In the wake of the ADA’s adoption of Resolution 37 last October, the regulatory landscape for sedation dentists is rapidly changing, creating confusion and impacting a growing number of dental practices.
Dr. Richard Stonely went to sleep Wednesday night, May 31st, a veteran oral sedation dentist with a thriving sedation dentistry practice. Up until that point, Dr. Stonely had performed hundreds of treatments during his career without a problem, adhering to the sedation protocols set forth by DOCS Education and in compliance with all guidelines and regulations.
When he awoke the next the morning, June 1st, Dr. Stonely faced the harsh reality that he no longer will be able to provide moderate enteral sedation in his home state of North Carolina once his current sedation permit expires.
"I have done everything the state has required — training, equipment, inspection, permit, BLS, ACLS, etc.," Dr. Stonely wrote in exasperation to John P. Bitting, Esq., Regulatory Counsel for DOCS Education. "Now, in order to continue doing what I’ve successfully been doing for 17 years, I will have to take a 60-hour IV course..."
Dr. Stonely is correct.
In fact, not a single dentist in North Carolina will be able to provide moderate enteral sedation to patients after their current permits expire regardless of the dentists’ prior experience — unless they have completed an accredited IV course.
"I've done everything the state has required."
While the name Richard Stonely is a pseudonym we’ve assigned, the dentist and his tale are 100% real. Moreover, this North Carolina practitioner is far from alone in abruptly awakening to the wide-ranging changes taking place in the field of sedation dentistry as the ripples of ADA Resolution 37 expand from one state to another, with no end in sight.
Although the specifics vary slightly from state to state, sedation dentists in Virginia, Louisiana, and New York are also now governed by new regulations that mirror those in North Carolina, especially when it comes to dentists who want to train to offer moderate enteral sedation for the very first time.
Texas, Georgia, Arkansas, West Virginia, and New Hampshire are considering similar regulations, while Ohio, Florida, Pennsylvania, Nevada, and Michigan have had similar rules in place predating the ADA’s October 2016 actions.
THE REAL SHOCKER
The choice facing thousands of sedation dentists who wish to continue serving their fearful and anxious patients is stark. Stop offering moderate oral sedation altogether (if not immediately, perhaps soon), or bite the bullet and register for the prescribed 60-hour IV sedation course, which also requires 20 live patient experiences.
The real shocker has yet to hit Dr. Stonely and other sedation dentists in a similar position. Even if they elect to register for the IV sedation classes that their states now require, they may have to wait years to find a qualified course that has available space. [See Editor’s Note below.]
This quagmire was foreseeable.
As DOCS Education wrote about extensively in 2015 and 2016, for more than a decade a small group of self-interested dental specialists — primarily oral surgeons — had been pushing the ADA to approve stricter educational guidelines governing the use of oral sedation by general dentists.
Get The Science Research Site
Despite ample scientific evidence to the contrary [Visit Get the Science], the oral surgeons argued that when sedating a patient, the route of administration — i.e. enteral v. IV — makes no difference. Following that logic — flawed as many respected scientists argue that it is — the oral surgeons maintained that if a dentist is going to provide moderate enteral sedation, he or she should be required to fulfill the same training requirements as a dentist who will rely solely on IV sedation.
DOCS Education, the Academy of General Dentistry, and others speaking for general dentists such as Dr. Stonely — who have safely and effectively treated patients using moderate enteral sedation for many years — fought ADA Resolution 37 and its predecessor, 2015’s Resolution 77. However, the oral surgeons and other specialists, who hold a disproportionate sway over the ADA’s governance, were able to successfully pass the new, stricter IV Sedation course guidelines at the group’s annual conference in Denver late last year.
While ADA Resolution 37 is only a guideline with no enforcement authority, many state dental boards look to the ADA guidelines to draft their own regulations, virtually rubber-stamping into law whatever the ADA recommends.
For many dentists and their patients, the future is bleaker than they realize. As state after state adopts regulations similar to those recommended in Resolution 37, fewer and fewer general dentists will elect to go to the trouble and expense to get their IV Sedation certification just to be legally allowed to continue to offer their patients moderate enteral sedation.
REGULATORY RUSSIAN ROULETTE
That will leave fearful and anxious patients with fewer, if any, choices for dental care — and many will simply stop visiting any dentist. (There are not nearly enough oral surgeons and IV-certified general dentists to serve the vast community of patients who won’t visit a dentist unless they can be treated using moderate enteral sedation.)
As unwarranted as DOCS Education believes it is to require general dentists who have already completed DOCS Education training in sedation to ask them to now take a completely new 60-hour IV Sedation course, for the foreseeable future that will be the only viable choice available to many dentists whose patients look to them for moderate sedation-based treatments.
Even for dentists living in states that have not yet indicated they are leaning toward adoption of Resolution 37-inspired regulations, the only certain way to step out of the regulatory "Russian Roulette" path appears to be to make the time and financial commitment to go ahead and obtain an IV Sedation permit.
Completing the IV Sedation certification course removes the threat of waking up one morning in the not-to-distant future, to discover — like Dr. Stonely — that you are no longer able to treat your patients with the care they deserve using your best professional training and judgment.
EDITOR’S NOTE: While DOCS Education strongly opposed passage of ADA Resolution 37, we recognize that an increasing number of dentists must now abide by its guidelines.
As such, in keeping with our unshakable commitment to provide the very best sedation dentistry education, we have teamed with Oregon Health & Science University (OHSU) to offer an IV Sedation course that complies fully with the new ADA guidelines and state sedation regulations. Graduates of this 60-hour class will be able to obtain the necessary permits to offer both moderate enteral sedation and IV Sedation in their states.
Maximum seating for this special class — one of the only courses we’re aware of in the nation that will allow you to complete your requirements this year — is 24. As of the publication of this article, only a few available slots for our next class remain.
The OHSU IV Course will be held July 20th — July 23rd, and continue on August 10th — August 13th in Portland, OR. In addition, dentists who enroll will be scheduled to obtain their live patient experiences in September or October, the exact dates to be determined.
We encourage any dentist who wants to ensure his or her ability to continue to provide patients with safe and effective moderate enteral sedation to review our course description at http://docseducation.com/catalog/iv-sedation-certification and register now, while some seats remain.
You may also phone one of our education services specialists at 866-391-2906. Should the July class close, or if you are unable to arrange your schedule to attend beginning next month, please ask to be placed on the wait list for one of our limited 2018 classes.
DOCS Education members who have questions about their specific state regulations are welcome to contact our regulatory counsel, John P. Bitting, Esq., at no charge. John is the nation’s only full-time dental regulatory attorney. He can be reached at john@DOCSEducation.com.
As part of its suite of membership privileges, DOCS Education makes John Bitting available to provide definitive, clear-cut answers to a variety of legal questions concerning state-by-state training, licensing and permit requirements; standard-of-care protocols and equipment requirements; patient complaints; dental board investigations; and advertising standards.
The information contained in this, or any case study post in Incisor should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 106 Lenora Street, Seattle, WA 98121. Please print a copy of this posting and include it with your question or request.