Write Your Own Letter of Protest
We want the ADA and our State Dental Boards to know that a large number of dentists strongly oppose the proposed guidelines.
Rather than mailing your letters of protest directly to the ADA and State Dental Boards, mail them to us. There is power in numbers. We hope to present the ADA with 1,000s of letters from respected dentists, such as you.
Use your own words. But make it clear that you view the ADA proposals as overkill and that existing ADA and State guidelines are sufficient to protect public safety. Tell the ADA how your patients will suffer if these changes go into effect. And let the ADA know that many people will simply stop going to see the dentist.
Deadline is January 31, 2007!
Please address your letters to the ADA Committee on Anesthesiology. Include:
Your name and professional credentials
Your full mailing address
Your business phone number
Your email address
Letters Must Be Addressed as follows:
TEAM 1500
P.O. Box 3714
This action by the anesthesia committee has been building for years. In 1998 the chairman of the Me. Anesthesia Commnittee sent a letter to the Maine Board of examiners proposing a tutorship by an oral surgeon for all dentists seeking parenteral and enteral sedation certification. I have a copy of the letter (I think). This current action is a culmination of their efforts.
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To Whom it may concern:
I have been a member of organized dentistry (ADA) since my first year out of dental school! This is because I believed in its leadership and purpose. I am sure many will agree how hard it is for a new graduate with what I would hardly call a job at that time, student loans, to be convinced to pay the ADA dues. I even had my first child when I graduated from dental school and could have used the dues money to just buy "diapers". Yet I remained with ADA until now when I have begun to question its purpose. Is it more "politically" motivated? Is ADA representing its members or pleasing a few selfish individual?
The recent ADA proposal for making oral sedation is based on what? Has any input been sought from its practicing members? Is it not important and rational to base decision on risk vs benefit?
There is risk to every procedure we do. There is probably more adverse incidence to administration of local anesthesia on record than use of oral sedation. Where is the rational for the proposal. If this proposal passes, ADA and I part relationship as I believe my dues is being abused.
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Sedation Dentistry is a method that specially licensed general dentists use to treat patients who are too frightened to have even the simplest dental procedure done. The patients are tranquillized so that the paralyzing affects of worry and fear are quieted.
With this procedure the patients are not asleep, nor in a deep state of general anesthesia, but in a pleasant, tranquil state of deep, relaxed consciousness. The medications used to accomplish this are no more dangerous than prescription sleeping pills that are used, without physician supervision, by millions of people every night all over the world.
Over the past ten years general dentists have used this procedure millions of times worldwide without relevant instances of harm. Yet, despite this stellar record, The American Dental Association (ADA) recently put together a panel of dentists, most of whom do not use oral conscious sedation, and this panel wants to make new licensing requirements so stringent that general dentists will find it too burdensome to achieve.
Without Sedation Dentistry people who are too afraid to go to a dentist will put off treatment until the condition becomes unbearable and sometimes life threatening. Because of the record, those in opposition to general dentists using Sedation Dentistry do not have a leg to stand on.
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Regarding the proposed changes to Conscious sedation requirements January 16, 2007: In the last 5-10 years programs have evolved that are designed to teach general practitioners to provide light oral sedation where the patient is able to maintain their own airway with drugs that our medical colleagues have prescribed for unsupervised home use. Now instead of a patient getting a bottle of 20-30 pills to take at home, we are trained to provide them in the office with professional monitoring with blood pressure and a pulse oximeter. The record speaks for itself. The systems taught by organizations such as Dentist for oral conscious sedation have been performed tens of thousands of times with an extreme level of safety and enabled tens of thousands of patients to receive the care they want and need. I will have to seriously reconsider my 23 year membership in the ADA, and any referrals to oral surgeons and periodontists if this change in the standards of education required for OCS is passed. Thank you, David Slater, DDS
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The ADA has embraced a number of concepts over the years. One of these is "Evidence Based Dentistry" and another involves "Access To Care". It seems their anesthesia committee did not take either of these concepts into account when they proposed new guidelines for the use of sedation in dentistry.
