I do not know how to multi quote so I just put what I am responding to in different color. Sorry about that.
I also believe our incidence of M/M in dentistry due to anesthesia is low. However, a great majority (99%) of the time our procedures/surgeries are elective. Thus, isn't one bad outcome due to anesthesia to many? I know there is literature to support this. I just do not have time to find it. This is the worst statement I think you could have made. Yes, there is 1 in 364,000 anesthesia related deaths in OMS (per latest research) and yes, that 1 is too many. But you are suggesting that working with a DA will make that mortality ZERO? You are implying that you will improve the M/M with anesthesia-related complications, but have no research/indications that it will. You are absolutely right, most OMS only sedate ASA I and II in their offices and send the ASA III/IV to a real anesthesiologist in a hospital. Regardless of whether I worked with a DA or not, you still will not be sedating worse than an ASA II in my office.....period. And if anyone lets you sedate a sick, sick patient outside of a hospital, that is very, very dangerous.
I apologize about the confusion. In no way did I mean that having a specialty in anesthesia it would lower or make dentistry's M/M with anesthesia zero. What I meant is that just because our M/M is low (even this could be argued) does not mean we should not have a specialty. A specialty would promote anesthesia knowledge in all of dentistry. I personally feel it is an absolute travesty that dental students graduate without the ability/knowledge or certification to even administer nitrous in many states. Anesthesia is a fundamental part of dentistry and all competent students should graduate with the ability/skill to safely administer nitrous, oral medications, and even IV moderate sedation.
I disagree. I think it should require some additional training to administer iv sedation. There's an old article somewhere about the ability of dental students to bag/mask or even operate the oxygen at their school. I will have to find it. I think we can all agree that we spend enough on our education to get this knowledge, and its benefit for our patients is without question….We have actually started a program at my current program where we teach a select group (we are too busy to teach everyone) about student IV sedation. These students should be able to graduate with the ability to obtain an IV moderate sedation permit in whatever state they chose to practice. If anesthesia were a specialty then every dental school in the country would have a dedicated anesthesia department who would be responsible to teach all dental students anesthesia knowledge from local to sedation.
False. Just because anesthesia is a specialty does not mean that dental schools would have a dedicated anesthesia department. Who would teach these anesthesia departments?? DAs??? There's only about 200. If they teach, you've just thrown your improved access to care argument straight out the window. You can't argue for both. And realistically, I would think most dental schools teach nitrous efficiently enough to use. I do not see how anyone could see this as a bad idea and I believe it is far superior/safer than having dentists take weekend DOCs courses.
ASA guidelines are not straightforward and routinely differ among providers. They should not be used as the sole guidelines between who receives GA in the office and who receives GA in a hospital setting. I would say sleep apnea, airway exam, etc are as important if not more important then ASA classification. I am sure you also know this and just did not write it (bad thing about these forums). My only point is ASA does change from provider to provider and just because someone is ASA 3 does not automatically rule them out from GA in office setting. I know my program provides GA in the dental school for many ASA 3 patients and will only provide GA for some ASA 2 patients in the hospital after performing a focused History and Physical. Knowing which patient is safe for GA outside the hospital setting is one of the fundamental items you will/must learn in DA residency.
Your articles are weak at best. They are surveys that are sent to DA programs (all 10 of them) and pediatric dentists who less than 50% responded and published in your own journal. What 50% do you think responded? I would assume the ones who use/like DA's. The articles can show a need for DA and I think if used responsibly/properly, they can be useful. But I, like the ADA House of Delegates, don't think this warrants a specialty. You've got 10 programs with 140 certified DA's in the U.S. You really think getting a specialty will increase the access to care? Your own article states, "Predicting the future need of DA's is an uncertain task". Your 140 will help, but again, I don't think it warrants a specialty recognition. Personally, I'm glad the ADA House of Delegates agrees with me.
I agree surveys are never the best for any research. However, I think you would agree that proving demand is very difficult…. I can speak from my firsthand experience. I am pediatric dentist and one of the primary reasons I am pursuing my anesthesia training is due to the daily frustration of obtaining GA for my patients. I know many pediatric dentists whose waitlist for GA is over 3 months. When I graduated, my pediatric residency programs waitlist was approaching 5 months. You try telling the family of a child in pain you cannot operate for 5 months. Not to mention the numerous families I saw whose insurance either did not cover hospital GA or they could not afford their co-pay (which generally was thousands of dollars). As a DA I will not have to tell a family I cannot care for their child.
