Dentaltown New Grad Edition 2019 - 39
by Dr. Michael D. Silverman, DICOI, FICD
Dr. Michael D. Silverman, DICOI, FICD, president and CEO of DOCS Education, is a globally recognized
lecturer, educator, author and patients' rights advocate. He has appeared in front of 27 dental
boards to advocate for the right of dentists to provide sedation in an environment of safe,
reasonable regulations. A graduate of the University of Pennsylvania School of Dental Medicine,
he is a passionate believer in continuing education. DOCS Education has taught more than 30,000
dental professionals how to implement sedation safely, and in turn, they have restored dental
health to 4.5 million high-anxiety patients. In 2015, Silverman was inducted as a Fellow of the
International College of Dentists for exemplary professional accomplishments and devotion to
improving the practice of dentistry.
The business side
With sedation qualifications, you can
market yourself and your practice to a wider
audience and generate revenue from a wider
range of services, including to patients
needing invasive procedures you might
otherwise refer out to specialists.
The ability to combine oral and IV sedation will make your day more efficient and
allow you to reach and satisfy the needs of
medically complex patients and patients
who do not respond quickly enough, or long
enough, to oral sedatives alone.
For those taking the route of joining an
already established practice, securing one's
sedation certification can make a lot of
sense. Established dentists are more likely to
hire an associate with sedation certification
than one without. In many areas of the
country, sedation certification (especially
moderate sedation, such as IV certification)
is competitive, rare or nonexistent, giving
you greater negotiating power.
The winds of regulatory change
Ever since the revised ADA Guidelines
for the "Use of Sedation and General
Anesthesia by Dentists" came out in October
2016, regulatory changes have been rapid,
with requirements varying from state to state.
According to these guidelines, the administration of "local anesthesia, sedation and
general anesthesia is an integral part of the
practice of dentistry."
Currently, at least 18 states specifically
reference the guidelines in their regulations,
and other states are in the process of reviewing
them in contrast to their current regulations.
While the ADA Guidelines may be considered
the national standard, some states have
adopted even more restrictive regulations,
and many others are poised to follow suit.
More and more states are adopting guidelines
requiring advanced sedation certification,
regardless of route of administration, whether
enteral (oral) or parenteral (intravenous).
Recent changes in Utah exemplify a
nationwide trend: Dentists who provide oral
sedation to their fearful and anxious patients
are losing their ability to do so unless they
obtain an IV sedation permit. Early in 2020,
Utah will eliminate Class II and Class III
sedation permits entirely. The only way for
dentists to continue offering oral sedation
with more than one drug in Utah will be to
complete 60 hours of fresh didactic study
and 20 live cases. No exceptions.
What level is right for you?
There are two levels of continuing sedation education (a third level-deep sedation/
general anesthesia-requires a residency).
Minimal sedation: Requires a 16-hour
minimum training, laying the foundation
for providing safe and comfortable dental
care using nitrous oxide with a single-drug
oral sedative. There are a number of training
options, including those integrating online
instruction, for gaining minimal sedation
certification. However, because this level
is restricted to a maximum recommended
dose (MRD) as printed in FDA-approved
labeling for unmonitored home use, the
chances of success, particularly with medically
complex or analgesic-resistant patients, are
significantly hampered.
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