Dental Anesthesiology is now recognized?

[dentalstudentprospect2]

---

Members don't see this ad.

The National Commision on Recognition is Dental Specialties just recognized Dental Anesthesiology as an ADA speciality. What changes, if any, can we expect from this? Will this impact OMFS’ dual provider/anesthestist model?

 

[Adlogin]

Where did you read that?

 

[AfterEffects]

No, OMFS will still do the same as always. Dental anesthesia being recognized as a specialty won't increase the need (or lack of) for them. It's purely political. Their services are reproducible (probably for cheaper) by properly trained CRNAs for private practice setting OMFS for those who want it. For more intensive cases in the OR, I do not see them pushing out actual MD anesthesiologists just cause they are now recognized.

 

[BluntForceTrauma]

Just another excuse for more programs to open more residencies and charge more money from more graduating students.

 

[dentalstudentprospect2]

Where did you read that?

Anesthesiology recognized as a dental specialty

 

[dentalstudentprospect2]

No, OMFS will still do the same as always. Dental anesthesia being recognized as a specialty won't increase the need (or lack of) for them. It's purely political. Their services are reproducible (probably for cheaper) by properly trained CRNAs for private practice setting OMFS for those who want it. For more intensive cases in the OR, I do not see them pushing out actual MD anesthesiologists just cause they are now recognized.

Good point. Recognition of a specialty does not suddenly increase demand for it. However, it may prompt more schools to include dental anesthesia or treating patients under GA into their curriculum. I can also see the specialty status potentially resulting in more defined standards of care which may impact current providers who offer in office sedations/GA for dental procedures. But my guess is as good as anyone’s.

 

[321931]

Good point. Recognition of a specialty does not suddenly increase demand for it. However, it may prompt more schools to include dental anesthesia or treating patients under GA into their curriculum. I can also see the specialty status potentially resulting in more defined standards of care which may impact current providers who offer in office sedations/GA for dental procedures. But my guess is as good as anyone’s.

In office its not a good investment in my opinion. Why?

One death in some dental office can prompt outrage and change in sedation policies in the state that it occurred. Whenever an unfortunate incident happens on the news, there is always some local news channel twisting the story, public outrage, dental witch-hunt, and possible proposal to change sedation laws.

There is this notion that dentists practice outside the standard of care then their counterparts MD's. Whenever there is a death on the news, you hear about how the dental office wasn't equipped enough to handle sedation. One bad apple ruins it for everyone. So even though you might practice to the standard of care- some other doc might not- and that effects laws/policies in the state.

That being said, the risk and reward ratio in my opinion isn't worth the squeeze. There is a limited amount of patients that need it. In my 5 years of practicing- I haven't met one patient who I had to refer out to a dentist who does sedation. The patients that do need it tend to be extremely fearful anxious meaning high stress. Even the places that may employ it- oral surgeons- are more then well qualified to do it on their own and not employ a dental anesthiologist...why share the compensation with another dentist? I'm sure you can make a living marketing yourself as "the sleep dentist" but that is a pretty limited demographic.

So not only are you limited in demographics, you are also held at the mercy of any policy changes in law. If GA only becomes permitted for hospitals and no outpatient procedures, you will be screwed pretty much. Market fluctuations always hits these kind of boutique practices the hardest. Ain't nobody gonna shell out a few thousand bucks to be put to sleep in a recession for a 50$ filling.

I think if you are interested in GA/anesthesia you should venture into OMFS and just get that license.

 

[dentalstudentprospect2]

In office its not a good investment in my opinion. Why?

One death in some dental office can prompt outrage and change in sedation policies in the state that it occurred. Whenever an unfortunate incident happens on the news, there is always some local news channel twisting the story, public outrage, dental witch-hunt, and possible proposal to change sedation laws.

There is this notion that dentists practice outside the standard of care then their counterparts MD's. Whenever there is a death on the news, you hear about how the dental office wasn't equipped enough to handle sedation. One bad apple ruins it for everyone. So even though you might practice to the standard of care- some other doc might not- and that effects laws/policies in the state.

That being said, the risk and reward ratio in my opinion isn't worth the squeeze. There is a limited amount of patients that need it. In my 5 years of practicing- I haven't met one patient who I had to refer out to a dentist who does sedation. The patients that do need it tend to be extremely fearful anxious meaning high stress. Even the places that may employ it- oral surgeons- are more then well qualified to do it on their own and not employ a dental anesthiologist...why share the compensation with another dentist? I'm sure you can make a living marketing yourself as "the sleep dentist" but that is a pretty limited demographic.

