This proposal would deny patients health care -- not just dental care.

George A Bare, Jr., DMD: Indiana

Shame on you! An organization that is believed to be a public watchdog or benchmark for excellence should be better at determining what is in the best interest of patients that would otherwise never seek professional health care. Yes! Health care! Notice I didn’t mention dental care. With all the latest advances in the early detection of oral cancer, periodontal health and its known relationship with many system diseases and other problems, the ADA wants to trash one of the best things ever done to promote overall health for thousands of patients across the nation!

This proposal will cause dentists to leave the ADA

Carolyn Kupka, DDS: Colorado

Please do not bar me from taking the best possible care of my patients. I cannot respect any organization which does not place the patient’s health foremost, and secondly, to trust the dentist’s professionalism to take the utmost care and safety in dentistry. I would find it very difficult to continue my 30-year commitment to the ADA if you cannot trust my ethics for patient care.

Peter J. Silver, DDS:  New York

If we cannot treat the most fearful of the population, your new guidelines will help push Dentistry backwards, rather than forwards. I love dentistry and enjoy working with my patients. I intend to keep practicing for a long time. I would like to remain a member of the ADA during that period. If you take away the opportunity to work with the most fearful patients, I cannot continue to support this organization.

Kirk Johnson, DDS: Alaska

I read last week in the ADA Journal an article written about membership in the ADA, and how the society is hoping to increase membership. One way to keep valuable members and not lose them in droves is to leave us lowly working doctors alone. Let us be the doctors we are, free to use our skills for the benefit of our patients.

Ward F. Gravel, DDS: New Hampshire

With this issue, I am seeing that the ADA does not truly represent me. If this regulation passes, this will be my last year in the ADA. One can only stand so much effrontery.

Oral conscious sedation belongs with general practitioners

Thomas E. Jenkins, DMD, MCCS, FDOCS, FAGD, FADI:  Delaware

Editor Delaware AGD Newsletter

Attending Faculty, Christiana Medical Center GPR Program

Attending Dentist Anesthetist, Stockley Hospital for Special Care Patients

President Elect, Delaware Academy of General Dentistry

By blocking the ability of a properly trained general dentist to perform sedation, the oral surgeons are attacking the problem incorrectly. The cure to their economic problem is to offer dental care to the [millions of] American patients who do not see a dentist at all due to extreme fear. The oral surgeons cannot open this market. Only general dentists trained in sedation can provide care to this suffering group of patients. The heat is on to deny dentists what is and always was ours from the very beginning. The evolution of dental practice has forced each general practitioner to be expert in the provision of anxiety and pain control. We cannot allow dental boards to unfairly over-regulate our ability to administer sedative agents beyond nitrous oxide. It is time for general dentists to take back the right to safely treat our patients – we brought conscious sedation to dentistry.

This proposal would lead to poor outcomes

Joseph M. Curley, DMD, FAGD: Pennsylvania

It is a travesty that the organization charged with protecting the public is considering placing barriers to care, with zero scientific evidence supporting the guideline changes.

Patrick A. Thompson, DDS:  Missouri

I am nothing short of appalled that the ADA would even be considering these changes to the anesthesia guidelines. Limiting oral medication to achieve only minimal sedation would really tie our hands. The typical sedation patient cannot tolerate treatment with just anxiolysis. As in years past, highly fearful patients would delay treatment until pain and/or infection forces them to seek treatment. That treatment more than likely will be extraction. I always thought we are supposed to be in the tooth saving business.

Conscious sedation helps patients overcome fears

J. Brad Bynum, DMD:  Georgia

One of my patients told me that her last cleaning visit was the first time she was able to come into our office without throwing up in the parking lot due to her fear. We successfully treated her with oral conscious sedation 2 years ago. She had not seen a dentist in 15 years before we treated her. Fifty percent of the population does not see a dentist on a regular basis, many of them due to fear. Your committee and the ADA should be promoting patient access to care.

Joseph M. Miranda, DDS:  Texas

The record of safety speaks for itself. The systems taught by organizations such as DOCS 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. In fact, once many of these patients have been able to get their mouth healthy and they are over their fears, they become routine general dental patients that do not continue to need sedation.

