Travel dentist who does Extractions/sedations

[Life of Pablo]

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If I may ask, why he/she cannot do the following? Is it due to laws (state), best practices, safety concerns, etc...? I don't do sedation myself due to risk/liability, but I'm just going off on what I hear OS groups are doing in my area.

The "sedation permit" that general dentists get is the same one that periodontists get. You can use versed/fentanyl but no propofol/ketamine/etc. It's considered moderate conscious sedation. The only ones able to give the other medications are OMFS/dental anesthetists/anesthesiologists/CRNAs.

On a side note, this thread scares me. Sedation and trying to go fast for "max profit" should not be used in the same sentence. That is how something very bad happens.

All on X can be tricky sometimes, as you might have some curveballs like having to stop every so often if the patient is having a laryngospasm, and so on.

Laryngospasm in an outpatient setting is a big deal. Not something you just briefly stop the procedure for and keep going; it is how someone can die. I highly doubt a general dentist with hardly any anesthesia experience could adequately break one. Are you going to use your bag mask skills that you have barely practiced? Are you going to deepen them with the propofol you don't have? Are you going to emergently push succ, paralyze them, then rely on your bag mask skills until they can breathe again? Again, this thread scares me with how nonchalantly sedations are being discussed.

 

[Bropofol*]

Rule of thumb for doing sedations as GP especially office to office sedations...don't! If you are going to market yourself as a sedation dentist and try to make a career out of it, then go complete 3 years of anesthesiology residency then start your career with caution as many new DAs do. There are no shortcuts to long term success.

 

[TanMan]

Rule of thumb for doing sedations as GP especially office to office sedations...don't! If you are going to market yourself as a sedation dentist and try to make a career out of it, then go complete 3 years of anesthesiology residency then start your career with caution as many new DAs do. There are no shortcuts to long term success.

I agree that doing sedations as a GP doesn't make much financial sense given the restrictions that many states place on sedating multiple patients, being stuck on moderate sedation, monitoring, logs, and all the other regulatory requirements that draw away from the profitability and hourly rate(s). God forbid someone dies in your chair, there goes all the goodwill that your practice built, and you'll end up having to rebrand or move. Sedation patients may be pleasant when they are sedated, but usually a PITA before and after.

 

[JacquesVallee]

God forbid someone dies in your chair, there goes all the goodwill that your practice built, and you'll end up having to rebrand or move.

Someone dying should be tragic enough to deter people from sedating. Just emphasizing how a death would ruin your practice is insane to me. We're talking about someone needlessly dying here. GPs who sedate and someone loses their life should lose their license.

 

[TanMan]

Someone dying should be tragic enough to deter people from sedating. Just emphasizing how a death would ruin your practice is insane to me. We're talking about someone needlessly dying here. GPs who sedate and someone loses their life should lose their license.

Yep, but if you can't appeal to people's humanity, you can at least appeal to the more objective aspects of why you shouldn't do things. Sometimes, it requires a different perspective to dissuade people from unintentionally killing others.

 

[StarENDO1]

Two intern years is not extensive training in OMFS. I saw your post on Reddit. I’m also not an OMFS, but I am an expert in sedation/anesthesia. There’s a reason why DAs go to three years of residency to travel and provide sedation/anesthesia. It’s hard enough when you’re in the same location everyday, but if you’re traveling to a different office each day there are so many moving parts and things that can get missed and go wrong. Are you prepared to handle a patient that has runs of VTach in an unfamiliar office? What about the patient that lies about npo status and aspirates mid procedure? The dental office that brought you in isn’t gonna be any help. Their staff isn’t trained to help (that’s why they’re bringing in someone). Especially if you just got your permit, all that means is you’ve met the bare minimum qualifications. You don’t have the experience to be doing this and I recommend you get a lot of cases under your belt before thinking about traveling to perform sedations.

And if you’re trying to maximize your day by seeing 15-25 patients while doing moderate sedation, you’re gonna kill someone. There’s a reason most DAs done see more than 10 patients in a day

I am hiring DAs for my future endodontic practices 🙂 Thank God for the DA.

 

[Localnative]

been practicing OS in FL for 16 years. Also have been doing legal work as an expert witness for several years and I’m currently in the midst of examining some extremely unfortunate cases. I’ve seen some very competent dentists get RUINED pushing the boundaries of what they should/shouldn’t do. It’s nightmare fuel. Years of litigation can drive one literally mad.

Let the OP go on his merry way and continue practicing the algorithm he “created”. There are some very hungry attorneys out there, and they will eviscerate one who makes a single very horrible misstep.

 

[SirBrotherJam]

Theres nothing wrong with a GP doing molar endos lol.

It's more the 30 mins I think.... and chair time

 

[D1Bound]

Is this you OP?

