Dental anesthesia practice

[AKMD_1984]

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See the comment I just posted, but we do actually do a lot of the same cases, at least at my program. (We are in traumas, neurosurgery, and regional and we do get icu training our third year). I’m not saying the training is identical, but to try and discount our training is disingenuous.

seems weird to me that a dental anesthesiologist will be doing trauma call for anesthesia alone.

which residency program is this?

 

[Hoya11]

seems weird to me that a dental anesthesiologist will be doing trauma call for anesthesia alone.

which residency program is this?

They probably shadowed a CA2/3 and helped get the room set up..

 

[Shimmy8]

There are some places and offices that respect what we bring to the table. Where you can pick your cases and have complete control of the setup, equipment, monitors, and anesthetic plan. And cash.

Not a bad side gig.

 

[AKMD_1984]

i tried dental anesthesia in office based setting…it’s not worth the stress. Felt like I was at a mom and pop shop.

And secondly, as a guiding principle, i no longer inconvenience myself for others for them to make money. I no longer want to be an instrument for any surgeon or dentist in this case. They can use local or do what they’ve been doing all this time or take pt to the hospital.

Thats what this is about. Offering anesthesia as ancillary services to drive patient volume.

I find most dentists quite ignorant of what we actually do yet they often say “oh we do x amount of anesthesia in training” like it’s supposed to be enough…

Our group used to work with two OMFS docs at a level 1 trauma ctr - and both were very difficult and often say “i do anesthesia in office” and try to force their concept of what’s needed for anesthesia on us in the hospital. No bro, I don’t care what you do in your office and how you do it and what you tell your patients in your building. But this is a hospital - move over.

They didn’t like that an anesthesiologist had to sign off on their H/Ps on epic because they weren’t MDs…lol…maybe got their ego hurt …

No one wanted to deal with them. They were always late
because they’re used to others waiting on them.
2 pm scheduled cases were starting at 4 pm because they’d overbook clinic.

i still remember one of my colleagues called them at 330 pm for a 2 pm case and said he’ll need to reschedule while he was “on his way” (he wasn’t). The OMFS still showed up and the call doc refused to do his case. Went and complained to admin - but nothing happened. Just very difficult and ignorant of hospital dynamics etc.

They themselves didn’t want to be there but because they were getting paid a call stipend they had no choice to do cases there. Again I am not saying all are like that but I find dentists a more business minded than physicians as they’re mostly outpatient and they base their “experience” on anesthesia as somehow equivalent to what a board certified anesthesiologist is capable of doing.

I think they forget that anesthesia is a systemic state. There is really no such thing as an isolated dental anesthesiologist. Comparing neuro and cardiac anesthesiologist or even pain or regional and saying well “i’m focused on the mouth” is stupid. You have to have strong fundamentals and be able to do good general anesthesia before you specialize because things are done in that context. I’m not convinced that you can skip being a general anesthesiologist and do “dental anesthesia” and pretend that they’re equal to a fully boarded general anesthesiologist.

 

[AKMD_1984]

They probably shadowed a CA2/3 and helped get the room set up..

yeah…i’ve never heard of this…

i’ve come across dentists that say that they take call? only to realize that it was pager call til 9 pm?

lol bro…picking up a phone to address off hours concerns is not the same as camping at the hospital overnight …

 

[NPJR]

yeah…i’ve never heard of this…

i’ve come across dentists that say that they take call? only to realize that it was pager call til 9 pm?

lol bro…picking up a phone to address off hours concerns is not the same as camping at the hospital overnight …

It would be impressive if those dentists/endodontists who do take call would come in and tackle an emergency root canal at 2am instead of saying "make an appointment" click.

Come to think of it, if there were dentists who worked off hours, that would disrupt the market.

 

[NPJR]

i tried dental anesthesia in office based setting…it’s not worth the stress. Felt like I was at a mom and pop shop.

And secondly, as a guiding principle, i no longer inconvenience myself for others for them to make money. I no longer want to be an instrument for any surgeon or dentist in this case. They can use local or do what they’ve been doing all this time or take pt to the hospital.

Thats what this is about. Offering anesthesia as ancillary services to drive patient volume.

I find most dentists quite ignorant of what we actually do yet they often say “oh we do x amount of anesthesia in training” like it’s supposed to be enough…

Our group used to work with two OMFS docs at a level 1 trauma ctr - and both were very difficult and often say “i do anesthesia in office” and try to force their concept of what’s needed for anesthesia on us in the hospital. No bro, I don’t care what you do in your office and how you do it and what you tell your patients in your building. But this is a hospital - move over.