Stanley Asensio, DMD: Florida

Florida Dist. #9 Forensic Odontologist

Member of the Dental Practice Based Research Network

I have been an active member of the ADA since I was a student in dental school back in the early 80’s, and very proud of it – until now! It has caught my attention that new guidelines are proposed for sedation dentistry that will interfere with the care I give to my patients, day in and day out. Let’s be real; who is going to benefit? It is obvious it will not be the general public or the needy patients. You have no idea what the patients that choose oral sedation go through to get their dental needs met.

Don’t put more barriers in front of patients

Stephen M. LaDuque, DDS, P.A.:  Texas

For most dentists in smaller, rural areas, we are the first and (to many) last line of defense against walking around with pain and infections that affect their daily life. We agree that we cannot and will not treat everyone that walks through the door, but we also have a duty as a profession to open treatment options when the treatment is within the ability, capacity, and aptitude of general dentists.

Walter Coleman, DDS: Michigan

My practice is located within a public health clinic. I can say with absolute certainty that oral conscious sedation is the only window of hope for an enormous segment of the community I serve. With provider shortages, excessive amounts of untreated decay, and over 30% of patients presenting only for treatment when they are in pain, the barriers to care are already significant. I strongly encourage you not to make access for these patients more difficult than it already is.

This proposal would deny patients access to dental care

Jack Austin Mirchin, DDS:  Maryland

Many of my patients could not receive the care they need without the sedation that I provide. They need my intelligence, and my experience to provide these services. The ADA has no business setting guidelines that exclude me or any other licensed dentist from doing conscious sedation. This is an outrage.

Harvey Winter, DDS, FDOCS: New York

Your proposed regulations would effectively be a needlessly insurmountable bureaucratic obstacle. They would serve to take dentistry back a generation or two, to a time when patients had little or no choice but to suppress their fears and put up with (in their minds) terrifying procedures from dentists whose compassion can be equated with that of Hannibal Lecter!

Sedation dentistry is safe

William J, Busacca, DDS: Washington

It is time for the CDEL committee to get real. There is virtually no morbidity or mortality with the use of oral conscious sedation agents. If the ADA does not require IV training for the use of local anesthetics, which are much more likely to kill someone than a benzodiazepine, why in God’s name are there proposals to require IV training for oral conscious sedation?

T. Kerry McAlister, DDS: Arkansas

Dentists have completed more than 850,000 treatments using oral conscious sedation without incident. It is my opinion that without OCS, many of these would have declined quality treatment due to excessive fear of dental procedures. It would be in the best interest for the ADA to look at this number as sufficient evidence.

Marcos Ortega III, DDS: California

I am sure that safety is the motivating factor behind the proposed regulations. What I don’t understand is why it has become an issue. I don’t recall there being any emergency incident or fatality due the use of 5 mg of Valium or 5 mg of Triazolam. What event or scientific study prompts this form of action? My guess is a general ignorance by the governing body of the ADA on the pharmacological action of the agents used.

DOCS has the right expertise for conscious sedation

James F. Crummett, DDS: California

With over one million successful cases treated by their members, no other organization is even close to having the level and amount of successful sedation dentistry achieved as DOCS.  While sedation dentistry may benefit from the setting of appropriate boundaries, please don’t do anything to hinder it. And save room for DOCS. They represent too much to too many to be denied access to the niche which they identified and developed.

Don’t sell out to special interests

Edwin A. Ernest III, DMD: Tennessee

This is a misguided effort on behalf of oral surgeons and dental anesthesiologists to practice protectionism and restraint of trade. My referrals to these specialists will likely be seriously revised for my future patients.

Kurt Schneider, DDS: California

I’ve been an ADA dues paying member since dental school, for over 20 years. I cannot think of anything the ADA has ever done or proposed that has angered me more than this. It sounds like a power and money grab on the part of specialists. It would only hurt our profession and the patients who have finally made it back into dentistry after years of neglect due to fear.

Robert S. Reaves, MS, DDS: Florida

Your committee may well be being used by special interests to advance their agenda. That’s what it looks like to most general dentists. The special interests are, of course, specialists who use serious sedation daily while they are doing dentistry, usually some sort of oral surgery or pediatric procedures. These specialties have a number of serious complications occurring among their ranks every year, sometimes death of a patient.