So not only are you limited in demographics, you are also held at the mercy of any policy changes in law. If GA only becomes permitted for hospitals and no outpatient procedures, you will be screwed pretty much. Market fluctuations always hits these kind of boutique practices the hardest. Ain't nobody gonna shell out a few thousand bucks to be put to sleep in a recession for a 50$ filling.

I think if you are interested in GA/anesthesia you should venture into OMFS and just get that license.

Thanks for the insight! Following up on the “sleep dentist” model, would being recognized as an ADA speciality now prevent dental anesthesiologists from practicing general dentistry? If so, I don’t see the benefit of pushing for recognition. If anything, it may have limited them to a field with low demand.

 

[setdoc7]

There are plenty of recognized specialties that do not have an enormous amount of private practice relevance....Oral/Max Radiology, Oral Path for instance, which do not attract large applicant pools and have few programs. I for one saw OralMax Radiology as perhaps a pathway to success if cone beam interpretation became a big payer, but it did not. The DA's wanted validation, and they got it. The Special Care folks want it, as well as the Pain Management dentists. Not sure how either will pan out. Will see if NY will accept this accredited residency (they may now have to go for reaccreditation as the name of the residency will surely change) for licensure, or fall by the wayside like pathology.
For the DA's.....congrats. You got what you wanted. Let's see if it works out. Lots of DA residencies have recently closed. There is no Oral/Max Radiology residency in NY. NY state has a lot of D schools.
Some dental students find out too late that they do not like to fix teeth. For them, some of these alternate paths are worthwhile. They are able to put their expensive diploma to use.

 

[FullyRelaxed]

In office its not a good investment in my opinion. Why?

One death in some dental office can prompt outrage and change in sedation policies in the state that it occurred. Whenever an unfortunate incident happens on the news, there is always some local news channel twisting the story, public outrage, dental witch-hunt, and possible proposal to change sedation laws.

There is this notion that dentists practice outside the standard of care then their counterparts MD's. Whenever there is a death on the news, you hear about how the dental office wasn't equipped enough to handle sedation. One bad apple ruins it for everyone. So even though you might practice to the standard of care- some other doc might not- and that effects laws/policies in the state.

That being said, the risk and reward ratio in my opinion isn't worth the squeeze. There is a limited amount of patients that need it. In my 5 years of practicing- I haven't met one patient who I had to refer out to a dentist who does sedation. The patients that do need it tend to be extremely fearful anxious meaning high stress. Even the places that may employ it- oral surgeons- are more then well qualified to do it on their own and not employ a dental anesthiologist...why share the compensation with another dentist? I'm sure you can make a living marketing yourself as "the sleep dentist" but that is a pretty limited demographic.

So not only are you limited in demographics, you are also held at the mercy of any policy changes in law. If GA only becomes permitted for hospitals and no outpatient procedures, you will be screwed pretty much. Market fluctuations always hits these kind of boutique practices the hardest. Ain't nobody gonna shell out a few thousand bucks to be put to sleep in a recession for a 50$ filling.

I think if you are interested in GA/anesthesia you should venture into OMFS and just get that license.

So to address your post.

First, in the history of Dental Anesthesia (and by that I mean anesthesia provided by a Residency trained Dental Anesthesiologists there has only been one death. That sort of safety record cannot be rivaled by any other provider...whether that be OMFS, Peds, CRNA, or MD.

In terms of limited patients needing it...I don't feel you're qualified to make that statement. You're talking about a service that you don't provide and then saying you don't see a need for it. Thousands of patients everyday get sedated for dental work...they range from the pediatric patient, to the special needs adult, to the anxious healthy adult. If you could easily provide them with sedation many many many of your patients would pursue that option. You would have more patients calling you for appointments if they knew they could be asleep for their procedure...you don't see that need because they aren't calling you. As a provider that does sedation myself I can tell you that patients travel for hours and hours to see a provider that will put them to sleep for their implants and extractions. We get referrals from special needs facilities all the time (1 whole day a week is just special needs patients getting very routine dental work)...and children 2-10 can have 20 tooth treatment in a single sitting without any problem because they're asleep.

In terms of being at the mercy of policy changes...well that is certainly true...but all providers doing outpatient anesthesia are held at that mercy. If peds lost the ability to sedate their whole specialty would remarkably change...if OMFS lost the ability to sedate their whole specialty would remarkably change...so yes policy change could hurt the specialty but it could hurt all specialties. Dental Anesthesia has been around for decades and decades and has survived...and that was without any formal recognition...now they have formal recognition and less of a chance of being hurt by policy change.