They didn’t like that an anesthesiologist had to sign off on their H/Ps on epic because they weren’t MDs…lol…maybe got their ego hurt …

No one wanted to deal with them. They were always late
because they’re used to others waiting on them.
2 pm scheduled cases were starting at 4 pm because they’d overbook clinic.

i still remember one of my colleagues called them at 330 pm for a 2 pm case and said he’ll need to reschedule while he was “on his way” (he wasn’t). The OMFS still showed up and the call doc refused to do his case. Went and complained to admin - but nothing happened. Just very difficult and ignorant of hospital dynamics etc.

They themselves didn’t want to be there but because they were getting paid a call stipend they had no choice to do cases there. Again I am not saying all are like that but I find dentists a more business minded than physicians as they’re mostly outpatient and they base their “experience” on anesthesia as somehow equivalent to what a board certified anesthesiologist is capable of doing.

I think they forget that anesthesia is a systemic state. There is really no such thing as an isolated dental anesthesiologist. Comparing neuro and cardiac anesthesiologist or even pain or regional and saying well “i’m focused on the mouth” is stupid. You have to have strong fundamentals and be able to do good general anesthesia before you specialize because things are done in that context. I’m not convinced that you can skip being a general anesthesiologist and do “dental anesthesia” and pretend that they’re equal to a fully boarded general anesthesiologist.

I agree these Oral Surgeons a majority of them are clowns for all the reasons you mentioned. Not to mention dangerous in the setting of them giving anesthesia while doing procedures.

The reality is all the patients who show up needing a dental procedure in the hospital operating room do not have any insurance. So they take exception that they were the one on call dealing with this. If they showed up at their office they would tell the patient to kick rocks. They are slimy.

With regard to dental anesthesia. There is an untapped market for dental anesthesia if a medical anesthesiologist were to make it his mission to get into that, the business is there. Especially pediatric dental.

 

[Dantrolene FC]

You guys are wild that support this.

We should probably let optometrists and podiatrists do anesthesia as well.

To be fair, a lot of people would love for the ophthalmologist to do their own anesthesia for cataracts without any additional training.

 

[SuxDrugs&Rocuronium]

They probably shadowed a CA2/3 and helped get the room set up..

Are you serious with this comment? I’ve been in multiple traumas, my record is 53 units of blood product given. No shadowing here

 

[SuxDrugs&Rocuronium]

yeah…i’ve never heard of this…

i’ve come across dentists that say that they take call? only to realize that it was pager call til 9 pm?

lol bro…picking up a phone to address off hours concerns is not the same as camping at the hospital overnight …

Maybe something isn’t clicking? My residency is not to practice dentistry. It’s 3-years of solely anesthesia. We take 24-hour call 1-2 times per week. We stay at the hospital and provide anesthesia for whatever cases need it. Appys, ex-laps, ectopics, cranis, traumas etc.

 

[SuxDrugs&Rocuronium]

seems weird to me that a dental anesthesiologist will be doing trauma call for anesthesia alone.

which residency program is this?

We don’t have a specific “trauma call.” We take 24 hour call and provide anesthesia for whatever cases come in. We obviously have an attending the same any other anesthesia resident does. NYU

 

[AKMD_1984]

Maybe something isn’t clicking? My residency is not to practice dentistry. It’s 3-years of solely anesthesia. We take 24-hour call 1-2 times per week. We stay at the hospital and provide anesthesia for whatever cases need it. Appys, ex-laps, ectopics, cranis, traumas etc.

everything is clicking just fine.
why not go through medical school and anesthesia residency route if you were going to do a residency in anesthesiology?
regular anesthesiologists do dental cases quite fine. a lot of us just prefer variety of other cases.

Not sure if hospitals or anesthesia groups would consider your training to be equal to a run of the mill anesthesiologist in community…

 

[UscGhost]

everything is clicking just fine.
why not go through medical school and anesthesia residency route if you were going to do a residency in anesthesiology?
regular anesthesiologists do dental cases quite fine. a lot of us just prefer variety of other cases.

Not sure if hospitals or anesthesia groups would consider your training to be equal to a run of the mill anesthesiologist in community…

While not 100% equivalent...

