In 2005, the American Dental Association House of Delegates approved an official ADA position on the use of conscious sedation, deep sedation and general anesthesia.

Meeting at the Pennsylvania Convention Center in Philadelphia, ADA delegates made it the official policy of the dental association to note that:

• “Use of a wide variety of anxiety and pain control techniques has enabled the profession to extend oral health care to millions of individuals who would otherwise remain untreated.”

• “Without effective anxiety and pain control, numerous dental procedures are virtually impossible and many patients do not seek needed dental treatment.”

ADA delegates went on to speak, with pride, about the “remarkable record of safety” that has been achieved by appropriately trained dentists.  Indeed, the official voting body of the ADA adopted this unambiguous policy statement:  “The use of conscious sedation, deep sedation and general anesthesia in dentistry is safe and effective when properly administered by trained dentists.”

What has ensued since October 2005 to change the ADA’s mind, such that it is  now proposing radical revisions to its guidelines for the use of conscious sedation?

Was the ADA mistaken in Philadelphia when it praised the “remarkable record of safety” for dentists who comply with its educational and procedural guidelines?   After all, it is those very same guidelines that the ADA said were providing needed care for millions of patients in 2005 that the ADA in 2007 says must be completely overhauled.

Why?

Back in the summer of 2005 – just a few months before the ADA adopted its official policy statement, Dr. Joel Weaver, the spokesman on anesthesia for the ADA, wrote that he worried that dentists administering oral sedation might not be able to effectively reverse the sedative effects of triazolam-like oral sedative drugs in an emergency.

“There is no published scientific evidence that [flumanzenil] is effective when given by any route other than by intravenous injection,” Dr. Weaver noted.  “Even then, there is no data to suggest that it would work fast enough, even if it did eventually work, to rescue a patient from hypoxic brain injury.”

Is that what happened?  Has there been an outbreak of hypoxic brain injuries among the hundreds of thousands of adult patients who were subsequently treated with oral conscious sedation under existing ADA guidelines and in keeping with the ADA’s stated policy?

Has the “remarkable record of safety” which the ADA delegates touted in October 2005 and which it credited with helping save the oral health of millions of patients been tarnished by Dr. Weaver’s hypoxic brain injuries?

Quite the contrary.

There is extraordinarily strong clinical evidence that oral conscious sedation as practiced by dedicated dentists in accordance with existing ADA guidelines is as safe and effective as the ADA promised it was in October 2005.  (Safer, perhaps, given the vast growth in live-patient experiences among the steadily increasing number of practicing dentists who provide oral conscious sedation.) 

What has changed at the ADA is the influence of a small group of oral surgeons, dental anesthesiologists and other specially trained dentists who have highjacked the ADA’s policymaking apparatus in service of their own selfish ends.

These members of the ADA’s Committee on Anesthesia (Committee H) and Council and Dental Education and Licensure (CDEL) are looking to bury the 2005 findings of the ADA’s own broad governing body in order to enhance the profits, influence and egos of a select few.

It is too bad, as such self-dealing harms the ADA, the dental profession and most especially the millions of dental patients who benefit from the safe, effective application of oral conscious sedation under existing ADA guidelines.

Ultimately, delegates to the ADA’s 2007 convention, to be held in San Francisco in September, may once again be asked to set policy on conscious sedation.  If these misguided proposals survive until then, we’re confident the delegates will once again affirm their commitment to access to care and demand that the ADA’s Committee H and CDEL explain what has transpired in two years to warrant such an upheaval.

How can CDEL respond? 

“We thought it was remarkably safe then, but we were wrong.  So trust us now and we will make it remarkably safe for the future?” 

And by the way, CDEL will have to add, “we’re doing this all based on instinct, since there really is no clinical evidence whatsoever of morbidity, mortality or Dr. Weaver’s brain damage (other than among those who are promoting these totally unmerited changes with a straight face).”  

-- DEAN ROTBART