Overall I see what you're saying...it is a fringe specialty and its need isn't as dire as the other more established specialties. But it certainly has a significant place in dentistry (general anesthesia was popularized by a dentist for goodness sake). And if you look at the guys who did a Dental Anesthesia Residency they make more money per hour than any other dental provider...no debate...so to say that it's frivolous just isn't true.

I for one am glad it's now "officially recognized"...it can only be a good thing for the field.

 

[shulk]

Only one death doesn't necessarily mean it has a better safety record - it needs to be calculated per sedation. There has been more than one death from OMFS, MD, CRNA but I would wager each of those groups as a whole have done vastly more sedations by sheer volume than dental anesthesia, so even if they were exceedingly safe you would expect more than one death from those groups.

 

[setdoc7]

So to address your post.

First, in the history of Dental Anesthesia (and by that I mean anesthesia provided by a Residency trained Dental Anesthesiologists there has only been one death. That sort of safety record cannot be rivaled by any other provider...whether that be OMFS, Peds, CRNA, or MD.

In terms of limited patients needing it...I don't feel you're qualified to make that statement. You're talking about a service that you don't provide and then saying you don't see a need for it. Thousands of patients everyday get sedated for dental work...they range from the pediatric patient, to the special needs adult, to the anxious healthy adult. If you could easily provide them with sedation many many many of your patients would pursue that option. You would have more patients calling you for appointments if they knew they could be asleep for their procedure...you don't see that need because they aren't calling you. As a provider that does sedation myself I can tell you that patients travel for hours and hours to see a provider that will put them to sleep for their implants and extractions. We get referrals from special needs facilities all the time (1 whole day a week is just special needs patients getting very routine dental work)...and children 2-10 can have 20 tooth treatment in a single sitting without any problem because they're asleep.

In terms of being at the mercy of policy changes...well that is certainly true...but all providers doing outpatient anesthesia are held at that mercy. If peds lost the ability to sedate their whole specialty would remarkably change...if OMFS lost the ability to sedate their whole specialty would remarkably change...so yes policy change could hurt the specialty but it could hurt all specialties. Dental Anesthesia has been around for decades and decades and has survived...and that was without any formal recognition...now they have formal recognition and less of a chance of being hurt by policy change.

Overall I see what you're saying...it is a fringe specialty and its need isn't as dire as the other more established specialties. But it certainly has a significant place in dentistry (general anesthesia was popularized by a dentist for goodness sake). And if you look at the guys who did a Dental Anesthesia Residency they make more money per hour than any other dental provider...no debate...so to say that it's frivolous just isn't true.

I for one am glad it's now "officially recognized"...it can only be a good thing for the field.

I for one did not fully understand your post, as you are listed as a Med student. Perhaps you are currently in an OMFS program now. In any case, it is my understanding that all OMFS clinicians are capable of deep sedation, so I am unclear who is traveling untold miles to see you as a DA, unless you are a OMFS as well, or the nearest OMFS is next door to you.
While I am well aware of the need to sedate many special needs patients, I am also aware that many are wards of the state, and therefore follow CMS guidelines for treatment, which may not be an adequate fee for the services they require. Because of the preponderance of co morbidities in this population, it is often more advisable to do these cases under GA in an OR where control of the airway may be better, and immediate adjunct services are available.
20 tooth treatment in one sitting sounds excessive to me, given that long bouts of anesthesia have been associated with learning delay or worse.
And as far as a residency trained DA making the most money per hour......you are clearly not in NYC. I think remuneration arguments are a waste of time anyway, as there will always be some new player who will claim to make more. If in fact you command the type of fees you are expounding upon on this thread, then good for you...and take notice all of you dental students who owe plenty. This may be your end game.

 

[2TH MVR]

Curious what malpractice liability premiums are for the DAs.

 

[Likkriue]

There is no Oral/Max Radiology residency in NY. NY state has a lot of D schools.

If you meant NYC sure but There is one radiology residency at Stony Brook. In addition there is also a DA program at stony brook.

 

[setdoc7]

If you meant NYC sure but There is one radiology residency at Stony Brook. In addition there is also a DA program at stony brook.

You are correct. Last time I looked, the closest OMF Rad residency to NY was UConn. I am not sure how old this program at SDM is, my guess is that it isn't up and running yet. In a state with 5 dental schools, it is interesting that there is only one program, which appears to be accepting its very first class in 2020. I am aware of all of the DA programs in NY, as there is one at my hospital. I am also aware that some are closed or closing. One of out DA residents has done an OMF Rad residency. Not sure how these specialist work other than in an academic setting. Anyone know?

