Vital Times 2017 - 30

ADVOCACY

Safe Pediatric Dental
Anesthesia: Any hope for
California legislation?
By	Karen	Sibert,	MD,	FASA	|	CSA	President

"P

olitically, you cannot legislate what rationally makes
perfect sense."

--Uwe Reinhardt, economist
When you tell any physician anesthesiologist that "sedation"
to the point of coma is given in dentists' and oral surgeons'
offices every day, without a separate anesthesia professional
present to give the medications and monitor the patient, the
response often is disbelief.
"But they can't do that," I've been told more than once.
Yes, they can. Physicians aren't allowed to do a procedure
and provide sedation or general anesthesia at the same time.
But dental practice grew up under a completely different
regulatory and legal structure, with its own board that is
separate from the Medical Board of California. It has its own
antiquated permit system. The Dental Board of California
(DBC) classifies types of sedation by route rather than
depth, and still uses terms such as "oral conscious sedation"
and "parenteral conscious sedation" instead of the standard
terminology of minimal, moderate, or deep sedation
independent of route of administration.
While dentists as a rule don't give deep sedation or general
anesthesia without a qualified anesthesia professional
present, they can give oral "conscious" sedation with nitrous
oxide after taking a weekend course and getting a permit,

30 		|	 	 CSA	Vital	Times

aided only by a dental assistant with a high school diploma.
Deaths have occurred when they "stacked" oral medications
to the point that patients stopped breathing either during or
after their procedures.
Oral surgeons receive a few months of education in
anesthesia during the course of their residency training.
They are legally able to give moderate sedation, deep
sedation or general anesthesia in their offices to patients of
any age, without any other qualified anesthesia professional
present. This is known as the "single operator-anesthetist"
model, which the oral surgeons passionately defend, as it
enables them to bill for anesthesia and sedation as well as
oral surgery services.
While California law states that an oral surgeon must have a
"dental sedation assistant" present during general anesthesia,
that law is routinely ignored. Only a handful of the
thousands of California dental assistants have completed the
110 hours of training required to become dental sedation
assistants. Typically, oral surgeons argue that they are giving
only sedation - as opposed to general anesthesia - if there
is no endotracheal tube in place, regardless of whether the
patient is drowsy, asleep, or unresponsive.

The Death of Caleb Sears
Against this backdrop of minimal regulation and infrequent
office inspections, a healthy six-year-old child named Caleb
Sears presented in 2015 for extraction of an embedded



Table of Contents for the Digital Edition of Vital Times 2017

Vital Times 2017 - Cover1
Vital Times 2017 - Cover2
Vital Times 2017 - 1
Vital Times 2017 - 2
Vital Times 2017 - 3
Vital Times 2017 - 4
Vital Times 2017 - 5
Vital Times 2017 - 6
Vital Times 2017 - 7
Vital Times 2017 - 8
Vital Times 2017 - 9
Vital Times 2017 - 10
Vital Times 2017 - 11
Vital Times 2017 - 12
Vital Times 2017 - 13
Vital Times 2017 - 14
Vital Times 2017 - 15
Vital Times 2017 - 16
Vital Times 2017 - 17
Vital Times 2017 - 18
Vital Times 2017 - 19
Vital Times 2017 - 20
Vital Times 2017 - 21
Vital Times 2017 - 22
Vital Times 2017 - 23
Vital Times 2017 - 24
Vital Times 2017 - 25
Vital Times 2017 - 26
Vital Times 2017 - 27
Vital Times 2017 - 28
Vital Times 2017 - 29
Vital Times 2017 - 30
Vital Times 2017 - 31
Vital Times 2017 - 32
Vital Times 2017 - 33
Vital Times 2017 - 34
Vital Times 2017 - 35
Vital Times 2017 - 36
Vital Times 2017 - 37
Vital Times 2017 - 38
Vital Times 2017 - 39
Vital Times 2017 - 40
Vital Times 2017 - 41
Vital Times 2017 - 42
Vital Times 2017 - 43
Vital Times 2017 - 44
Vital Times 2017 - 45
Vital Times 2017 - 46
Vital Times 2017 - 47
Vital Times 2017 - 48
Vital Times 2017 - 49
Vital Times 2017 - 50
Vital Times 2017 - 51
Vital Times 2017 - 52
Vital Times 2017 - 53
Vital Times 2017 - 54
Vital Times 2017 - 55
Vital Times 2017 - 56
Vital Times 2017 - 57
Vital Times 2017 - 58
Vital Times 2017 - 59
Vital Times 2017 - 60
Vital Times 2017 - 61
Vital Times 2017 - 62
Vital Times 2017 - 63
Vital Times 2017 - 64
Vital Times 2017 - 65
Vital Times 2017 - 66
Vital Times 2017 - 67
Vital Times 2017 - 68
Vital Times 2017 - 69
Vital Times 2017 - 70
Vital Times 2017 - 71
Vital Times 2017 - 72
Vital Times 2017 - 73
Vital Times 2017 - 74
Vital Times 2017 - 75
Vital Times 2017 - 76
Vital Times 2017 - 77
Vital Times 2017 - 78
Vital Times 2017 - 79
Vital Times 2017 - 80
Vital Times 2017 - 81
Vital Times 2017 - 82
Vital Times 2017 - 83
Vital Times 2017 - 84
Vital Times 2017 - 85
Vital Times 2017 - 86
Vital Times 2017 - 87
Vital Times 2017 - 88
Vital Times 2017 - Cover3
Vital Times 2017 - Cover4
https://www.nxtbook.com/allen/csvt/vital-times-2021
https://www.nxtbook.com/allen/csvt/2020
https://www.nxtbook.com/allen/csvt/2019
https://www.nxtbook.com/allen/csvt/2018
https://www.nxtbook.com/allen/csvt/2017
https://www.nxtbook.com/allen/csvt/2016
https://www.nxtbook.com/allen/csvt/2015
https://www.nxtbook.com/allen/csvt/2014
https://www.nxtbookmedia.com