Dental providers have several options available to help manage anxious patients. The least invasive route is providing traditional behavior guidance and a comfortable office environment. For patients who elect pharmacological intervention to relieve anxiety, an oral premedication can be prescribed. This may include the use of benzodiazepines or sedatives. If the dentist has obtained a moderate sedation permit, they are able to provide moderate sedation for their patients. However, if these alternatives do not provide adequate sedation for the patient, the option of general anesthesia in an office based setting may be indicated. Practitioners must always evaluate risk associated with office based deep sedation or general anesthesia. This level of pharmacologic behavioral modification should only be used when the risk of orofacial disease outweighs the benefits of other modalities. The use of deep sedation/general anesthesia may facilitate the provision of oral health care.
So, you have decided you want to utilize the services of an anesthesiologist in your practice. How do you get started? First and foremost, you need to find a licensed anesthesia provider, such as a dental and/or medical provider with valid credentialing. Qualified medical personnel, including dentist anesthesiologists, physician anesthesiologists, oral and maxillofacial surgeons, certified registered nurse anesthetists (CRNA), and/or certified anesthesiologist assistants (CAA), may be considered as appropriate anesthesia providers within an office based setting.
Prior to employing these personnel, state guidelines should be reviewed and considered. Depending on the state, CRNAs or CAAs may require direct supervision of an individual trained and licensed to provide deep sedation/general anesthesia. Things to look for in a provider include current licensure and general anesthesia permits in the specific state of practice. Anesthesia providers are also required to obtain valid certifications in BLS, ACLS, and PALS, as well as sufficient training and experience in managing any medical emergencies that may arise.
Another thing to consider is the provider’s experience with specific patient demographics being treated, whether that be with pediatrics, individuals with intellectual disabilities, or highly anxious patients. For high-risk patient groups, it may be necessary to utilize a licensed anesthesia provider, who is independent from the individual performing or assisting with the dental/surgical procedure. Refer to Table 1 for specific education and training requirements for each anesthesia provider.2,4
Dental anesthesia is a specialty recognized by the American Dental Association. Dentist anesthesiologists are licensed anesthesia providers who undergo 36 months of training via a Commission on Dental Accreditation (CODA) approved residency program. There are currently eight CODA accredited programs within the United States and one in Canada. General dentists and dental specialists alike utilize the services of dentist anesthesiologists. The benefits of utilizing anesthesia providers in your office include improved access to care, decreased administrative procedures, and facility fees compared to a hospital, and use of traditional dental delivery systems with access to a full complement of dental equipment, instruments, and auxiliary personnel.
The use of in-office anesthesia providers offers safe, quality care for dental patients when access to traditional surgical facilities may be limited. Providers who utilize office-based anesthesia must take all necessary measures to ensure patient safety. They should vet their provider thoroughly and foster a good working relationship. Both providers should be familiar with the ASA physical status classification of the patient and risks. It is important to clarify the expectations and responsibilities to ensure the adequate care and safety of the patient.
References
- American Academy of Pediatric Dentistry. Use of anesthesia providers in the administration of office-based deep sedation/ general anesthesia to the Pediatric Dental Patient. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2021:372-6.
- American Academy of Pediatric Dentistry. Policy for selecting anesthesia providers for the delivery of office-based deep sedation/general anesthesia. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2021:169-71.
- Giovannitti, J.A., Jr., Montandon, R.J. and Herlich, A. (2016), The Development of Dental Anesthesiology As a Discipline and Its Role As a Model of Interdisciplinary Collaboration. Journal of Dental Education, 80: 938-947.
- Weaver, J.M. Accreditation of Dentist Anesthesiologist Residencies is Approved by CODA. Anesth Prog 1 June 2007; 54 (2): 43–44.
- Commission on Dental Accreditation. Accreditation Standards For Advanced Dental Education Programs in Dental Anesthesiology. Chicago, Ill.: Commission on Dental Accreditation. 31 January 2020. www.ada.org/coda.