 

[Likkriue]

You are correct. Last time I looked, the closest OMF Rad residency to NY was UConn. I am not sure how old this program at SDM is, my guess is that it isn't up and running yet. In a state with 5 dental schools, it is interesting that there is only one program, which appears to be accepting its very first class in 2020. I am aware of all of the DA programs in NY, as there is one at my hospital. I am also aware that some are closed or closing. One of out DA residents has done an OMF Rad residency. Not sure how these specialist work other than in an academic setting. Anyone know?

Oh it’s running, there’s 3 residents we students at stony brook interact with all the time. One of them is finishing and the others just started their first year here. You are correct it is a very new program, It started the same time I got into dental school and is a two year program.

The DA residents at stony brook are GME funded, I’m guessing they are at yours as well?

 

[setdoc7]

Yes, our DA program is accredited and funded.
I know your dean and some of your faculty.....Dr. Larsen and I go back a long way.

 

[Likkriue]

Yes, our DA program is accredited and funded.
I know your dean and some of your faculty.....Dr. Larsen and I go back a long way.

Dr Larsen is amazing! Happiest person I have ever met.

 

[FullyRelaxed]

Only one death doesn't necessarily mean it has a better safety record - it needs to be calculated per sedation. There has been more than one death from OMFS, MD, CRNA but I would wager each of those groups as a whole have done vastly more sedations by sheer volume than dental anesthesia, so even if they were exceedingly safe you would expect more than one death from those groups.

The specialty has been around for more than 30 years...if there's only 1 death then that beats OMFS by quite a bit. On dentaltown someone posted that OMSNIC (the insurance company that handles nearly every OS) published their findings that a little more than 5% of oral surgeons will have an anesthesia death. There are about 275 dental anesthesiologist members of ASDA. Only 1 of them has had a death. That's 0.3% In order to match the OMFS numbers 13 of them would have had to have a death. So you can objectively say that Dental Anesthesia has a safer track record. OMFS still have a great safety record...but it's pretty definitive that the dental anesthesiologists have a better safety record.

 

[maxillofacialradiologist]

I am a current maxillofacial radiology resident in one of the oldest and most reputed programs in the country and the lack of awareness seen in some of the posts here is baffling.

Coming to the point about DA, why was it given specialty status before something like Oral Medicine? There are around 8 programs, some of which have been around since a long time and the board is recognised as per CODA. Why not give that specialty status if they are handing out specialty status?

 

[AppalachianDentalBoy]

I am a current maxillofacial radiology resident in one of the oldest and most reputed programs in the country and the lack of awareness seen in some of the posts here is baffling.

Coming to the point about DA, why was it given specialty status before something like Oral Medicine? There are around 8 programs, some of which have been around since a long time and the board is recognised as per CODA. Why not give that specialty status if they are handing out specialty status?

Probably politics

 

[shulk]

The specialty has been around for more than 30 years...if there's only 1 death then that beats OMFS by quite a bit. On dentaltown someone posted that OMSNIC (the insurance company that handles nearly every OS) published their findings that a little more than 5% of oral surgeons will have an anesthesia death. There are about 275 dental anesthesiologist members of ASDA. Only 1 of them has had a death. That's 0.3% In order to match the OMFS numbers 13 of them would have had to have a death. So you can objectively say that Dental Anesthesia has a safer track record. OMFS still have a great safety record...but it's pretty definitive that the dental anesthesiologists have a better safety record.

While I don't think there is much point in engaging further, this still doesn't prove that DA has a better safety record. It's a misrepresentation of the data. If we invented a new specialty, say Optometry Anesthesiologist in 2020 and trained 1 individual in anesthesia, and allowed them to perform a sedation, and the person didn't die from it, we could then say: Optometry Anesthesia is even safer! No deaths ever from it! But obviously, that would be extremely misleading. It is certainly possible that DA can perform anesthesia safer than other health care providers - but you still haven't shown that per sedation DA is safer than say OMFS. The research question you would be trying to answer is: If I undergo a sedation, what are the chances I would survive if it is done by a DA? an OMFS? an anesthesiologist? You would also need to show that the patient population treated is similar for each group, and that the types of sedation performed by these groups is similar too in order to draw meaningful conclusions.

