One of the many privileges of DOCS Education membership is access to our EliteDOCS® Forum, an exclusive 24/7 online community where there are always fellow dentists and faculty members happy to respond to requests for advice and support.
What follows are four recent posts and responses from the EliteDOCS Forum. The posts and replies are edited for clarity and brevity.
Guidelines for Sedating Patients Who Use Marijuana
Eleven states plus Washington, D.C. have legalized recreational use of marijuana, and 22 states have legalized its medical use. Yet there is scant literature on how weed impacts existing sedation protocols.
A member in Corunna, Michigan, seeks insight:
I'm looking for guidelines for sedating patients (both oral and IV) who indicate regular use of marijuana? Recreational or medicinal, I haven't been able to find much information about the topic.
Dr. Anthony Carroccia, of St. Bethlehem Dental Care in Clarksville, TN, a long-time DOCS Education member, Diplomate, and EliteDOCS administrator responds:
That’s the million-dollar question.
Why are they doing this? What type of marijuana is it? Frequency? Addiction? How are they with it: relaxed, paranoid, etc.? Hypo-responder due to this substance and tolerance? Hyper-responder?
A sedation with this on board could be like playing Russian roulette – you may be okay while your team and the patient all have a good experience or it may be a nightmare.
The best piece of advice in the most current publication is to refrain from use for 72 hours before anesthesia/sedation. It is best if these psychoactive substances are not in the system of the patient; However, I'm certain that most of us have sedated a patient who did not disclose the use of that substance.
Am I Putting My Sedation Permit at Risk?
The regulations governing dental sedation vary from state to state. To help dentists stay in the good graces of their boards, DOCS Education employs a full-time regulatory attorney to guide them on what is, and what is not, allowable. This essential service is available for free to members.
A member in Santa Rosa, CA writes:
I work in a community health center and we are starting our OCS program.
Our organization does not want to obtain the necessary licensing to be able to store anticonvulsants at the clinic (all patients will be bringing their prescribed sedation meds with them), but these are required by the California Dental Board to have in our emergency equipment.
Would it be sufficient to have the patient's physician (we are working closely with their MDs) prescribe them an anticonvulsant prior to their appointment and have it stated in our policy that we are not doing any sedation unless the patient brings in their anticonvulsant medication with them?
My concern is that if we are ever audited, would this be acceptable to the dental board or does the med need to be stored on-site to meet their requirements?
J. Kathleen “Kate” Marcus, J.D., Regulatory Counsel for DOCS Education, responds:
The full list of equipment and meds required to be on-premises to use your OCS permit in California can be found here. There is no exception to this, and not having the required anticonvulsants on-premises can lead to the revocation of your permit.
Treating a Patient Who Has Undergone Gastric Bypass Surgery
Approximately 200,000 Americans undergo bariatric surgery annually.
A member in Clarkston, WA, asks:
Are there specific considerations/precautions for a patient who has had gastric bypass surgery? Surgery was in 1998.
Dr. Carroccia responds:
Less GI tract means less surface area for drugs to absorb and less time for them to be in the GI tract to get into the body. You should expect malabsorption. If you are looking at IV, this would not be an issue. This is a stronger indication for sublingual triazolam. I would go low and slow, as one cannot predict the degree of malabsorption.
The One and Only Dumb Question in Dentistry
DOCS Education members quickly realize that standard of care questions don’t end with graduation from dental school; they just begin. A hallmark of DOCS Education conferences is that our faculty encourages questions from registrants and reminds dentists that no inquiry is out of bounds. The same holds true on the EliteDOCS forum, which has responded respectfully to thousands of questions since it was launched.
A member in Hagerstown, Maryland, risks embarrassment:
I wasn't sure in which EliteDOCS category to post this question. It's a dumb one.
Where do you all order your flumazenil and how often do you order it? We'd gotten our "starter drugs" setup from Darby, and our flumazenil expired so we ordered more, and they sent us a bottle that expires in 4 months. We talked to them about it, and they said flumazenil shelf life is 3-6 months.
When I search online, I find most databases say it has a 3-year shelf life. Given that this is our "emergency" drug, and we ideally won't use it, do you all have any suggestions where to order it so it will last longer, or do you order from Darby for $250 every 3-6 months?
Dr. Carroccia responds:
First, the answer to your question. I agree with your database research and would suggest looking at another vendor if yours cannot be more helpful.
Now, about that one dumb question. If a patient walks in with a toothache and only has one tooth, don't you dare ask, "Which one is it?" That is the ONLY dumb question in dentistry!
Do you have pharmacology, protocol, practice management, equipment/drug, or regulatory questions you’d like answered? Likewise, would you like to lend your voice and experience to help fellow dentists from around the country?
EliteDOCS forum members are connected to one another – and to our faculty – 24/7. There are always friendly and knowledgeable fellow dentists online who are happy to respond to requests for advice and support.
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