A new dental anesthesiologist with 3 years of OR training ( sounds like very similar OR experience to what an anes resident gets) is going to be vastly better than a new CRNA

And given that CRNAs function independently in many places...

Dental anesthesiologists are perfectly fine. A significant amount of the med school experience is largely irrelevant by the time you are 5-10 years in private practice. That derm and ortho rotation really that useful for you?

 

[AKMD_1984]

While not 100% equivalent...

A new dental anesthesiologist with 3 years of OR training ( sounds like very similar OR experience to what an anes resident gets) is going to be vastly better than a new CRNA

And given that CRNAs function independently in many places...

Dental anesthesiologists are perfectly fine. A significant amount of the med school experience is largely irrelevant by the time you are 5-10 years in private practice. That derm and ortho rotation really that useful for you?

where did crna come from and how are they relevant here?

 

[UscGhost]

where did crna come from and how are they relevant here?

Because you seem to be worried about how a hospital views a dental anesthesiologist capabilities...when they are more than happy to accept significantly less trained crnas.

Hospitals arent exactly a good judge

 

[AKMD_1984]

Because you seem to be worried about how a hospital views a dental anesthesiologist capabilities...when they are more than happy to accept significantly less trained crnas.

Hospitals arent exactly a good judge

i think you should worry about doing tap blocks on everyone

i’m not worried about anything - i’m not the one trying to practice as an anesthesiologist without being one

crnas are irrelevant because they’re not anesthesiologists as per WHO definition

been part of credentialing committees for a long time at multiple sites… never seen a dental anesthesiologist apply for privileges or be accepted and expected to participate in call for anesthesia

not sure how it works and how they fit in. must be office based thing

it’s not a well known route of training so credentials and training needs to be looked at

are they considered to be eligible for abms certification?

 

[UscGhost]

i think you should worry about doing tap blocks on everyone

i’m not worried about anything - i’m not the one trying to practice as an anesthesiologist without being one

crnas are irrelevant because they’re not anesthesiologists as per WHO definition

been part of credentialing committees for a long time at multiple sites… never seen a dental anesthesiologist apply for privileges or be accepted and expected to participate in call for anesthesia

not sure how it works and how they fit in. must be office based thing

it’s not a well known route of training so credentials and training needs to be looked at

are they considered to be eligible for abms certification?

I am not worried following asa recommendations. Perhaps you should be.

Ooo..a credentials committee? How did you get suckered into that

Just to clarify, your argument is that a new grad crna is more capable than a dental anesthesiologist, despite less schooling and less case experience...because a hospital creds committee deems it so?

 

[pgg]

You guys are wild that support this.

We should probably let optometrists and podiatrists do anesthesia as well.

Hey, if they want to do a 3 year residency in anesthesia specific to their clinic work, more power to them.

 

[AKMD_1984]

no that is not my argument actually.
i didn’t bring up crnas at all in this topic…

it seems that you like to argue for no reason.

yes it’s quite important to be at the table. credentials, mec, bylaws, budgeting etc - i can understand why you wouldnt think so…

 

[AKMD_1984]

Hey, if they want to do a 3 year residency in anesthesia specific to their clinic work, more power to them.

how is scope of practice determined then? who determines equivalency given completely different degree - dentist vs physician?

 

[pgg]

how is scope of practice determined then? who determines equivalency given completely different degree - dentist vs physician?

Same way your and my scope of practice is determined: they can do whatever they want, subject to state law, their licensing authority, and the credentialing committee at the facility where they work.

ER docs sedate people all the time in ways that I wouldn't. If some other doctorate-level healthcare person* wants to sedate someone for a procedure, and they're in a facility that credentials them to do it, fine.

If I'm asked my opinion as part of that credentialing process, the only answer I can give is one grounded in my own standard of care, so I'd likely vote against it at my hospital.

And of course, I reserve the right to not personally be part of anything I think is unsafe. Please refer to the OP, asking about mobile work going to dental clinics. Hard no from me.


* except DNPs, those are fake degrees

 

[UscGhost]

no that is not my argument actually.
i didn’t bring up crnas at all in this topic…

it seems that you like to argue for no reason.

yes it’s quite important to be at the table. credentials, mec, bylaws, budgeting etc - i can understand why you wouldnt think so…

Ah..so you just mentioned the hospital credentials committee for no logical reason then.

Carry on

 

[AKMD_1984]

Ah..so you just mentioned the hospital credentials committee for no logical reason then.