 

[321931]

My biggest question is what is the difference between a doc taking a weekend ce course and or weeklong ce course on iv sedation and advertising sleep dentistry in their own office versus a dental anesthesiologist?

Do specialists make more per case? I know quite a few sleep sedation dentists and none of them are dental anestheliogists...

Just trying to learn. Thanks!

 

[FullyRelaxed]

While I don't think there is much point in engaging further, this still doesn't prove that DA has a better safety record. It's a misrepresentation of the data. If we invented a new specialty, say Optometry Anesthesiologist in 2020 and trained 1 individual in anesthesia, and allowed them to perform a sedation, and the person didn't die from it, we could then say: Optometry Anesthesia is even safer! No deaths ever from it! But obviously, that would be extremely misleading. It is certainly possible that DA can perform anesthesia safer than other health care providers - but you still haven't shown that per sedation DA is safer than say OMFS. The research question you would be trying to answer is: If I undergo a sedation, what are the chances I would survive if it is done by a DA? an OMFS? an anesthesiologist? You would also need to show that the patient population treated is similar for each group, and that the types of sedation performed by these groups is similar too in order to draw meaningful conclusions.

Yeah you definitely don’t understand. They’ve slept hundreds of thousands of patients in 3+ decades...one death. They treat far more patients under 10 years old. I’m sorry you have an odd bias against them. Good luck.

Edit: i think you’re under the impression that the n is too low...and i think maybe you don’t have much exposure to DAs...can i ask your familiarity with the field? I’m doing my anesthesia residency and train alongside DAs. My dad is a dentist who uses a large DA group. I plan on providing outpatient anesthesia, including dental, when i finish but i’m pretty familiar with the field. They treat many many patients and have for many many years. Again, what is your experience with the field?

 

[dentalstudentprospect2]

My biggest question is what is the difference between a doc taking a weekend ce course and or weeklong ce course on iv sedation and advertising sleep dentistry in their own office versus a dental anesthesiologist?

Do specialists make more per case? I know quite a few sleep sedation dentists and none of them are dental anestheliogists...

Just trying to learn. Thanks!

The difference is the degree of sedation and the complexity of cases they are trained to do. Also, don’t all specialist get to bill at a higher fee than GP’s?

 

[dentalstudentprospect2]

While I don't think there is much point in engaging further, this still doesn't prove that DA has a better safety record. It's a misrepresentation of the data. If we invented a new specialty, say Optometry Anesthesiologist in 2020 and trained 1 individual in anesthesia, and allowed them to perform a sedation, and the person didn't die from it, we could then say: Optometry Anesthesia is even safer! No deaths ever from it! But obviously, that would be extremely misleading. It is certainly possible that DA can perform anesthesia safer than other health care providers - but you still haven't shown that per sedation DA is safer than say OMFS. The research question you would be trying to answer is: If I undergo a sedation, what are the chances I would survive if it is done by a DA? an OMFS? an anesthesiologist? You would also need to show that the patient population treated is similar for each group, and that the types of sedation performed by these groups is similar too in order to draw meaningful conclusions.

You can exteapolate the number of cases from the 30 years and 275 DA’s practicing to have a large enough sample size to confidently argue that the mortality rate per sedation is low compared to other providers.

 

[321931]

The difference is the degree of sedation and the complexity of cases they are trained to do. Also, don’t all specialist get to bill at a higher fee than GP’s?

Complexity and fees don’t translate to higher fees. I know oral surgeons that do not do facial reconstruction because the liability and fees isn’t worth it. Plucking out 4 wisdom teeth in 5 min on sedation is much easier then 1-2 workup for a 2-3 hour operating room surgery with potential death as a side effect.

Don't confuse complexity = higher pay.

I guess if one really wants complex cases and academics it makes sense, and or niche area in dentistry?

 

[dentalstudentprospect2]

Complexity and fees don’t translate to higher fees. I know oral surgeons that do not do facial reconstruction because the liability and fees isn’t worth it. Plucking out 4 wisdom teeth in 5 min on sedation is much easier then 1-2 workup for a 2-3 hour operating room surgery with potential death as a side effect.

Don't confuse complexity = higher pay.

I guess if one really wants complex cases and academics it makes sense, and or niche area in dentistry?

Agreed. Of course higher yield procedures tend to be more simple. I’m answering your questions separately. DA’s have the ability to provide deeper forms of sedation on and handle patients who are more complex. Whether or not this is higher yielding is dependent on other factors.
The second part about being able to bill more, I am not sure of which is why I phrased it as a question. I assume that now DA’s are recognized, perhaps insurance compensation is higher?

