On the one year anniversary of Jenny Olenick’s death, Medscape posted, what I refer to as “Anesthesia Media Blitz II”. Since early March, the AAPD and other associations have released various press releases promoting putting children to sleep to perform dental procedures. The Medscape article is the second round. Medscape could have posted a story on the hazards of such practices, but didn’t. I’m not saying it was on purposely, however, I’ve learned seldom are stories published without reason.
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April 6, 2012 — Pediatric dentists cannot find enough dentist anesthesiologists to meet the needs of their patients, according to a survey of pediatric dentists published in the spring 2012 issue of Anesthesia Progress.
The survey responses differed somewhat by region, sex, and years in the specialty, with 20% to 40% of participants saying they currently use a dental anesthesiologist and 60% to 70% saying they would use one if one were available.
The demand for dentist anesthesiologists has been increasing in recent years in pediatric dentistry, according to a separate survey of dental anesthesiology program directors published in the same journal.
"The trend in the past has been that many dentists provided [both] anesthesia and dental care," coauthor James Jones, DDS, chair of pediatric dentistry at Indiana University in Indianapolis, told Medscape Medical News.
Now, many pediatric dentists would prefer to concentrate on the dentistry while someone else focuses on anesthesia, he said. "We're realizing that it's a safety issue."
Dr. Jones said researchers at the university had become aware of the need for anesthesia in their patients because they provide service to a lot of low-income patients who need extensive dental work of the type that often requires general anesthesia.
To see what other pedodontists were experiencing, they sent out emails to all 2586 active board-certified pediatric dentists who are members of the American Academy of Pediatric Dentistry and who made their email addresses available, asking them to participate in an online survey.
The messages bounced back from 659 of these, leaving 1927, of whom 494 completed the survey.
Participants disclosed their sex, age, years in practice, region, number of years as a diplomate of the American Board of Pediatric Dentistry, use of in-office sedation, and use of intravenous (IV) sedation. They also commented on their use of a dentist anesthesiologist.
The respondents differed in their use of anesthesiology by demographics. Thirty-nine percent of women answered "yes" to the question, "Do you use the services of a dentist anesthesiologist?" compared with 23% of men, which is a statistically significant difference (P < .01).
Only 12% of those in practice for longer than 21 years used IV sedation in their office, and only 25% of this group used dentist anesthesiologists (P < .01). Although only 53% of this group answered "yes" to the question, "Would you use the services of a dentist anesthesiologist, if available?" this percentage was not statistically significant compared with dentists who have been in practice for fewer years.
In contrast, 30% of those in practice for 5 years or fewer used in-office IV sedation, 38% used dentist anesthesiologists, and 74% would use dentist anesthesiologists if they could (P < .01).
Group practices were least likely to administer in-office sedation; solo practices were the most likely.
Practices in the Southwest were most likely to use in-office sedation. Westerners were most likely to administer in-office IV, employ dentist anesthesiologists, and use dentist anesthesiologists if they could.
Dental Anesthesiologists Address Many Needs
Dr. Jones said the finding points to a need for more training programs for dentist anesthesiologists. "I think the demand is going to increase over time," he said.
He pointed out that bringing an anesthesiologist into the office is half as expensive as taking the patient to a hospital or day-surgery center for anesthesia.
American Academy of Pediatric Dentistry Spokesman John Liu, DDS, agreed, noting that hospitals and surgery centers charge for the use of their facilities.
Dr. Liu, a clinical assistant professor of dentistry at the University of Washington in Seattle, told Medscape Medical News that pediatric dentists are in greater need of help from dentist anesthesiologists for several reasons.
First, more children are being diagnosed with behavior-related conditions such as autism and attention deficit disorder, he said.
Second, fewer parents are comfortable with having their children physically restrained through frightening and sometimes painful treatments. "The reality is that it's not an easy thing to sit through something like that," Dr. Liu, who has a private practice in Issaquah, Washington, told Medscape Medical News.
Dr. Liu also said that some state dental boards prohibit dentists from providing general anesthesia or deep sedation, even if they have completed residency programs in anesthesiology, and he thinks these regulations should be changed.
"I find it tremendously helpful to have a dental anesthesiologist, as opposed to an MD anesthesiologist, because he knows exactly what I'm doing and when I'm going to be done," said Dr. Liu. "I have used a dental anesthesiologist for more than 20 years, and I don't know how anybody manages without one."
Dr. Liu and Dr. Jones have disclosed no relevant financial relationships.
Anesth Prog. 2012;59:12-17. Full text