Carry on

there is a logical reason…they determine “credentials” to practice…

it’s a liability issue among other things

is that too hard to digest?

 

[UscGhost]

there is a logical reason…they determine “credentials” to practice…

it’s a liability issue among other things

is that too hard to digest?

And that often has little to do with someone's actual competency and skillset..as this thread was discussing the capabilities of anesthesiologists vs dental anes vs dentists vs crnas

A hospital creds committed merely decides who they will allow at that specific hospital. Some allow crnas, some dont. Anes assistants, MD, DO, board cert, NBPAS vs AMA

Many meet criteria despite terrible community reputations for example

Its often just an exercise in paperwork and checking boxes

 

[Southpaw]

You guys are wild that support this.

We should probably let optometrists and podiatrists do anesthesia as well.

You need to understand that it doesn’t really matter what we as individuals support. The Asa supports it. The whatever the dental society is called supports it. He did a 3 year residency. He’s fine to provide anesthesia in the office. Better yet, he’s a good soul to do so. Because he makes what may otherwise be a very unsafe situation very safe.

Know what we shouldn’t support? Omfs doing sedation AND the procedure (and shhhh…billing for both! And getting paid for both!). Now that is something no one should support.

 

[Gator7]

You need to understand that it doesn’t really matter what we as individuals support. The Asa supports it. The whatever the dental society is called supports it. He did a 3 year residency. He’s fine to provide anesthesia in the office. Better yet, he’s a good soul to do so. Because he makes what may otherwise be a very unsafe situation very safe.

Know what we shouldn’t support? Omfs doing sedation AND the procedure (and shhhh…billing for both! And getting paid for both!). Now that is something no one should support.

Very safe? These places are unsafe for any actual anesthesiologist. So why would someone with less training and placed in a terrible environment be safe?

The field of dental anesthesia has no reason to exist. If the case requires anesthesia then it should be done at a hospital or proper asc with an anesthesiologist.

How many pediatric dental deaths do we need before we agree on this?

Also, we can probably get rid of the field of pediatric dentistry if parents would just brush their kids teeth and stop giving them apple juice at 2am.

 

[UscGhost]

Very safe? These places are unsafe for any actual anesthesiologist. So why would someone with less training and placed in a terrible environment be safe?

The field of dental anesthesia has no reason to exist. If the case requires anesthesia then it should be done at a hospital or proper asc with an anesthesiologist.

How many pediatric dental deaths do we need before we agree on this?

Also, we can probably get rid of the field of pediatric dentistry if parents would just brush their kids teeth and stop giving them apple juice at 2am.

Well,

Its likely that you are conflating a few issues here

The majority of deaths i hear about (granted i havent actively researched this topic), are dentists doing their own sedation.

So you have a distracted clinician, without airway expertise, performing sedation in an office with minimal support . Thats the problem

A dental anesth, MD anesth, and crna would all be fine to perform sedation in a office setting with the minimum ASA requirements met. And i guarantee you a new grad dental anesthesiologist would be safer than a new grad crna, they have much more OR experience.

These cases dont need to go to hospitals, unless the patients are ASA 3/4, syndromic ,etc. Doing them in a hospital doesnt magically make it safer. Its just better if patient is at risk for needing advanced post op care (cardiac cath, respiratory support, fiberoptic bronch) which ASA1/2 would not be expected to need

Not sure what you folks need to be safe in an ambulatory setting. Oxygen, suction, meds, glidescope, tiva, MH cart, crash cart, intra lipid. Most small ASCs and plastics dont have anything beyond that.

 

[NPJR]

Very safe? These places are unsafe for any actual anesthesiologist. So why would someone with less training and placed in a terrible environment be safe?

The field of dental anesthesia has no reason to exist. If the case requires anesthesia then it should be done at a hospital or proper asc with an anesthesiologist.

How many pediatric dental deaths do we need before we agree on this?

Also, we can probably get rid of the field of pediatric dentistry if parents would just brush their kids teeth and stop giving them apple juice at 2am.

The problem is that there are not enough anesthesiologists to fill that need even at 700 an hour you couldnt fill it and its rather impractical to get these kids into a hospital on a major scale. This is where we are. The deaths are not painful enough yet.

 

[Gator7]

It’s not a need it’s a want. These aren’t emergencies.

 

[SuxDrugs&Rocuronium]

It’s not a need it’s a want. These aren’t emergencies.