 

[P7898]

The specialty has been around for more than 30 years...if there's only 1 death then that beats OMFS by quite a bit. On dentaltown someone posted that OMSNIC (the insurance company that handles nearly every OS) published their findings that a little more than 5% of oral surgeons will have an anesthesia death. There are about 275 dental anesthesiologist members of ASDA. Only 1 of them has had a death. That's 0.3% In order to match the OMFS numbers 13 of them would have had to have a death. So you can objectively say that Dental Anesthesia has a safer track record. OMFS still have a great safety record...but it's pretty definitive that the dental anesthesiologists have a better safety record.

More OS than Dental Anesthesia guys/gals so numbers are skewed. Larger sample size for OS

 

[avangusva]

Yeah you definitely don’t understand. They’ve slept hundreds of thousands of patients in 3+ decades...one death. They treat far more patients under 10 years old. I’m sorry you have an odd bias against them. Good luck.

Edit: i think you’re under the impression that the n is too low...and i think maybe you don’t have much exposure to DAs...can i ask your familiarity with the field? I’m doing my anesthesia residency and train alongside DAs. My dad is a dentist who uses a large DA group. I plan on providing outpatient anesthesia, including dental, when i finish but i’m pretty familiar with the field. They treat many many patients and have for many many years. Again, what is your experience with the field?

With your vast experience in the field, shouldn't you understand that there are so many variable in patients? Do you think the anesthesia risk for an ASA 1 patient undergoing a 30 minute tooth cleaning and fillings under general endotracheal intubation is different than an ASA 4 undergoing a four hour CABG which is very different than an open airway moderate sedation which is different than a deep sedation?

Are you claiming with your statement "That sort of safety record cannot be rivaled by any other provider...whether that be OMFS, Peds, CRNA, or MD." that dental anesthesiologists are safer than these other providers? Is there something special about dental anesthesiology training? Are dental anesthesiologists using different medications?

Where are you doing your anesthesia residency and what year are you in your residency training? What makes you familiar with the field of dental outpatient anesthesia, the fact that your father is a dentist and uses a DA group?

 

[dentalstudentprospect2]

More OS than Dental Anesthesia guys/gals so numbers are skewed. Larger sample size for OS

You’re never going to have the same sample size if you compare OMFS and DA. But statistics does not need two groups to have the same sample size to be significant. There have been enough cases performed but DA’s in their 30 years of existence to offer some meaningful statistics.

 

[P7898]

You’re never going to have the same sample size if you compare OMFS and DA. But statistics does not need two groups to have the same sample size to be significant. There have been enough cases performed but DA’s in their 30 years of existence to offer some meaningful statistics.

True, just a lot of variation. Are the same drugs being used? OS also have complex patients that have multiple medical issues with them.

 

[P7898]

What is the process of having an in-house dental anesthesiologist? What if a Perio or a GP used one? Would the anesthesiologist be paid by the patient or would they have to be put on the payroll?

 

[vellnueve]

The specialty has been around for more than 30 years...if there's only 1 death then that beats OMFS by quite a bit. On dentaltown someone posted that OMSNIC (the insurance company that handles nearly every OS) published their findings that a little more than 5% of oral surgeons will have an anesthesia death. There are about 275 dental anesthesiologist members of ASDA. Only 1 of them has had a death. That's 0.3% In order to match the OMFS numbers 13 of them would have had to have a death. So you can objectively say that Dental Anesthesia has a safer track record. OMFS still have a great safety record...but it's pretty definitive that the dental anesthesiologists have a better safety record.

It’s way less than 5%

 

[FullyRelaxed]

With your vast experience in the field, shouldn't you understand that there are so many variable in patients? Do you think the anesthesia risk for an ASA 1 patient undergoing a 30 minute tooth cleaning and fillings under general endotracheal intubation is different than an ASA 4 undergoing a four hour CABG which is very different than an open airway moderate sedation which is different than a deep sedation?

Are you claiming with your statement "That sort of safety record cannot be rivaled by any other provider...whether that be OMFS, Peds, CRNA, or MD." that dental anesthesiologists are safer than these other providers? Is there something special about dental anesthesiology training? Are dental anesthesiologists using different medications?

Where are you doing your anesthesia residency and what year are you in your residency training? What makes you familiar with the field of dental outpatient anesthesia, the fact that your father is a dentist and uses a DA group?

I get the feeling you’re omfs and you feel like i’m attacking your field...i am not. OMFS do a great job...my point was brought up bc someone earlier specifically said dental anesthesia wasn’t safe.

