(EDITOR’S NOTE: The theme of this year’s 10th Annual Sedation Safety Week was “Awareness.” Many dentists remain dangerously unaware of the regulatory climate that threatens their ability to serve their patients as they deem most appropriate, as well as their livelihood. Overzealous regulators in a growing number of states are moving – without scientific or clinical evidence – to dramatically restrict the use of oral sedation.)

The earth is flat.

Elvis is still in the house.

And even dentists who’ve administered oral sedatives to their patients for years – safely, effectively, and without incident – must go back to the classroom and obtain an IV sedation permit to continue to treat their patients using moderate enteral sedation (and to comply with newly adopted dental guidelines and regulations.)

In the spring of 2018, it makes no difference if science, clinical experience, and common sense disagree. The push to further regulate oral sedation dentistry is in full bloom.

Indeed, for all the advances that the dental profession has made in attracting and caring for fearful and anxious patients, overzealous regulators in some states – supported by a small but influential group of financially self-interested specialists – are working overtime to reverse much of the progress of the past 20 years.

Dental anxiety remains an overwhelming public health crisis, with tens of millions of Americans still too fearful of visiting a dentist to get the preventative and restorative treatment that is necessary for both their oral and overall physical health.

Those calling for still tighter regulation of sedation dentistry do so, ostensibly, to better protect the public’s safety. Their actions come in the wake of a small number of highly publicized deaths involving patients – both adults and children – who were anesthetized in their dentist’s office.

The entire point of Sedation Safety Week, now marking its tenth year, is to help prevent such sedation-related deaths and injury.

If the new regulations would actually do that, there is no doubt that every fair-minded dentist in the country would favor such regulation, and Sedation Safety Week would be the biggest champion of the new laws.

But the new regulations not only fail to increase the safety of sedation dentistry, they actually make our profession less safe because they drive both patients and dentists away from taking full advantage of proven oral sedation treatments.

Dr. Raymond A. Dionne
Dr. Raymond A. Dionne

Raymond A. Dionne, DDS, MS, PhD, is a noted expert on the subject of pharmacologic management of dental fear and anxiety, having previously served as Chief of the Pain and Neurosensory Mechanisms Branch and Clinical Director for the National Institute of Dental and Craniofacial Research. He is currently a research professor in the Department of Pharmacology and Toxicology in the Brody School of Medicine at East Carolina University.

Dr. Dionne says that recent stricter oral sedation guidelines adopted by the American Dental Association in October 2016, and written into law (before or after) by more than a dozen state dental boards are “illogical.”

Dr. Dionne contends that the basis for some of those individuals who are promoting additional restrictions and training requirements for dentists who offer oral sedation is “just another restraint of trade strategy.”

Whatever their motivation, and no matter how sincere or insincere the regulators are, tighter oral sedation laws are being adopted – or at least considered – by an alarming number of state dental boards.

US regulatory map

Take a minute to study the multi-colored map of the United States above. It was prepared by John P. Bitting, Esq., who is the full-time regulatory counsel for DOCS Education, and the nation’s foremost attorney specializing in dental sedation regulations.

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Only the Blue states, for now, have stuck with the national oral sedation guidelines that have effectively and safely governed the profession since at least 2007, with some going all the way back to 2000. “These states do not appear to be actively considering fresh restrictions,” says Mr. Bitting.

John P. Bitting, Esq.
John P. Bitting, Esq.

The Red states have already embraced regulations and restrictions on oral sedation that go well beyond what either science or clinical experience have demonstrated are necessary to protect public safety.

The Yellow and Gray states, based on Mr. Bitting’s analysis, are either likely to embrace stricter sedation regulation, or are at least weighing the possibility.

Question:  If there are dentists who fail to follow the mandated regulations to the extent that one of their patients is grievously harmed, will tightening those regulations prevent such harm?

The dental office tragedies that have occurred since the annual Sedation Safety Week first began in March 2009 did NOT arise from weak or insufficient regulations and training. They arose, as best as anyone can determine* because dentists failed to carefully follow existing safety regulations, best-practice protocols, and proper patient selection.

Moreover, millions of Americans who would otherwise avail themselves of regular dental care are being priced out of the dental care marketplace, as the new and unnecessary guidelines and regulations continue to push up the cost of oral sedation care while simultaneously reducing the pool of dentists who are licensed, trained, and permitted to provide it.

Down the road – and not very far down the road at that – public anger over these developments in dentistry threatens to engulf our profession in the same type of ‘us v. them’ mindset that fuels the widespread protests that we’ve seen over the cost and availability of medical care.

If the dental profession itself doesn’t correct this overreach, then access to care and the price of dentistry may well – for better and worse – face the specter of federally mandated oversight and a blurring of the lines that have, to date, separated medical regulation from dental regulation.

With Sedation Safety Week just passed, now is the perfect time for caring, dedicated dentists to commit themselves to protecting their patients’ access to oral sedation care and to fight to prevent further unnecessary regulation of oral sedation.

(* The lack of publicly available records in most states pertaining to dental-office fatalities greatly hinders the scientific community’s ability to pinpoint exactly what caused patients to die – and hence, what might be done in the future to prevent similar deaths. One of the only published studies that does exist, Risk Factors for Dental Outpatient Sedation Procedures Derived from Deaths Reported in the Public Domain, by Dr. Raymond A. Dionne, had to rely on the compilation of news reports – not exactly ideal when it comes to accuracy or detail.)



  • There is strength in numbers. Become a member of DOCS Education and join with thousands of other sedation dentists in opposing unnecessary national and state-wide dental guidelines and regulations.

    From its founding in 1999, DOCS Education members have fought to reduce unnecessary regulation and interference that only serve to raise the cost of dental care (and the profits of a small group of “elite” specialists) without benefiting patients.

    Professional activism is a core component of DOCS. Be sure to read the DOCS Education Proclamation, outlining the goals and principles of the membership community at: https://www.docseducation.com/membership.

  • Join your state dental board or become a member of one of its rules or anesthesia committees. Too few dentists who rely on oral sedation to care for their patients are represented on their state regulatory boards. As a result, dentists who do NOT provide oral sedation – or actively oppose it for reasons of financial self-interest – are the ones who pass the overzealous regulations.

  • Recruit some of your most satisfied oral sedation patients to write or call your state dental board and express their support for reasonable, affordable oral sedation regulation. You may also encourage your patients to write your state’s governor, who typically is the individual who appoints dental regulators.

  • Speak up. Literally. Accept invitations, or solicit invites, to speak about oral sedation and access to care at local civic clubs, churches, synagogues, mosques, health fairs, and any similar venue where you can spread the message. If you need help preparing your remarks, contact John P. Bitting, Esq., DOCS Education’s full-time regulatory counsel.

    (Members of DOCS Education are entitled to unlimited consultations with Mr. Bitting, who is available to answer all of their legal and regulatory questions. If you’re not already a DOCS Education member, until March 30th, you can get a free, two-month membership by contacting Lindsay Olsen, membership director, at 206-812-7712, or at: lindsay@docsedu.com.)


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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 3250 Airport Way S, Suite 701 | Seattle, WA 98134. Please print a copy of this posting and include it with your question or request.
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