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|  | Dr. Ronald Davies is a USC dentist who is medically trained in Anesthesiology and double Board Certified in his field. He has an unsurpassed 30 year safety record limiting his practice to anesthesia for dentistry. - General Anesthesia Evaluator for the Dental Board
- Past Associate Professor in Anesthesia at LLU, UCLA and USC
- Past President: American Society of Dentist Anesthesiologists, California Society of Dentist Anesthesiologists
- Member: ADA, CDA, OCDS, OCDA, JADE, ASDA, ADSA, CSDA
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Death Under Anesthesia in Newport Beach
|  It has been reported that a patient died in January while receiving dental implants by a general dentist utilizing the services of an MD anesthesiologist whose General Anesthesia Permit was canceled ten years ago.
No findings as to fault have been published but if true the operating dentist may be in trouble regardless, because using an anesthesia provider without an anesthesia permit from the Dental Board (unless the dentist has their own general anesthesia permit) may result in the revocation of their dental license (Business and Professions Code 1646.7a)
Why take this risk? Make sure your anesthesia provider has a valid anesthesia permit AND has been evaluated for equipment and knowledge of medical emergencies. Some dentists mistakenly think that it is safe to use someone without a permit merely because they have hospital privileges. The ability to anesthetize a patient in the hospital for cardiac surgery with extensive support and backup does not translate into the dental office setting. And even if the dentistry goes well, if the patient sues over the dentistry, discovery will reveal that they used an un-permitted provider and their license will be at risk.
To make sure your anesthesia provider has a permit so that you don't lose your dental license, click here: BDE.
If you use an MD, ask the Dental Board if the provider has taken and passed the GA evaluation by e-mailing here: Licensing. I
have been told by a Board member that there are many MD providers that have
refused to take this basic exam and that the Board is in the process of
revoking those permits. Safety is no accident. To see my permit click here: GA Permit.
 
In a related note (to be covered in detail in the next issue) if you give oral sedatives to children or adults you must have an OCS permit from the DBC or risk losing your dental license. Several dentists I've spoken with recently didn't realize this and have put their licenses at risk. To
get a permit, you must take a Board approved course of 25 hours, have required equipment and drugs among
many other mandates. You need one permit for
children and another for adults! CA B&P Code 1647.18.
And please, if you are using oral sedatives, use those that have scientific and approved efficacy and taught in the courses. Don't pick "cocktails" you heard about over lunch at an out of state cosmetic dentisty course. I've heard of some dentists using (in my opinion) an unsound combination of Ativan and Vicodin for sedation. I asked Dr. Malamed for his opinion of this combination and he wrote: "This is the first I've heard of this combination . . . No idea where it originated but it can't be from someone who knows anything, or cares about, sedation and safety." How would you like to hear that on the witness stand against you? There is no reason that oral sedation can't be a safe, effective tool in your practice. Just follow the rules and get a permit.
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Loma Linda Anesthesia Symposium
|  Implanted Vagal Nerve Stimulators for Status Epilepticus was discussed.
"Under the conditions of this study, use of common dental electrical devices did not alter the function of a vagus nerve stimulator.The findings of this study, however, should not be generalized to all types of electrical dental or medical devices, as a recent report indicates that treatment with diathermy devices is contraindicated for patients with implanted nerve stimulators."
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CDSA Meeting: March 10, 2010
|  Check Your AED Today
One interesting presentation had to do with a study in Seattle and King Counties, WA. There was about 1 use of the AED per 1,000 offices per year. Not much, but if your AED isn't working you are in trouble.
I was recently asked to go over some basic emergencies in an office. Shortly into the scenario the AED was called for. I noticed from 15 feet a RED flag where a GREEN should be. Batteries dead? No, the batteries had never been installed. The doctor thought staff had done it, staff thought salesman had done it. It took us 15 minutes to get it working. Check your batteries and check your emergency drugs regularly.
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110 Hour Anesthesia Provider in Effect
|  Lowest Standard of Care Possible?
California has recklessly reduced the standard of care for anesthesia in the dental office by implementing AB2637 B&P Code 1750.5 the "Dental Sedation Assistant". It is now legal for a dental assistant with only 110 hours of in-house training to perform as a de-facto anesthesiologist by drawing up, labeling, injecting general anesthesia drugs and monitoring the patient if the operating dentist has a general anesthesia permit. While this is illegal in most states and in most of the world, it is now legal in California. I think it is important to read section(g): "The duties listed in subdivisions (b) to (e), inclusive, may not be performed in any setting other than a dental office or dental clinic." In other words these assistants are deemed incapable of safely performing these duties in a hospital setting or on your pet. Sort of "what happens in the dental office, stays in the dental office" attitude.
Supported by the CDA, I was told that the reasoning is, astonishingly, that Oral Surgery wanted to give assistants a track for improvement. Thankfully the FAA isn't training Flight Attendants in 110 hours to fly planes "under supervision" although that would be far less dangerous.
Experimenting with lives is universally thought of as the last place to "try out "something new" and yet, that is what OS and CDA have done in implementing this law. Oral surgeons are paid about twice as much by Delta Dental as dental or medical anesthesiologists charge,so this is not a "cost" issue.
Even Veterinary medicine requires 3 years of training for a veterinary technician to perform anesthesia on the family pet under direct supervision. Nurse anesthetists have a minimum of two years anesthesia residency, physicians three years, and dentists two years. Oral Surgeons, according to CODA, as little as four months. Before you send a loved one to an office using one of these assistants, think twice.
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Safe Anesthesia is No Accident
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- NO Set-up, Front Loaded Charges
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- 30 years experience in dental anesthesia with a perfect safety record.
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