In answer to some of your points...of course patients have different risks...but the patients that DAs put to sleep are absolutely higher risk...they do far more pediatric patients 10 years of age and younger on a regular basis. Omfs do a majority of healthy 16-18yo getting 15 minutes of anesthesia. Again i’ll ask what your experience with dental anesthesiologists has been? In california a bulk of their patients are pediatrics being put to sleep for 45 minutes to an hour.

I’m claiming that the anesthesia record of DAs cannot be beaten by anyone. It’s a combination of factors...3 years training the majority of which is outpatient (more than omfs, more than MDs, wayyyyy more than CRNAs...not a fan of CRNAs personally). But mostly...it’s that they don’t do anesthesia and operate simultaneously. If omfs had the luxury of not multitasking their numbers would be dramatically better.

I’m not attacking omfs, but hands down DA have a better safety record...1 outpatient death...ever.

I’m in my last year. We work with the DA’s. I’ve shadowed 4 of them over the last 3 years. My father gas used a large DA group. I train alongside them and my best friend is a DA. Like i said i hope to provide outpatient anesthesia so ive spent a lot of time doing my research.

 

[FullyRelaxed]

It’s way less than 5%

So this is directly based off the numbers from their closed claim data from that large insurance company run by oral surgeons. I encourage you to contact them...you can verify it yourself. The numbers are way higher than you thought...same on the MD side with our own outpatient closed claims analysis and SAMBA.

Someone posted it on dentaltown about 2 years ago.

 

[Sublimazing]

Dental Anesthesiologists...OMFS...they’re both dorks...imagine if some guy did both...he’d be such a jerk.

 

[DentistScientist]

oooohh

Some of my classmates would recommend me to do something like this cause they see me doing research and taking this cold, leftover pizza slice that nobody wants to take. How naive. Why would someone spend extra years in school to get into the least competitive residency? 😀

 

[BluntForceTrauma]

. Why would someone spend extra years in school to get into the least competitive residency? 😀

Because they like the scope of the speciality maybe?

 

[DentistScientist]

Because they like the scope of the speciality maybe?

nah. I know them. if they don't have the grades, they want fee for service implants, invisilign, and botox. If they have grades, they want endo or ortho. whatever the most lucrative and best life style. I don't care whatever they want. It's their freedom. But don't recommend me things that they would never do.

 

[setdoc7]

I know a few OMFS who are also boarded DA's. In fact, one of our OMFS residents has done a DA program. Wondering if their numbers overlap, and are counted by both specialties. What about the Peds who are also DA's? Know a few of them as well. Until the country follows CA, the actual work for DA's will still be small, and many will supplement by actually performing dentistry. If DA was more lucrative, there would be more programs opening, not closing. DA works if you are getting FFS, but is not so great if you are being paid by CMS. That is true for most of dentistry.
The patient pool willing to pay for multiple sedations and high quality dentistry is slim. Even under deep sedation or GA, it is not always possible to complete quality dental work in one visit.

 

[FullyRelaxed]

I know a few OMFS who are also boarded DA's. In fact, one of our OMFS residents has done a DA program. Wondering if their numbers overlap, and are counted by both specialties. What about the Peds who are also DA's? Know a few of them as well. Until the country follows CA, the actual work for DA's will still be small, and many will supplement by actually performing dentistry. If DA was more lucrative, there would be more programs opening, not closing. DA works if you are getting FFS, but is not so great if you are being paid by CMS. That is true for most of dentistry.
The patient pool willing to pay for multiple sedations and high quality dentistry is slim. Even under deep sedation or GA, it is not always possible to complete quality dental work in one visit.

I don’t know much about national trends on academic DA. In medicine an academic department’s ability to turn a profit has nothing to do with how they do in private practice. At my hospital only 3 departments actually make a profit. So i see little correlation with academic profitability and private practice earnings.

Private practice DAs I’ve met do extremely well. They don’t perform any general dentistry they just do anesthesia. None of them accepted medicaid and i don’t know why anyone would do that...maybe wherever you’re at is a poor area?...it’s all cash. The overhead is almost nothing (25-50 dollars per patient) and patients pay between 500-1000 per hour. The lifestyle is very relaxed 99% of the time. I am near the west coast, but ive talked with DAs in texas and the midwest as well and they gave me similar numbers... so maybe your area is just different?

I hope the field stays small...less competition 🙂 i enjoy your perspective interesting to see how different careers can be region to region.

