WSS Moderate Sedation Position Statement

In October, 2016, the ADA house of delegates adopted new Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students. Western Surgical and Sedation believes that the new “individually managed” and participant-faculty recommendations for moderate sedation are unnecessary and potentially harmful.

An article “reviewed more than 20 studies with adequate data focusing on death associated with dental procedures since 1955 and found 218 deaths out of 71,435,282 patients.  Although rare, death following general anesthesia in dentistry, is a critical side effect mostly seen in patients with compromised health condition. Therefore, appropriate case selection in regard with patients’ general health status as well as standard technical and equipment conditions are mandatory to diminish the risk of death during dental anesthesia”. (J Clin Diagn Res. 2017 Jun; 11(6): ZE07–ZE09)

Another study conducted at the request of the Dental Board of California “…reviewed mortality data from the Dental Board, lawsuits from a major California malpractice insurance company, anesthesia regulations from other states, and the published scientific literature. In California between 1991 and 2000, there were 12 deaths related to general anesthesia permits, 0 deaths related to conscious sedation permits, and 8 deaths related to non-permit holders (four deaths with oral sedation in children and four deaths with local anesthesia alone)”. (J West Soc Periodontol Periodontal Abstr. 2005; 53(2):37-9)

The results of these studies suggest:

  1. General anesthesia results in more deaths than moderate sedation.
  2. Medically compromised patients are at greater risk than healthy patients.
  3. Dentists with moderate sedation permits (California or equivalent) can provide safe sedation.
  4. Moderate sedation should be limited to healthy, adult patients.

The ADA “individually managed” and participant-faculty recommendations are unnecessary and burdensome for two reasons.

  1. The number of patients needed for individual management is increased by a factor of 4.
  2. The recommended participant-faculty ratio of four individually managed patients supervised by one faculty member decreases patient safety and participant learning.
    • One instructor cannot possibly supervise and properly teach 4 locations simultaneously.
    • The previous ADA guideline of 4 participants, 1 patient, and 1 faculty member insures patient safety and a quality teaching environment.