WHOA WHOA WHOA!!!!!! So you're saying that your anesthesia cost will be free? If they could not afford their co-pay, how are you saving them cost? Now you have the cost of treatment and anesthesia. It may be cheaper than a hospital GA, but i assume you charge for your services. And how does making your field a specialty help with access to care? Again, you only have a handful of DAs. If the 200 DAs suddenly became recognized specialists, will the wait list magically drop to 1 month? I can see the issue, but you aren't providing a solution. My pediatric dental friends across the country continually ask/beg me come back to their area, and I have 23 months more of training. I am not even mentioning the need for perio, endo, or even GP patients. For all the GPs out there, how would you like to complete a whole complex tx plan with implants, crowns, exts, etc all at one time under ideal patient cooperation? How many patients would want this? Quite simply the need is there.
Be careful. Are you going to put a foley in these patients for these long complete treatment plans?
Haha. You're right, we don't really want government to tell us what is/isn't a specialty. I just wish we had a group of people that decided that. Oh wait, the ADA House of Delegates decided it was not a specialty. You are saying that to prevent government control, we should specialize everything?
Someone mentioned implantology and TMJ as areas that are fundamentals to dentistry and are not specialties. I say if they met the criteria for specialty then yes they should also be a specialty. Again I refer to you the criteria:
http://yes2anesthesia.com/ada-criteria.html
I considered putting the criteria and explaining how anesthesia met each one (very powerful stuff) but the post become too long (even for me) and complicated. I beg everyone to review these criteria which include need, and how that proposed specialty is
(a) separate and distinct from any recognized dental specialty or combination of recognized dental specialties;
(b) Cannot be accommodated through minimal modification of a recognized dental specialty or combination of recognized dental specialties.
Again, I respect your opinions and I understand that you want your career to become a specialty. Our governing body said you don't qualify for a specialty. I'm ok with that. That doesn't make you any less useful, just not special.......I'm just kidding on that one.
You and I both know that it was AAOMS that fought and ultimately prevailed in defeating anesthesia as a specialty. Furthermore, this was done to protect their self-interest and prestige. Below are the comments to a reporter asking why the application failed. Words are from Dr. Ganzberg.
What ultimately swung the opinion in the negative direction? You mean after unanimous approval that all the criteria were met by the Committee on Specialty Recognition and overwhelming approval from the Council on Dental Education and Licensure, the ADA Trustees and the Dental Education Reference Committee? Basically, it comes down to the political influence of the AAOMS who made deals, used misinformation and innuendo to sway delegates away from what the ADA spent, according to them, one million dollars to evaluate comprehensively. The process at the House of Delegates was so flawed with the Speaker of the House allowing lengthy negativity testimony from pro microphones to not explaining the process, that many long time members of the ADA felt this was the worst parliamentary procedure in recent memory by a Speaker of the House, who interestingly is an oral surgeon.
This action by the ADA confirms that the the ADA process of specialty approval is fatally flawed. This was clearly an effort by the ADA, through AAOMS, to restrict professional activities that specialty recognition would have provided. In the ADA's favor, the professional staff, including the committees and councils tried to convince the House of Delegates of the extensive vetting process but, a small group can never overcome the hurdle if the AAOMS does feels that their prestige will be lessened. At the same time, as the ADA has done after two other failed anesthesia specialty applications, they have decided to review and change the specialty application criteria to no doubt raise the bar again and make it harder still to become an ADA recognized specialty. These transparent unprofessional activities make this a sad day for the ADA which is losing dentist members at an alarming rate.
At this time, the ASDA will no longer pursue specialty approval through the ADA but will instead seek all state and federal remedies that restrict the professional activities of a group of specialized dentists that complete a minimum of two years of accredited residency training funded by the federal Centers for Medicare and Medicaid Services. This is all fluff. DA has attempted to become a specialty three times now and failed. You can blame AAOMS if you want, but the ADA House of Delegates aren't entirely puppets. I'm sure I could find an interview of an AAOMS official who blasted the argument in the other direction. Don't quote this guy like he's a prophet. It's an opinion.
I guess in the end arguing this point is similar to arguing religion or politics.
Definitely the smartest thing either of us has said. We agree on something at least. I just wish to eliminate the false information and shed light on the subject.