 

[setdoc7]

I am in NYC. Perhaps it is the high malpractice here. Also, the initial investment in equipment is large. The rules for ambulatory sedation and GA in NY are quite strict, and compliance going from office to office is not simple, since the office owner must carry the same insurance as the DA. All malpractice carriers in NY ask if you treat patients who are "asleep". 500-1000 per hour does not sound like a lot to me. Most good dentists can restore 3-4 implants or do 3-4 laminates in an hour, and that's 8000-10,000. Since the DA bills separately, it sounds like a win to me if you can attract those patients and don't mind the extra premium.

 

[dentalstudentprospect2]

I am in NYC. Perhaps it is the high malpractice here. Also, the initial investment in equipment is large. The rules for ambulatory sedation and GA in NY are quite strict, and compliance going from office to office is not simple, since the office owner must carry the same insurance as the DA. All malpractice carriers in NY ask if you treat patients who are "asleep". 500-1000 per hour does not sound like a lot to me. Most good dentists can restore 3-4 implants or do 3-4 laminates in an hour, and that's 8000-10,000. Since the DA bills separately, it sounds like a win to me if you can attract those patients and don't mind the extra premium.

8k/hr?! Even with overhead, that’s insane. Is this a common workday or is this an allocated day of the month where all the implants restorations/laminates are done?

 

[setdoc7]

NYC prices are hi. Lots of practices command these fees. Even in the Bronx a crown is $1200.

 

[Big Time Hoosier]

nah. I know them. if they don't have the grades, they want fee for service implants, invisilign, and botox. If they have grades, they want endo or ortho. whatever the most lucrative and best life style. I don't care whatever they want. It's their freedom. But don't recommend me things that they would never do.

I’ve already counseled you that you just need to do you. Stop comparing yourself to others. There will always be someone “better” than you, like Jonny Kim. He is a former Navy SEAL medic/sniper, who then went on to Harvard Medical School, and is now training with NASA to become an astronaut.

You will forever live in Jonny Kim’s shadow. Now move on. If you want to specialize, only do it if you have a genuine interest, not because you have something to prove to somebody else. You will never be happy if you live your life like this.

Big Hoss

 

[AppalachianDentalBoy]

If you want to specialize, only do it if you have a genuine interest, not because you have something to prove to somebody else. You will never be happy if you live your life like this.

Big Hoss

BuT WHat AbOuT ThE LifEsTyLe

or

I ju$₮ wan₮ ₮o €xtra¢t wi$dom ₮€€₮h

 

[ab117]

I’ve already counseled you that you just need to do you. Stop comparing yourself to others. There will always be someone “better” than you, like Jonny Kim. He is a former Navy SEAL medic/sniper, who then went on to Harvard Medical School, and is now training with NASA to become an astronaut.

View attachment 254884

You will forever live in Jonny Kim’s shadow. Now move on. If you want to specialize, only do it if you have a genuine interest, not because you have something to prove to somebody else. You will never be happy if you live your life like this.

Big Hoss

Brilliant.

 

[thewingman]

Legitimate question: why would anyone hire a dental anesthesiologist when you can get a anesthesiologist to come to your clinic and do sedations for a similar cost? Many people around my neck of the woods do this. If anything does happen in your clinic, you can argue to the board that you had an actual anesthesiologist running the sedation.

 

[adamkiewicz]

The cost isn’t lower. We bill patients directly for the sedation. Most practices don’t have enough patients to justify employing an anesthesia provider but if they did have sufficient volume then hiring a CRNA would be cheaper (and the dentist would profit off their billing).

I’ve heard that dental anesthesia can be very lucrative. However, I wouldn’t want to work in that environment as an anesthesiologist. No support staff to help with issues (difficult airway, MH, anaphylaxis, aspiration, running a code, etc) if you’re solo at an office. No dedicated PACU and trained PACU nurses to help recover patients while I take care of the next patient.

I thought the post above mentioning safety outcomes was a bit silly. You’re reporting what you read on a forum by a 275 member DA group. Self reporting outcomes? Regardless anesthesia is safe. Worldwide general anesthesia deaths are 7 in a million cases. I read a Times article where anesthesia related deaths were on a rise after declining for decades due to older and sicker patients going through more surgeries.

I do a ton of dental cases in ambulatory surgery center. Some of them have learning disabilities but most of them are kids needing ton of dental work >1 hour anesthesia time and those kids deserve proper recovery time in the PACU. All the healthy routine stuff is probably stay in the office. When they come to us there is always a reason.