What do you suppose we do for the autistic kid with abscessed teeth when the hospital wait list is over a year out?

 

[SuxDrugs&Rocuronium]

Very safe? These places are unsafe for any actual anesthesiologist. So why would someone with less training and placed in a terrible environment be safe?

The field of dental anesthesia has no reason to exist. If the case requires anesthesia then it should be done at a hospital or proper asc with an anesthesiologist.

How many pediatric dental deaths do we need before we agree on this?

Also, we can probably get rid of the field of pediatric dentistry if parents would just brush their kids teeth and stop giving them apple juice at 2am.

You do know dentists have been involved in anesthesia since the beginning? Your hubris is showing

The History of the Specialty of Dental Anesthesiology - PMC

pmc.ncbi.nlm.nih.gov

 

[cittykat]

You do know dentists have been involved in anesthesia since the beginning? Your hubris is showing

The History of the Specialty of Dental Anesthesiology - PMC

pmc.ncbi.nlm.nih.gov

The specialty didn’t mature until Waters, Dripps, and Rovenstine came on the scene in the 1920s-30s.

 

[Gator7]

What do you suppose we do for the autistic kid with abscessed teeth when the hospital wait list is over a year out?

Go to the ER. ENT adds on dental abscesses all the time.

What’s more alarming is that you and the dentist are going to try and either wrestle or dart the 300lb autistic kid in the middle of a strip mall.

 

[SuxDrugs&Rocuronium]

Go to the ER. ENT adds on dental abscesses all the time.

What’s more alarming is that you and the dentist are going to try and either wrestle or dart the 300lb autistic kid in the middle of a strip mall.

One of the worst takes I’ve read so far. Let’s wait until the kid has an abscess because having to induce a noncooperative kid with Ludwig’s from an abscess sounds like a much better alternative.

 

[UscGhost]

One of the worst takes I’ve read so far. Let’s waiting until the kid has an abscess because having to induce a noncooperative kid with Ludwig’s from an abscess sounds like a much better alternative.

Gator7 would rather let an abscess develop...then have the patient go to the ER....hoping that its one of the very few ERs that have a dentist/omfs on call...then the patient can get surgery at 8pm, maybe stay overnight.

All because he is more worried about a dental anesthesiologist (with significantly more OR airway experience) doing a simple case.. meanwhile he is comfortable with ED and CRNAs managing airways and sedation with less expertise.

Seems he is a bit too obsessed with titles instead of a practical evaluation of appropriate capabilities and experience.

 

[SuxDrugs&Rocuronium]

Gator7 would rather let an abscess develop...then have the patient go to the ER....hoping that its one of the very few ERs that have a dentist/omfs on call...then the patient can get surgery at 8pm, maybe stay overnight.

All because he is more worried about a dental anesthesiologist (with significantly more OR airway experience) doing a simple case.. meanwhile he is comfortable with ED and CRNAs managing airways and sedation with less expertise.

Seems he is a bit too obsessed with titles instead of a practical evaluation of appropriate capabilities and experience.

Thank you

 

[UscGhost]

Thank you

I would simplify it this way. What's the issue at play here?

Capabilities of the sedation provider?
Generally, MD would be better than a dental anes, than crna, than Dentist
-although a dental anes would begin to close that gap the further they get into private practice as they are doing exclusively dental office cases, and a PP anes may not have done one in 10 years. Same with peds, OB, trauma...skillsets fade over tim
-comfort and familiarity with the procedure and environment is very impactful
-dentist shouldnt be giving sedation
-Crnas- i think their training is insufficient....but the community accepts it
-dental anes and MD are fine

Equipment available
ASA standards should be the minimum. Are dental office equipment and safety standards less? I dont personally know...but if they are, THATs the problem

Pacu care
-how is that handled in a typical dental office after patients undergo GA?

Location
-If its GA, i would recommend referring any patient that doesnt mean ASC criteria, should also not be done in a dental office for the same general reasons

 

[SuxDrugs&Rocuronium]

I would simplify it this way. What's the issue at play here?