 

[TanMan]

Another lesson here for not just the OP but also other dentists in higher risk categories is the way you structure your wealth. If you are performing high risk procedures that could generate significant liability, it would be prudent to have your assets in a different entity and any debt you have saddled onto you personally. It makes you a lot less of a target to get sued since the lawyers will have to work a lot harder to pierce the veils and less likely that they can go after your money. Also, take advantage of your homestead laws if you have any in your state.

 

[JacquesVallee]

Is this you OP?

This guy had two sedation deaths... My goodness. General dentists should not be sedating.

 

[AlbinoPolarBear]

This guy had two sedation deaths... My goodness. General dentists should not be sedating.

He's the worst type of doctor.

Got kicked out of oral surgery residency, and thinks he knows oral surgery.

Literally the poster boy for Dunning Kruger effect.

 

[702]

He's the worst type of doctor.

Got kicked out of oral surgery residency, and thinks he knows oral surgery.

Literally the poster boy for Dunning Kruger effect.

Which program and for what reasons?

 

[AlbinoPolarBear]

Which program and for what reasons?

He got kicked out of 2 programs actually.

Brooklyn, and San Antonio.

Dude was super toxic and caused drama everywhere he went.

 

[JacquesVallee]

He got kicked out of 2 programs actually.

Brooklyn, and San Antonio.

Dude was super toxic and caused drama everywhere he went.

He calls himself an "implant surgeon" on his dental website. I think the title "surgeon" should be reserved for those who complete OMFS residency...

The fact that one death at his office didn't stop him as a GD from sedating blows my mind. I'd struggle to even go back to practicing if such a tragedy happened to me. I'd be more understanding of him as a person if he'd been in over his head with sedation and blame the system for allowing it. But dude, after one death as a GD, you should never touch sedation again.

Cases like this will continue to perpetuate the general public fearing to go to the dentist.

 

[AlbinoPolarBear]

Some articles about our favorite GD

Client Challenge

https://dn710201.ca.archive.org/0/items/gov.uscourts.txwd.1107941/gov.uscourts.txwd.1107941.1.0.pdf

 

[StarENDO1]

Some articles about our favorite GD

Client Challenge

https://dn710201.ca.archive.org/0/items/gov.uscourts.txwd.1107941/gov.uscourts.txwd.1107941.1.0.pdf

Wow. There is no word to describe this. So who is at fault ? It said he was harassed by supervisors? Is the Omfs culture like this? This is scary.

 

[yappy]

He got kicked out of 2 programs actually.

Brooklyn, and San Antonio.

Dude was super toxic and caused drama everywhere he went.

I am surprised someone would be given two chances.

Edit: so this guy made it to chief year of OMS training? If so, he had received the requisite anesthesia training any OMS would have. Why is everyone attributing this tragedy to lack of training?

 

[Colastick]

I am surprised someone would be given two chances.

Edit: so this guy made it to chief year of OMS training? If so, he had received the requisite anesthesia training any OMS would have. Why is everyone attributing this tragedy to lack of training?

Doing anesthesia rotation isnt equivalent to omfs anesthesia training because you do a lot of in office sedation in your chief year (at least in most programs).

Also, firing a resident is a big deal and it is actually difficult to do. The fact that you get fired means that something was seriously wrong or lacking, that you are a danger to patients or that you are untrustworthy. So no, you cant compare this guy to an omfs

 

[702]

I am surprised someone would be given two chances.

Edit: so this guy made it to chief year of OMS training? If so, he had received the requisite anesthesia training any OMS would have. Why is everyone attributing this tragedy to lack of training?

How do you know he made it to chief year?

 

[yappy]

Doing anesthesia rotation isnt equivalent to omfs anesthesia training because you do a lot of in office sedation in your chief year (at least in most programs).

Also, firing a resident is a big deal and it is actually difficult to do. The fact that you get fired means that something was seriously wrong or lacking, that you are a danger to patients or that you are untrustworthy. So no, you cant compare this guy to an omfs

It would be interesting to know what the root cause was in this case. Is it negligence as you’re suggesting, or an issue with the operator-anesthetist model. I hire an anesthesiologist to do my cases. I am not an OMS but it’s easy to be task saturated while just doing what I do. In my past life in the medical field, we usually put separate people on drugs, airway, equipment, etc. and RSI was a team event. I struggle to see how the model this dentist was employing didn’t contribute to patient’s unfortunate outcome. It appears to be partly a system error.

 

[AlbinoPolarBear]

I am surprised someone would be given two chances.

Edit: so this guy made it to chief year of OMS training? If so, he had received the requisite anesthesia training any OMS would have. Why is everyone attributing this tragedy to lack of training?

He's had a bunch of intern years the programs he was at.

Never went past PGY-1.

PGY-3, (senior) and PGY-4 (chief), is when you start operating.

The years prior to that is mostly scut work.

 

[yappy]

He's had a bunch of intern years the programs he was at.

Never went past PGY-1.

PGY-3, (senior) and PGY-4 (chief), is when you start operating.

The years prior to that is mostly scut work.

