of conscious sedation which I learned in the Navy and continuing education prior to DOCs.” (Wisconsin dentist)
- “Liability issues scare me off.” (Minnesota dentist)
Make no mistake about it: there's a grand battle going on here
- “Dental anesthesiologists are so expensive that OCS has taken away a lot of their business, so they want the most onerous regs/education regs so fewer GP's are doing OCS. Oral surgeons don't like OCS because GP's can do 3rds in their office, and that is an oral surgeon's bread and butter. DOCS doesn't want to be driven out of business by onerous rules. The dental school and continuing education industry wants to drive DOCS out of the business by bringing the classes back to the dental schools.” (California dentist)