Two issues, one in the area of monitoring and the other in the educational/teaching recommendations, fly in the face of these pronciples.
The proposed educational guidelines increase the number of hours of training to 60 with a 1:1 instructor/student ratio. The change is based on what evidence? DOCS members have documented thousands of cases with no known mortality or morbidity. The evidence would argue against more restrictive changes. Fewer dentists training would markedly lower access to the fearful patients out there for common dental procedures.
The second requirement, that dentists stay in the treatment room continuously until the patient recovers is clinically unnecessary for minimal/moderate sedation. In fact, if minimal sedation enteral meds should not exceed the dosages safely taken by an unsupervised patient at home, where could the evidence exist to warrant the recommendation proposed? The anesthesia committee says it focuses on the level of sedation, not the route of administration. It should be simplifying the safe administration of enteral sedation, not complicating it by simplifying how its guidelines are written.
State Boards, such as ours in Maine, should eliminate language in their rules referring directly to the ADA's guidelines. This is a good example of how a convenient abdication of responsibility can backfire when the body referred to changes the rules. Boards have a responsibility to the public to provide access to safe and appropriate care. Following the proposed guidelines will certainly reduce access and do so without any evidence that curent guidelines propose a danger to the public.
I urge the ADA's anesthesia committee to look at the evidence outside the close circle of advisors perhapes dominated by specialtry interests and look at the front lines of general dentists who have been providing safe effective oral conscious sedations for years. I also encourage state boards to accept input from the same front lines and not be swayed by those who may have credentials that seem impressive but have no real experience in OCS other than extrapolation from what they believe is best but not based on evidence.
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An extraordinary letter, I will be paraphrasing this letter to my NH ADA rreps.
Quite frankly, this reminds me of the fiasco in the 1980’s when the ADA did not have the gumption to critically think about the sterilization of handpieces. It took a 60 Minutes segment to totally embarrass Chicago into the appropriate change of policy. Its time the ADA walked the talk in terms of Access to Care and Evidence Based Dentistry and not be manipulated by those intent on protecting their turf. Look at the evidence; it is overwhelming in terms of number of patients treated and the hours of safe treatment provided.
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our goal is to provide safe ,effective and affordable services to our patients.Ada does not have any substantial evidence for need for extended proposed training.Moer than thousand dentists have helped more than million patients to save more than billion teeth.Just for political interest of certain group , we can not limit services to well deserving anxious patients with extra high fees to make it difficult. ADA is failing to support the right kind of dedicated, caring dentists who also support right goals of Ada
Dr.Manilal Patel
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I have treated numerous OCS patients over the last two years without incident, with truly great dental success and without this burdensome, stifling regulation. My patients are safe with the training guidelines I have received. The ADA is truly creating the type of political climate here that our profession has so successfully dodged governmentally over the last 25 years. Let us practice safely and freely for our patient's sake.
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It is amazing that a group of professionals cannot stay focused enough to provide access to dental care to the growing phobic population. The new proposed ADA regulations will make it all but impossible for general dentist to provide care to this dental group. It would seem reasonable that the group making the regulations provide this type of sedation and provide the general dental services that would be regulated. This should not be a turf war but public access to general dental care.
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please do not change the OCS guidelines .
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A large part of the population does not receive dental care due to fear. Incremental conscious sedation allows many of them to recieve treatment. If you do these changes, you might as well place TV ads saying " Afraid to go to the dentist? Too Bad!
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I am disappointed that the ADA would propose this requirements that appear to have no evidence in the basis and heighten the barriers that many patients experience as obstacles to receiving dental care.
