With a reported 85 million people living in the United States who are afraid to visit the dentist, oral conscious sedation (OCS) has provided a viable option-often the only one-for receiving proper oral health care, according to the January issue of AGD Impact, the newsmagazine for the Academy of General Academy (AGD).
OCS-also called enteral sedation-is a hot-button topic in dentistry. Many general dentists believe that it is a useful technique when treating patients, especially those that have anxiety in the dental office.
"This issue is huge. When patients become dentally handicapped or disabled their entire health is effected," says Mike Edwards, DMD, Chair of the AGD's OCS Taskforce on Sedation. "It is well established that patients who have chronic dental infection suffer from lack of proper care, which causes a decline in their general health."
Many general dentists believe that oral surgeons don't want them to administer sedation, either orally or intravenously. Oral surgeons contend that safety is their primary concern and support the general dentists' right to administer sedation, but only by those who have received permits.
"It's a hot topic because some dentists feel like they can do this without training," says Richard Tennenbaum, DMD, chair of the American Association of Oral and Maxillofacial Surgeon's (AAOMS) Committee on Anesthesia.
In some states, an intravenous sedation permit is required to perform OCS; in others, it's a combination of education and patient experiences. Some states have no requirements. The American Dental Association (ADA) created two documents in the 1970s, Guidelines for Teaching the Comprehensive Control of Anxiety and Pain in Dentistry (Guidelines for Teaching) and Guidelines for Use of Conscious Sedation, Deep Sedation and General Anesthesia in Dentistry (Guidelines for Dentists). Many state dental boards use them to develop individual regulations and requirements.
"At one time, any dentist could administer general anesthesia, but safety issues prompted the ADA (indirectly through the Guidelines) and state dental boards (directly by law) to limit general anesthesia to those dentists with specific training," says Joel Weaver, DDS, PhD, dentist anesthesiologist at Ohio State University and ADA media spokesperson for dental anesthesia.
The Dental Organization for Conscious Sedation (DOCS) says it is working to promote consistent requirements (18 hours of instruction and 20 clinically-oriented experiences for general dentists who wish to provide conscious sedation in their practices) in order for general dentists to administer OCS. The DOCS organization believes that if general practitioners do not speak up for themselves on this issue, they could ultimately lose the right to perform OCS.
"General dentists are responsible for more progress in dentistry than anyone else," says Manuel Cordero, DDS, MAGD and AGD spokesperson. "How can you keep the people who are out on the forefront out of educating themselves? I worry about the repercussions to the public."
For additional information on OCS, please visit the AGD's Web site, www.agd.org.
The AGD is a non-profit organization of more than 37,000 general dentists dedicated to staying up-to-date in the profession through continuing education. A general dentist is the primary care provider for patients of all ages and is responsible for the diagnosis, treatment, management and overall coordination of services related to a patient's oral health.