Capabilities of the sedation provider?
Generally, MD would be better than a dental anes, than crna, than Dentist
-although a dental anes would begin to close that gap the further they get into private practice as they are doing exclusively dental office cases, and a PP anes may not have done one in 10 years. Same with peds, OB, trauma...skillsets fade over tim
-comfort and familiarity with the procedure and environment is very impactful
-dentist shouldnt be giving sedation
-Crnas- i think their training is insufficient....but the community accepts it
-dental anes and MD are fine

Equipment available
ASA standards should be the minimum. Are dental office equipment and safety standards less? I dont personally know...but if they are, THATs the problem

Pacu care
-how is that handled in a typical dental office after patients undergo GA?

Location
-If its GA, i would recommend referring any patient that doesnt mean ASC criteria, should also not be done in a dental office for the same general reasons

I agree with all your points. If a dental office isn’t up to standards then it’s not okay. We typically bring everything needed to meet those standards but if for whatever reason an office is stocking them for us, you’d better believe I’m checking at the start of the day.
We bring standard monitoring equipment, airway equipment (nasal and oral tubes, lmas, naps, opas etc), multiple backup video laryngoscopes, yankauer suction, zoll, portable anesthesia machines with circuit, ambu bags, IO kits and everything else that could be needed in an emergency. Most of us drive large SUVs to fit everything we bring.

For PACU care, I know some travel with a recovery nurse but I personally stay with the patients until they are awake enough for parents to come back at which point they’re basically ready for discharge. I won’t start another case until they meet all of the discharge criteria.

Agree that if they’re not suitable for an ASC they should not be seen in an office. I’d argue I’m stricter about my selection criteria than your average ASC. ASA I or II only and if a kid is too big and combative that it’s not going be safe to perform a mask induction then I’m not doing it.

 

[UscGhost]

I agree with all your points. If a dental office isn’t up to standards then it’s not okay. We typically bring everything needed to meet those standards but if for whatever reason an office is stocking them for us, you’d better believe I’m checking at the start of the day.
We bring standard monitoring equipment, airway equipment (nasal and oral tubes, lmas, naps, opas etc), multiple backup video laryngoscopes, yankauer suction, zoll, portable anesthesia machines with circuit, ambu bags, IO kits and everything else that could be needed in an emergency. Most of us drive large SUVs to fit everything we bring.

For PACU care, I know some travel with a recovery nurse but I personally stay with the patients until they are awake enough for parents to come back at which point they’re basically ready for discharge. I won’t start another case until they meet all of the discharge criteria.

Agree that if they’re not suitable for an ASC they should not be seen in an office. I’d argue I’m stricter about my selection criteria than your average ASC. ASA I or II only and if a kid is too big and combative that it’s not going be safe to perform a mask induction then I’m not doing it.

Sounds very reasonable.

In your experience, where do most of the ASA 3/4, morbid obese, "high risk" adult patients actually go for their procedures? I dont see many ASCs doing dental cases... definitely not hospitals

I have come across many ASCs with very low thresholds for passing on regula cases due to bmi, asa, as well

 

[NPJR]

I agree with all your points. If a dental office isn’t up to standards then it’s not okay. We typically bring everything needed to meet those standards but if for whatever reason an office is stocking them for us, you’d better believe I’m checking at the start of the day.
We bring standard monitoring equipment, airway equipment (nasal and oral tubes, lmas, naps, opas etc), multiple backup video laryngoscopes, yankauer suction, zoll, portable anesthesia machines with circuit, ambu bags, IO kits and everything else that could be needed in an emergency. Most of us drive large SUVs to fit everything we bring.

For PACU care, I know some travel with a recovery nurse but I personally stay with the patients until they are awake enough for parents to come back at which point they’re basically ready for discharge. I won’t start another case until they meet all of the discharge criteria.

Agree that if they’re not suitable for an ASC they should not be seen in an office. I’d argue I’m stricter about my selection criteria than your average ASC. ASA I or II only and if a kid is too big and combative that it’s not going be safe to perform a mask induction then I’m not doing it.

are you a DDS or an MD?

 

[SuxDrugs&Rocuronium]

Sounds very reasonable.

In your experience, where do most of the ASA 3/4, morbid obese, "high risk" adult patients actually go for their procedures? I dont see many ASCs doing dental cases... definitely not hospitals

I have come across many ASCs with very low thresholds for passing on regula cases due to bmi, asa, as well

That’s a great question. I would guess many of them don’t get care because nowhere will see them. Some find oral surgeons who will see them which doesn’t end well. I read a news article recently of a dentist (who went to an oral surgery residency but was dismissed and never graduated) who sedated a BMI 62 patient who ended up dying.