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I work in a very busy four doctor practice. We see several OCS patients per day, and in my two years of practice have had exactly zero adverse events. More importantly, the other doctors who have practiced OCS for DECADES have had zero problems. A significant portion of our patient base comes to our office (often from long distances)solely because we provide OCS, and dentists in their town do not. Where do you think they'll go if OCS is not an option anymore? Nowhere. Is that the aim of the ADA? To hinder dentists in their ability to care for patients? To alienate patients with anxiety and/or extensive needs? If so, I do not want to be a part of the ADA anymore. Our membership dues are what provide these idiots with the ability to sit around making up problems for which to find solutions . If we all stop paying dues, they'll have to go back to their day jobs.... Seeing patients. I bet then they'll want to be able to use OCS themselves. There is absolutely no reason general dentists can not be trained sufficiently to administer OCS. Think about all the specialties in medicine. How long do you think it's been since your dermatologist, radiologist, or allergy specailist has dealt with a true medical emergency by his self? I bet no one would debate if they wanted to use OCS for some reason, though.
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I think it is completely uncalled for that the ADA would again step in and do southing that doesn't represent the majority of dentist in the profession. They are never interested in the dental profession. They are mainly interested in lining their pockets. the sedation issue is just another example of how they ADA isn't interested in the dentist or the people they serve. They are only interested in acting as a god that will shower his people with their will. There is no way this legislation should pass. It is completely ridiculous that it has even come before the ADA. the millions of cases that are preformed by the dental population and not a single fatality. That has to say something. Leave it alone. I treat 3-4 people a week with oral sedation because they will not seek treatment any other way. To them it is wonderful. its life changing and to think that I need to have additional training to administer a pill? you have got to be kidding me. Get real ADA wake up to modern dentistry and Stop being stuck in the dark ages!! You are always a blister on the side of the dental practitioner never an asses when it comes to the advancement of the general dentist.
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This is who I am:
Member of the ADA continuously since 1984, the year I graduated from the Medical College of Virginia. Delegate of the NJDA. Trustee of the Monmouth-Ocean County Dental Society. Fellow Academy of General Dentistry. Fellow Dental Organization of Conscious Sedation. Member of the American Dental Society of Anesthesia. Member NJ Dental Society of Anesthesia. Permitted to administer enteral conscious sedation in the state of NJ. I have safely administered oral conscious sedation over 2000 times to over 1000 terrified Americans to allow general dentistry to be performed.
I am disappointed that the ADA would propose onerous requirements that appear to have no evidence in their basis and heighten the barriers that many patients experience as obstacles to receiving dental care.
The ADA is risking its organizational health by alienating a large segment of its membership. These members may choose not be part of an organization that no longer listens to them. The ADA could become the AMA of today, becoming ineffective with rapidly declining membership.
I have received written, audio and video testimonials from many of the patients that I have helped. I was able to restore their mouths from disaster to health. None of this dentistry would have been possible for them without oral conscious sedation. Don’t take it away from them. Mitchel L Friedman DDS FAGD FDOCS
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I am a Periodontist in Phoenix Arizona. I graduated from Indiana university in 1981 and completed my Periodontal residency from USC in 1985.
The proposed ADA regulations regarding sedation dentistry are onerous on the practitioner and crteate undue barriers to patients receiving the care they need.
It is time for this Concil to reconsider its recommendations. I have contacted my Trustee regarding this and encouraged him to vote agaist these recommendations as they currently stand.