“Plaintiff was previously a Chief Resident in an oral surgery program at Brooklyn Hospital Center. “

 

[AlbinoPolarBear]

“Plaintiff was previously a Chief Resident in an oral surgery program at Brooklyn Hospital Center. “

Interesting. I didn't read the entire thing tbh. I get my info from the grapevine.

 

[Torshammer]

Accidentally posted these in another thread

Days before this patient died during dental procedure, his dentist pleaded no contest to felony charge

A Ponte Vedra dentist who had two patients die and was arrested for felony grand theft has faced no discipline by the Florida Board of Dentistry.

www.firstcoastnews.com

Biological Sciences Alum to Pursue Dental School

Franco Sebastiani plans to become an oral surgeon and perform cleft lip and palate surgeries in third world countries. | Point Park University

www.pointpark.edu

Sad stuff all around

 

[SaltyCFTR]

Hey everyone,

Just wanted to clear things up real quick. I did extensive training in OMFS but didn’t finish the program, so I’m not board-certified and I’m definitely not claiming to be an oral surgeon. The post was originally AI-generated, I corrected it, but I kept the first short draft because my question was just about the business side and I didn’t want to overload it with personal details.

I totally get why people here are protective of the profession — I respect that a lot. It just helps when we have the full context before making assumptions.

For what it’s worth, I only do moderate conscious IV sedation and I’m actually extra careful with it (probably more cautious than a lot of OMFS folks). As an example, there was an OMFS program director in Ohio who ended up losing both his anesthesia permit and dental license because of general anesthesia/deep sedation issues. I don’t have a deep sedation permit and I don’t carry Prop with me.

Public forums make it easy for things to get blown out of proportion when the whole story isn’t there. Thanks for letting me clarify, appreciate it.

How much of the training did you get? I'd say it doesn't matter unless you got the anesthesia training. This all sounds like a good way to kill someone to make some extra money. Moderate sedation is still dangerous. In fact, anesthesia is by far the most dangerous thing an OMFS does. Even with all the training we receive, it needs to be treated with respect.

 

[SaltyCFTR]

I went to a remote anchorate course, which was meant for oral surgeons, and a lot of general dentist were there.

They wanted to learn how to do zygomatic implants, pterygoid implants, transnasals, but some of them have never even done an All-on-X before.

All of them were struggling with dissections. I had one ask me how far the infra orbital nerve was. I've done so many ZMC fracture repair/Lefort I's that this was second nature to me, as with all of my OMFS colleagues. But for someone to not know where things are, how are they supposed to perform things safely in patients?

Of course, you are allowed to do anything you want. But if things go wrong, a specialist will be on the board, and they will be judged on how they would be doing, on a specialist level.

So question is, does OP want to work for a long time? or does he want to make a lot of money at once, and then something goes wrong, gets sued, and lose everything?

It's honestly surprising that remote anchorage is covered for general dentists/perio. I know there are some very capable dentists out their that have learned it well and people like Holtzclaw, BUT these surgical sites aren't even in the dentition/alveolar region. I'm just surprised malpractice insurance covers a general dentist who took a weekend course placing implants that could skewer the globe, maxillary artery, pterygoid plexus and many other structures. There are states that don't even let dentists inject botox outside of the area immediately adjacent to the oral cavity.
How do these people handle complications?

 

[Colastick]

It's honestly surprising that remote anchorage is covered for general dentists/perio. I know there are some very capable dentists out their that have learned it well and people like Holtzclaw, BUT these surgical sites aren't even in the dentition/alveolar region. I'm just surprised malpractice insurance covers a general dentist who took a weekend course placing implants that could skewer the globe, maxillary artery, pterygoid plexus and many other structures. There are states that don't even let dentists inject botox outside of the area immediately adjacent to the oral cavity.
How do these people handle complications?

Most of them dont handle complications. They refer those to you

 

[D1Bound]

Most of them dont handle complications. They refer those to you

They better be paying out the you know what and kissing you know what for a referral like that

 

[TanMan]

It's honestly surprising that remote anchorage is covered for general dentists/perio. I know there are some very capable dentists out their that have learned it well and people like Holtzclaw, BUT these surgical sites aren't even in the dentition/alveolar region. I'm just surprised malpractice insurance covers a general dentist who took a weekend course placing implants that could skewer the globe, maxillary artery, pterygoid plexus and many other structures. There are states that don't even let dentists inject botox outside of the area immediately adjacent to the oral cavity.
How do these people handle complications?

Doesn't make much business sense... Profitability per hour v. potential liabilities seems to be terrible. At least the less risky out of the scope of practice can be covered by a medical director and even then, that makes little sense to do yourself v. hiring cheaper auxiliary staff injectors under a different billing entity.

 

[SaltyCFTR]

Most of them dont handle complications. They refer those to you

That'd be a real quick no from me, unless they also referred me a lot of high quality stuff. What incentive is there to take on the liability of fixing their mistake if they presumably do all their own surgery?