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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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Still Some Confusion on Oral Sedation Permits
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I attended Dr. Malamed's lecture at the OCDS last month. To his great surprise and mine, there were still dentists in the room administering oral conscious sedation to patients without a permit because of ignorance of the law. I have outlined permit requirements on my website.
Oral sedation can be an effective way to relax your patient. Under current law, non-permitted dentists are allowed to administer (to adults) up to the maximum recommended dose (MRD) of any single sedative as would be prescribed to a patient at home. Nitrous oxide/oxygen can be added to this one drug technique without a permit. However, a permit is needed for any oral sedation on children less than 13 years old and adults where multiple drugs are given.
Those who administer oral sedation in excess of the MRD (or drug combinations) to patients 13 and older must take a 25 hour course in oral sedation, comply with equipment and facilities standards, follow extensive monitoring standards and paperwork procedures. They must also have a permit from the DBC. Dentists are exempt from both the course and permit if they have a GA or Conscious Sedation (IV) permit.
Dentists are exempt from the course but not the permit if they complete a periodontal or general residency, or other advanced education in a general dentistry program, but the applicant must have his or her educational institution complete the Certification of Oral Conscious Sedation Training(OCS-2) form.
Regardless of how you employ oral sedation in your practice, remember to use medications that have scientific and approved efficacy and taught in the Board approved courses. Don't invent "cocktails" on your own such as lorazepam (Ativan) with oxycodone (Vicodin), currently a combination "making the rounds". Dentists without a permit doing this risk losing their dental license. I asked Dr. Malamed about this combination and he said: "This is the first I've heard of this combination . . . I have no idea where it originated but it can't be from someone who knows anything, or cares about, sedation and safety." Not something you would like to hear from the witness stand against you.
I spoke with TDIC Risk Management and there are serious dangers in ignoring the law. Even if oral sedation is properly performed and safely administered without a permit, a lawsuit unrelated to the sedation but involving dissatisfaction with the dentistry could be catastrophic. A good attorney would seize upon the fact that the dentist practices "outside the law" by ignoring the permit process and may convince the jury that he/she "ignores the rules" and is "reckless". It would unfavorably affect a malpractice defense.
It has been said that properly sedated and monitored patients are less likely to have a medical emergency and statistics bears this out. An awake and terrified patient with an already accelerated heart rate, who is then administered epinehprine, is a prime candidate for a medical emergency. Properly administered and monitored oral sedation may decrease adverse reactions and increase both patient and dentist's comfort and safety.
Risk management is a crucial part of a successful practice. I am proud of the fact that I have a perfect safety record spanning 30 years and I have never had a lawsuit, or even a complaint filed against me. My patient's comfort and safety are my primary concerns and I operate without taking shortcuts. 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 if necessary.
Next month: "Can oral sedation be rapidly and safely reversed in an emergency without an IV line, or it that potentially fatal wishful thinking?"
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Dentists Exempt From Red Flag Rule
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CDA has announced that dentists will be exempt from the Federal Trade Commission's Red Flags Rule that goes into effect Jan. 1, 2011.
President Obama signed into law the Red Flag Program Clarification Act of 2010, which clarifies and narrows the definition of a "creditor" and thereby excludes dentists and other small businesses. Under the Red Flags law, creditors and financial institutions must implement written identity theft detection and monitoring programs, designed to help business and organizations detect and respond to patterns, practices or specific activities that could indicate identity theft.
The ADA has estimated the nationwide savings in implementation and compliance costs associated with this exemption to be $72 million for dental offices alone. |
Drug Interactions Phone Apps
|  Droid
iPhone
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| NEW BLS and ACLS Guidelines |  Article Subheading
The new BLS Guidelines
The new ACLS Guidlenes (3mb PDF)
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Advertising of Legitimate Credentials
|  "The U.S. District Court for the Eastern District of California ruled Thursday that the State of California and its dental board are prohibited from enforcing a provision in California law against allowing general dentists to advertise their legitimate credentials. The "Potts" lawsuit was filed and litigated by the American Academy of Implant Dentistry (AAID). The AGD thanks the AAID for its efforts and success, and is pleased to have had the opportunity to file a separate "friend of the court" brief in support of the proposition that general dentists should be allowed to advertise their Fellowship and Mastership awards. The Court further declared that the statute was unconstitutional, both on its face as well as in application. This ruling is good news not only for AAID members, but for AGD members as well. While this ruling currently applies only to California, there is an adage which states that many trends start in California and move eastward. For more information about this litigation and its implications, contact the AGD at advocacy@agd.org" |
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Safe Anesthesia is No Accident
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- NO Set-up, Front Loaded Charges
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The information contained herein is provided for informational purposes only and does not constitute dental or medical advice. Dr. Davies shall not be responsible for any claims, damages, demands or liabilities of any kind arising from or related to the use of this information.
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