Orest G Komarnyckyj DDS
1277 E Missouri 208
Phienix Az 85014
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My name is Dr. Vivian DeLuca, DMD. I graduated from University of Florida College of Dentistry in 2001 then spent three years working for the United States Navy Dental Corp. I have been practicing Comprehensive General Dentistry in Tampa Florida for the past two and a half years. I took the DOCS course on Anoxiolysis shortly after my arrival because of the shocking state of oral health of the patients who presented in my new practice. On average my new patients last saw a dentist 5-20 years ago. . . and are scared to death. They have only now presented for emergency dental care because the pain of infection has finally exceed they’re fear of dental work or their spouse has threatened divorce if they do not eliminate the fowl stench emanating from their mouths. We see on average three to five sedation patients per week. They frequently see the hygienist, then the dentist for comprehensive treatment. All of these patients have refused dental care over the years because something like sedation was not available. These people are transformed from an infected diabetic mess to drastically improved and significantly healthier, diabetic stable individuals. If the ADA continues to pursue such restrictions on "general" dentists, then I will have no choice but to renounce my membership to it and all associated organizations. I will oblige myself to what my State licensing board deems appropriate regarding the use of oral conscious sedation. The ADA (misguided by profit oriented/ not patient oriented specialists) can vehemently state their opinion regarding this matter but do not have jurisdiction over individual state laws. I am helping people immensely through safe oral sedation who have "neglected" their dental care out of tremendous fear for years. Now, they are getting the help they need and deserve. I am very grateful to D.O.C.S. and its founding members for bringing their level of education to dental professionals so that we may help so many "helpless" people. Through oral conscious sedation, General Dentists can treat multiple dental needs in their practices in a single sitting, unlike the majority of specialists who can only offer to extract teeth under sedation instead of saving them. I feel that the ADA's proposed OCS guidelines further restrict patient’s access to care in a state that is already deficient in its ability to provide needed dental care to its constituents. I am not aware of any reports of abuse of OCS. Adult OCS utilizing triazolam, even in stacked doses, is one of the safest forms of light sedation. I have personally used OCS to sedate nearly 625 patients in the past 2.5 years and have not once had a single problem. It is time the ADA walked the talk in terms of Access to Care and Evidence Based Dentistry and not be manipulated by those intent on protecting their turf. Look at the evidence; it is overwhelming in terms of number of patients treated and the hours of safe treatment provided.
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Who I am:
Graduate of Tufts 1975
Practicing Dentistry for 31 years
Member of the ADA since 1975
Member of the AACD,FAGD,AAID
While the professed main concern of our profession is access to care, the ADA feels compelled to make new restrictions that will do just the opposite.The record of successful enteral conscious sedation (on patients who otherwise might not access care at all) through the techniques and protocols taught and tested by DOCS proves the safety standards are already established.Do politics and control issues win even when proven clinical results and safe scientific protocols are well proven?Having used OCS techniques for many years, I have tried to stay ahead of the curve with safety and credentialing issues (Med tech,ACLS,DOCS Training,In-Office emergency drills etc) and I am certainly willing to do whatever is necessary to take more courses in order to provide safe care.But - where are the facts documenting the reasons for the ADA to force further credentialing, possibly limit access to care or increase the cost of care?
Daniel J. Armstrong DMD,FAGD,AACD,AAID
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I have been a full time practicing dentist with post graduate hospital training for over 30 years. My area of special interest is dental implants and am Certified by the American Board of Oral Implantology/Implant Dentistry. Oral presedation is a valuable and incredibally safe manner inwhich to practice. I see no reason to add substantial training to utilize this modality.
I am very strongly against any attempt to limit my ability to practice in the manner inwhich I have been accustomed to for many years.
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I hope it't not too late to file my protest to the proposed ADA sedation guidelines. We are at a crossroads in the delivery of dental care in this country in my opinion due largely to the advancement of oral sedation dentistry as a safe solution for millions of dental patients who had been basicly forgotten. I feel a great deal of pride to be associated with this new generation of caring and compassionate dentists who have decided to reach out to these dental patients with the information that times have changed, and going to the dentist will never be the same again. It is beyond me to understand how our dear ADA could consider anything that might limit comfortable delivery of dental care to those fearful millions of deserving patients. Please add my name to the growing list of doctors in opposition to the proposed changes to our oral sedation guidelines. Sincerely, Randall L. Sandlin, DMD (soon to be a 30 year member of the ADA) 1318 Stratford Rd SE, Decatur, AL 35601 256-355-0259
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Dr. Sandlin: Your letter will get to the right folks at the ADA. Thanks for submitting it. Although the deadline for our "first wave" of letters is close of business today, 2/16, we will continue to solicit and collect letters for a second wave later. So please encourage your patients and your dental colleagues to write us. Thanks, DEAN
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Dentist have been prescribing oral sedatives and administering Nitrous oxide safely for many, many years. Sadly, a few specialists and a couple of general dentist have not followed guidelines thus causing the death of some patients. Changing the guidelines will not prevent those specialist from not following the new rules nor will it prevent other dentist who aren't following the present guidelines from ignoring the new ones. This proposal is simply an effort to limit what patients can be seen by general dentists in order to fatten up the pockets of specialists who limited their patient pool by specializing and are now trying to limit my patient pool. The end result will be limiting access to care for countless patients.
