March 9, 2007

Rear Admiral Kenneth P. Moritsugu

Office of the Surgeon General

5600 Fishers Lane

Room 18-66

Rockville, MD 20857

Dear Dr. Moritsugu:

In May 2000, Surgeon General David Satcher issued the first-ever report on oral health and challenged the healthcare community to embrace innovative methods to reach out to the tens of millions of Americans who lack adequate access to dental care.

One group of dedicated dentists took up the call, focusing on the large segment of the adult population who avoid visiting their dentists out of fear and anxiety, resulting in the kind of serious oral disorders that Dr. Satcher warned “may undermine self-image and self-esteem, discourage normal social interaction, and lead to chronic stress and depression as well as to incurring great financial cost.”

By honing methods that had been in informal use for decades, these dentists developed a safe and effective protocol for relieving the stress of dental visits with the administration of a mild oral sedative that was and remains in wide use by the general medical community.  Best of all, these dentists developed a curriculum that could teach the entirely safe use of this innovate procedure – known as oral conscious sedation – to family dentists and their staffs during a readily comprehensible three-day course.

In fulfillment of Dr. Satcher’s vision, these dentists succeeded greatly in reducing the barriers between patients and oral health services.  Indeed, what began with a small group of general dentists snowballed and since 2000, well over one million patients – most of whom previously avoided seeing a dentist altogether – have been treated safely and effectively with oral conscious sedation. 

Many of the dentists who administer oral conscious sedation tend to the very communities most in need of improved dental care, including the poor, the elderly and members of racial and ethnic groups.  These general dentists and non-specialists typically live and work in the very communities that they serve.

One example is Dr. Matthew Winkle, who works in a public health clinic serving the Confederated Tribes of Siletz Indians in Oregon.  “In this rural community, dental caries and periodontal disease are higher than the typical United States population,” Dr. Winkle notes.  “Many are also dental phobic to a paralyzing degree.”

Oral conscious sedation has been a huge aide to Dr. Winkle and more than 7,000 other similarly trained dentists.   Their efforts offer a blueprint for the kind of public-private partnerships envisioned in the Surgeon General’s May 2000 report.

But the work and dedication of these oral conscious sedation dentists has not been universally lauded.

As often happens, these dentists have run up against the entrenched interests of some of dentistry’s most influential actors, who are now mobilizing to rob the dentists such as Dr. Winkle and their patients of the amazingly effective protocol of oral conscious sedation.

Under the pretext of protecting the public’s health, two highly influential committees of the American Dental Association have proposed new guidelines to govern the use of oral conscious sedation.  The guidelines, for which there is no scientific or even anecdotal justification, would ask all dentists who wish to provide their patients this valuable service to triple the number of hours of educational training they receive and add an unnecessary, financially burdensome and impractical clinical component.

Such a severe increase in the training requirements (as well as the associated costs) will put the attainment of accreditation in oral conscious sedation outside the reach of most general dentists, even those who’ve long administered oral conscious sedation safely and effectively.

That appears to be the very goal of those pushing this misguided ADA agenda. 

In the view of a group of oral surgeons and dental anesthesiologists – who dominate the ADA committees that govern educational and practice guidelines – general dentists who offer oral conscious sedation have been too successful in reaching needy members of the public.  In the effort to preserve what has historically been the province of the oral surgeons and dental anesthesiologists, these ADA committees are maneuvering to shut down the family dentists’ practical ability to offer oral conscious sedation.

More than 1,000 dentists and patients have already submitted letters of protest to the ADA, noting the long, proven safety record and effectiveness of oral conscious sedation under existing ADA guidelines and in compliance with existing state-mandated regulations.  But the letters are falling on deaf ears.

While the ADA’s mission is to serve the public interest, the reality is that merit is not always the basis for its actions.  Unfortunately, sometimes internal political considerations trump what’s in the public’s best interest.

(It is worth noting that in the fall of 2005, less than two years ago, the broad ruling body of the American Dental Association, known as the House of Delegates, affirmed the safety and efficacy of OCS and other forms of anesthesia and lauded their “remarkable record of safety” under existing ADA guidelines. The ADA in 2007 offers no explanation whatsoever as to why now it feels that significant new training is required.)

As the nation’s chief health educator, you and your staff by word and action have a vital influence on preserving public health and minimizing the risks of illness and injury.  Moreover, you are charged specifically with elevating the quality of public health practice.

With those responsibilities and obligations in mind, I am writing to you today on behalf of the thousands of dedicated oral conscious sedation dentists and hundreds of thousands of their patients who implore you to intercede to protect the public’s access to safe and effective dental care.

Specifically, we would ask that you and your office speak out to help prevent the American public from losing a vital, effective treatment method solely because it infringes on what a small cabal of dentists view as their exclusive domain.

We believe that as powerful as these ADA committee members are, their sway with the overall membership can’t compare with a clear, unambiguous endorsement from the Surgeon General’s office in favor of the continued availability of oral conscious sedation under existing, safe and proven ADA and state-mandated guidelines. 

Thank you in advance for your attention to this matter.  By your prompt actions, you will literally bring a smile to faces of millions of your fellow citizens.

Sincerely,

Dean Rotbart, Director

Team 1500

Phone:  1-866-612-TEAM/Fax:  310-861-0763

The Trust for Equal Access Medicine (TEAM) is a non-profit coalition of more than 1,500 independent healthcare providers who are dedicated to making quality medical and dental care available to all Americans.

TEAM 1500 seeks to overcome unnecessary and cost-prohibitive regulations and interference foisted upon the general public by self-serving bureaucrats and medical professionals who have constructed and defend economic and racial moats around quality, safe medical care.

TEAM 1500 believes that undue and burdensome regulation of healthcare professionals disproportionately impacts the poor and minorities and raises the cost of quality medical and dental care for all Americans.