Florida Department of Health files complaint against St. Johns County dentist after patient dies

The State of Florida Board of Dentistry has filed an administrative complaint against a local dentist, Francesco Sebastiani. The complaint was filed on January 21, 2025. The complaint claims Sebastiani failed to treat a patient properly in 2023, which led to her death.

www.news4jax.com

It’s a terrible situation and there’s no justification seeing that lady in a non-hospital setting

 

[SuxDrugs&Rocuronium]

are you a DDS or an MD?

DDS

 

[cittykat]

Sounds very reasonable.

In your experience, where do most of the ASA 3/4, morbid obese, "high risk" adult patients actually go for their procedures? I dont see many ASCs doing dental cases... definitely not hospitals

I have come across many ASCs with very low thresholds for passing on regula cases due to bmi, asa, as well

We do a lot of pre-TAVR/TEVAR/ICD dental extractions at our hospital.

 

[Southpaw]

Very safe? These places are unsafe for any actual anesthesiologist. So why would someone with less training and placed in a terrible environment be safe?

The field of dental anesthesia has no reason to exist. If the case requires anesthesia then it should be done at a hospital or proper asc with an anesthesiologist.

How many pediatric dental deaths do we need before we agree on this?

Also, we can probably get rid of the field of pediatric dentistry if parents would just brush their kids teeth and stop giving them apple juice at 2am.

This is all wishful thinking. I'll choose to live in reality. By the way, if we wanted to briefly live in your world perhaps we could tell people to eat less and exercise more, so we wouldn't need to remove so many gallbladders and replace so many joints. In that world perhaps we now have some actual room in our daily OR schedule for dental procedures.

Peds dental will exist. In office anesthesia is going to exist. Endo centers, ASCs, etc etc.. The field of dental anesthesia is going to exist. Clearly you don't believe it should and you can exercise your opinion to whoever you want, perhaps some higher ups at the ASA actually involved with dental anesthesia residencies.

It's my opinion that if you're taking the time to do an accredited 3 year program that's approved by both the ASA and whatever the dental society is called, that you're perfectly fine and adequately safe to do the anesthesia. And if i'm reading the dental anesthesiologist correctly, and I think I am, he's clearly elevating the standard of safety when he goes into the office with his presence, his equipment, and his demand that dentists meet a safety standard. And if they can't do that, he just moves on to another office because there's high demand for his services.

In short, we can agree to disagree.

 

[GassYous]

We don’t have a specific “trauma call.” We take 24 hour call and provide anesthesia for whatever cases come in. We obviously have an attending the same any other anesthesia resident does. NYU

I don't think this is true

 

[pgg]

Also, we can probably get rid of the field of pediatric dentistry if parents would just brush their kids teeth and stop giving them apple juice at 2am.

LOL

LOLOL

Might as well get rid of most of medicine and especially surgery if you're going to wave your hands and magically get rid of self-inflicted disease.

Presto-chango! Abracadabra!

No more smokers or obesity or motorcycle riders or sadness!

 

[UscGhost]

I don't think this is true

Why not?

 

[pgg]

I don't think this is true

Do you think he's lying?

We had OMFS residents rotate with us and do everything CA1s did, during their 6 month rotation.

Doesn't seem implausible that he is doing the same kind of thing.

I would think hearts and other advanced cases would be given to anesthesiology residents over a dentist anesthesia resident, but maybe they've got enough volume where diluting the CA1-3s' experience isn't an issue.

 

[cittykat]

Dental Anesthesiology (ANESTH) Program at NYU Langone Dental

www.nyulangonedental.org

Training is at Brooklyn site. Likely not much if any cardiac or OB and no Bellevue team captain rotation but the program seems more than adequate for the job. Only suggestion would be more pediatric wards/clinic exposure.

 

[Hoya11]

Dental Anesthesiology (ANESTH) Program at NYU Langone Dental

www.nyulangonedental.org

Training is at Brooklyn site. Likely not much if any cardiac or OB and no Bellevue team captain rotation but the program seems more than adequate for the job. Only suggestion would be more pediatric wards/clinic exposure.

I guess the issue in my mind is the path itself. Very often this is a person who tried dental school , had some major issue, and this was the backup plan. What were the issues ? What are the standards for admission into such a program ? Is it all former dental students with some kind of issue ? Probably. And if that is the case , maybe it’s not so much worse to have a CRNA who excelled in nursing school and CRNA training without any issues