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I can not begin to elaborate on my disappoval to increase the requirements needed for oral sedation. I am a UCLA graduate from 1993 and in dental school, oral sedation was recommended for phobic patients. We were given strick guidelines and it enabled us to treat many patients who would otherwise aviod treatment. I know I am not alone when I say that the ADA's proposals are going to hurt a lot of nervous, anxious and phobic patients who do not have the financial means to pay for an anesthesiologist. This in turn will result in an increse in decay, infections, loss of dentition at an early age and probably an increase in the number of children innoculated by caries and perio causing bacteria. Various studies support the innoculation of children by their parents/caregivers. The ADA's campaign to improve the public's oral health will be negated by the ADA's oral sedation proposal. If we can make it affordable for the caries infected adults to obtain treatment then and only then can we successfully combat the disease in their offspring. I truly hope the ADA will reconsider their stance and support the general dentists who have obtained additional training in order to continue to utilize oral sedation in their practices.
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At the least currentl dentist using Valium and N20 should be grandfathered in their use. There must be sufficient research to limit its use before such action is taken.
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While I strongly approve of proper training for practitioners offering sedation options, I believe the restrictions currently being considered are too harsh given the historical safety record of the profession. I have been offering I.V. sedation to my patients for 23 years with zero incidents. I am well trained and use proper technique and protocol. Undergraduate dental training, however, should be sufficient for dentists to provide nitrous oxide sedation and oral sedation.
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I disagree with ADA new proposal for more requirement for oral sedation and nitrous oxide use. If this passes, this would further hurt our anxious patients who are in disparate need for the oral sedation and nitrous oxide usage. I strongly believ that general dentist are eligible with their license and current requirement to do oral sedation and use Nitrous oxide in their dental practice. I hope policymakers come to more understanding that health of the public should be the number one priority. I also hope that we the help of dental professionals and the public we all come to more understanding that our goal should be to make oral health a service for most people. Today, general practitioners are helping the public at much more lower fee than specialist. Many people are not capable of going to a specialist to have their simple extraction done. If an anxious patient with pain who can not afford to go to a specialist for a simple extraction and oral sedation, his pain and suffering would cause him/her to take time off from his work, this would put a burden on his/her family, and most importantly compromise his/her overall health. This is not fair to our patients. I hope that policymakers do not allow this happen for the sake of our patients and the overall health of the public. Thank you!
Regards,
Faye Farhangi, DDS
Proud ADA Member
Torrance, California
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Back to barber Dentist. If this flys I sugest we drop DDS and make dentistry a high school elective. Get license at the DMV. I also sugest we stop using local anesthetic to increase the margin of safty for the trade of dentistry. Our own worst enemy turns out to specialist as usual.
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These proposed restrictions are outreagous and a barrier to many people seeking dental treatment.
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I must say I am not opposed to a higher requirement for education for OCS, but in raising the requirements, was there any curriculum proposed? Just what exactly would the additional education teach us, and how is it relevant? If we are missing something, I personally look forward to the enlightenment, but if the additional training was an arbitrary amount, then I object.
The simple clause that would make OCS a problem for me is the requirement that I personally monitor the patient. I am a solo practitioner, required to be efficient with the offering of my time, and the increased fee required for me to sit with a patient for an hour or so induction time would put the cost of OCS outside the realm for at least some. These are the ones that would suffer.
As a further observation, I have been shocked to learn how many State Boards simply march in lock-step with the ADA on clinical matters such as this. While I certainly realize that State Boards may not have the resources of the ADA, to abdicate their own regulatory power makes the various Boards seem less valuable in protecting and serving the public in their State.
To me, this is a defining action on the part of the ADA. And perhaps this brings me personally to a point at which I would have to truly question the purpose of the organization and my tiny role within it.
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