The ADA is proposing revolutionary changes to its guidelines for oral conscious sedation.  Yet the organization is keeping a closely guarded secret its reasoning and justification. Herein, we publish just a few of the letter's we've received from dentists who regularly offer their patients oral conscious sedation and feel that the ADA's actions are unwarranted.  We challenge the ADA, likewise, to publish letters from dentists who practice oral conscious sedation who are asking the ADA to implement its new guidelines.  Come on, ADA, show us what you've got! 

Letters may be edited and/or abbreviated for clarity and space considerations. Emphasis added.

Stephen J. Markus, D.M.D., F.A.C.E.:  New Jersey

I can tell you first hand that in the previous five years I have probably saved 5,000 teeth on 500 patients who, when properly evaluated medically, have no problem with OCS.  These were 5,000 that would otherwise have ended up in the jars of incoming dental school freshman, complements of the oral surgeons of this land.

What I find impossible to comprehend is that with our DEA licenses we are able to prescribe a myriad of different drugs to patients who have the potential to take a bottleful while we’re not looking, and kill themselves.  However, you are saying to us:  ‘Doctor, if you have these drugs in your office, and choose to dispense them individually to a fearful patient, while you are continually monitoring them on a pulse oxymeter, this is something you need an extra 60 hours of training to do, in a fantasy institution where the student faculty radio is less than 3:1.’

Mathew Winkle, D.D.S.:  Confederated Tribes of Siletz Indians

My dental practice is in a public health clinic in a very small town on the Oregon Coast.  Conscious sedation is an extremely important factor to deliver essential care to the people of this community.  In this rural community, dental caries and periodontal disease are higher than the typical United States population.  Many are also dental phobic to a paralyzing degree.

I hope you would consider the hundreds of people in my community who would be physically and mentally damaged by your proposal.

Thomas A. Dawson, D.D.S., F.A.G.D.:  Michigan

I have safely used conscious sedation for years and chose that over I.V. administration, in which I was previously trained.  In my hands, especially for long and involved dental treatment of fearful patients, conscious sedation is absolutely the vehicle of choice.

Chris Raforth, D.D.S.:  Washington

I have been trained as a graduate of Creighton University in intravenous (IV) deep sedation, and I have treated many patients with IV deep sedation and general anesthesia to eliminate their fear and anxiety so they can receive proper dental care to improve their health.

Not only do [my] patients make requests for oral conscious sedation treatment, I would recommend it as the primary means of safely and effectively treating dental fear and anxiety in my patients.

Thomas A. Berard, D.D.S., F.A.G.D.:  Illinois

I constantly hear from the ADA about improving access to care.  A large part of the population does not receive dental care due to fear.  Incremental conscious sedation allows many of them to receive treatment.  If you pass these changes, you might as well place TV ads saying, ‘Afraid to go to the dentist?  Too Bad!”

Cliff R. Schweitzer, D.D.S:  North Carolina

My practice is located in a rural area of North Carolina.  If current proposed changes are made, my patients who currently enjoy the benefits of oral health will have to travel out of area and pay exclusive prices to continue treatment which in many cases will cease treatment.

I believe that as doctors devoted to patient health, if my patient can overcome the fear of walking in the door and dedicate themselves to oral health, then I should make every effort to bring them the rest of the way.  By providing oral sedation, this is possible in my rural area of the world.

James L. Nager, D.M.D.:  Massachusetts

For the past 17 years I have been a Clinical Instructor at Harvard and an Associate Clinical Instructor at Boston University dental schools.  I have held these positions at the same time.

The OCS protocols I learned are prudent.  We screen our patients medically like never before.  We use low doses of benzodiazepines with known safety.  We monitor the patients such as we have never done before.  We are careful.  We are safe.

Please do not change the ADA guidelines for oral conscious sedation and anxiolysis.  They have been well thought out and safely implemented for a huge number of cases.

Scott B. Boltz, D.D.S.:  Indiana

I am a general dentist with a hospital-based general practice residency background.  I have been providing light to medium enteral/inhalation sedation safely to my patients for over 23 years.  This amounts to over 750 cases without incidence. 

The current new proposals are over-restrictive, excessive and unacceptable.  Most importantly, they will take safe proven methods of oral conscious sedation away from the dental patient population that relies heavily on them.

Joe Theisen, D.D.S.:  Wisconsin

“I think you should be required to publish in the ADA Journal your scientific reasoning for change.  I think that you should also publish the names of your committee members – their personal opinion – and their credentials.  I suspect that most or all of the committee members will qualify for permits under the new guidelines.

Rym C. Partridge, D.D.S.:  California

If you [do] this I would seriously consider revoking my 30 years-plus membership in the ADA.  This all would serve no one.

I would like to hear personally why you would seek to limit a treatment modality that has always been open to the general dentist.

Benjamin T. Watson, D.D.S., M.A.G.D:  Virginia

I have been a member of the ADA since I graduated from dental school.  I have relied on them to represent me in all aspects of dentistry.  Now, I feel they have abandoned me.  They have given no good reasons for the change.

If these guidelines are passed I do not feel I could remain a member of an organization that does not represent me as a general dentist.

Renee Watts, D.D.S., F.A.G.D:  Oregon

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.

Thomas J. Fenlon, D.D.S.:  Maryland

As a professional working in private practice for 30 years and taking great pride in my continuing education over the years, I think I am quite capable, having been properly trained, to provide safe OCS to my patients.

Chris Chaffin, D.D.S.:  Washington

Are we not registered with the national and state agencies to prescribe medications as we have been trained by credentialed dental schools?  Are we not licensed by national and state dental boards, and certified as practicing dentists in our states and given a license to do such?  Where is the basis for taking such inappropriate action?

Tod Twichell, D.D.S.:  NewYork

The proposed training requirements are not only excessive, but probably unattainable when one considers the availability of any program with a 1:1 or 1:3 faculty ratio.  The requirement of 60 hours didactic training including 10 live patients is in itself overkill for a technique that on adults has a long track record of safety as taught by programs such as DOCS and others.

Even if a training program is ever developed that would meet the requirements proposed, it would have to come at a cost that would make it impossible for most dentists to provide affordable conscious sedation to their dental phobic patients.  Are you prepared to cut off the same access to care that the Surgeon General has been demanding for the past several years?

Anthony S. Carroccia, D.D.S., F.A.G.D.:  Tennessee

I must consider the [Anesthesia] Committee to be in good humor to consider such a ridiculous student:instructor ratio for the teaching of these courses as outlined.  In an age where we are experiencing an ‘Educational Crisis’ you are proposing to tax the system further?!

Barry L. Watson, D.D.S.:  North Carolina

Many patients self medicate before dental appointments.  Isn’t it better for them to do it in a supervised setting?  Our primary medication for OCS is 0.25 mg Triazolam which patients could easily get from their primary care physician and take all they want unsupervised.

Ushma Patel, D.M.D.:  Georgia

I recently decided to get trained in these techniques due to demand from my existing patients who are ready to get the work they need but have been holding back because they are fearful of going through with the treatment without sedation.  If sedation was not easily available, then I wholeheartedly believe they would not seek the care that they need.  With increasing evidence that good oral health is linked to good overall heath, this proposal would deny patients access to their well being.  Does the ADA really want this on their heads?

The ADA proposals are really an overkill considering the safety record and that existing ADA and State guidelines are sufficient to protect public safety based on the evidence.  So I would ask the Anesthesia Committee to reconsider these proposals, as it is not too late.

Angela M. Schuck, D.D.S.:  Minnesota

Patients fear more than extractions.  Some patients fear all aspects of dentistry.  Dentists need to be trained and actually need to utilize sedation as well; not necessarily as a practice builder but to protect the public.  Otherwise many people will live with advanced dental problems that will affect their health. 

A few years back, a local woman in her 30s died of an undiagnosed dental abscess.

Her medical doctor was unsuccessfully sued as he referred her and she did not follow through.  It would be interesting to know if fear kept her away. Doing any invasive procedure whether it is in the medical field or dental field with out the option available for complete patient comfort is antiquated and below standard of care in my opinion. 

My dad had a [non-invasive] MRI and was given oral sedatives for the procedure.  He also had a colonoscopy at a separate procedure and was again offered oral sedatives.  Dentistry is much more invasive and to not have oral conscious sedation is not fair to patients and most certainly will keep thousands if not millions of people from receiving dental care. 

Oral conscious sedation for adults is safe and I don’t think we want to take our dentistry to hospitals and do this under GA.  Medical doctors use OCS a lot and don’t have an anesthesiologist involved.  We should be able to offer our patients the same opportunities to have an invasive procedure completed.

Dennis W. Nagel, D.D.S.:  Michigan

Before I became certified in Oral Conscious Sedation, I was against it.  This is because I thought, well, I’m very gentle, give painless and generous local anesthesia, and so I don’t need sedation, and no one else should either if they did good anesthetic and were gentle and caring in their treatment approach.  And why give people drugs and medications because they all have risks and side effects?

…I swallowed my pride and arrogance and went to the Oral Conscious Sedation Certification Training and was actually surprised to find out how extremely safe and doable sedation dentistry is.  The side effects are minimal and manageable and the serious risks are about as low as any drug could be.  This is a truly significant means to increase the dental health of a very large number of people.

Sedation is worth it and after many years of ‘toughing it out’ I will choose Sedation Dentistry as often as possible.  It has made the long, long appointments go by quickly and the after effects of the sore jaw muscles, sore neck and shoulders, and tension energy drain were absent.

If the voting majority of this [ADA] committee has not at a minimum taken the certification for Oral Conscious Sedation, then how can they have an accurate understanding of the issues and not be swayed by some other slant on the usefulness and safety of Oral Conscious Sedation?  Thus how can they have a conscientious right to vote on it?

Please do not do this to us and our patients.

Michele J. Rase, CDA RDH BS:  New York

I have been in dentistry for over thirty years.  I have seen first hand the need for and incredible results with oral conscious sedation.  We treat not only anxious and phobic patients, but also patients with tremendous gag reflexes who otherwise would be too embarrassed to seek dental treatment . 

The proposed changes of this alternative care would be a great injustice to an already underserved dental population.

Alice P. Moran, D.M.D., A.P.C.:  California

These tools [OCS and Anxiolysis] became a large part of my practice in the Navy and were essential in treating anxious and fearful patients.

I urge you, if you care about access to care for the general public, do not change the current guidelines for OCS.