The Minnesota Board of Dentistry, which in March approved a regulation requiring dentists to remain with their patients at all times, even if the patient or dentist goes to the bathroom, will revisit the rules at a hearing on June 20, 2007.

TEAM 1500 wrote about the new rules in May, noting that they raise "all order of potential bathroom embarrassments."

In support of the dentists in Minnesota who are working to reverse the ill-considered regulations, TEAM 1500 prepared a fact sheet.  A copy of it appears below.

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Minnesota Board of Dentistry Mission Statement:  "To ensure that Minnesota citizens receive quality dental health care from competent dental health care professionals."

The Minnesota Board of Dentistry permanent rules that went into affect on March 19, 2007 require that a dentist “must remain in the operatory room to continuously monitor the patient once…conscious sedation is achieved and until all dental services are completed on the patient.”

While the rule is undoubtedly intended to further the Board’s mission of ensuring that Minnesotans receive quality and safe dental health care, it also produces consequences that the Board likely did not anticipate.

Most notably:

• Approximately one out of two oral sedation patients who receive extended-treatment ask to use the bathroom at least once while still sedated.  Complying with the MBD new rules means dentists must accompany their patients into the bathroom under these circumstances, even when their patients are of the opposite gender. 

Prior to the adoption of the new regulations, dentists could assign a specially trained member of their staff to closely and continuously monitor patients who must use the bathroom.  Further, the old regulations permitted a specially trained member of the dentist’s staff to remain with the patient in the operatory when the dentist needed a brief bathroom break.

• If a Minnesota dentist has sedated a patient for a routine procedure under the new guidelines, that dentist is not permitted to attend a walk-in emergency patient even briefly.  Indeed, the new regulation chains the dentist to the sedated patient regardless of extenuating circumstances.  Previously, a specially trained member of the dentist’s staff could monitor a patient if the dentist’s services were required elsewhere.

• The restriction on Minnesota dentists requiring them to personally monitor their sedated patients at all times means that dentists – contrary to the current standards of care everywhere else in the country – can’t attend more than one patient, even during those periods when the sedation medication has yet to take full effect or is in the process of wearing off.

The practical impact of this, which is unique to Minnesota dentists, is that they must charge their patients significantly more for the same care, because they must fully dedicate themselves to only one patient at a time.  Moreover, other patients who require standard, non-sedated care, find it more difficult to garner appointments with their family dentists.

Rather than encourage dental patients to seek needed care, the higher costs and longer wait times discourage patients from seeking timely and necessary treatments.  The poor, elderly and disabled are disproportionately affected.

What Is The Record Pertaining To Staff Monitoring of Sedation Patients:

• Clinical observation in Minnesota and nationally encompassing more than one million adult patients who have been safely and effective treated with oral sedation find no reported cases of injury or death arising from a specially trained staff member briefly monitoring patients without the dentist in the operatory.

• At least 100,000 adult patients under the effects of sedation have safely used the bathroom during the course of their procedures without incident or injury when supervised and escorted by a specially trained member of the dentist’s staff.

• More than 7,500 dentists nationally, including all dentists in Minnesota with conscious sedation permits, have safely attended to emergency walk-ins and other non-emergency patients while permitting a specially trained staff member to closely and continuously monitor a sedated patient.  The evidence-based support for the safety of such actions is indisputable.

The March 19th regulations require a dentist administering conscious sedation to a patient to have in attendance personnel who are currently certified in CPR.   In an emergency, the MBD is saying that it has confidence that such support personnel can help save a patient’s life.

To the extent that the MBD already trusts specially trained personal to behave responsibly and professionally in the event of a cardiac event, it seems only logical to extend that trust to specially trained team members who monitor a healthy, sedated patient.  In an emergency, these staff members know not only how to spot trouble early and attend to the patient, but also how to immediately summon a dentist who may be in the bathroom or attending another pressing health issue.

The MBD has a long and highly respected record of looking out for its citizens.  In this instance, it can continue its service of quality and safety by modifying the regulations and permitting specially trained team members to monitor sedated patients without bringing harm to patients.

See Earlier Article on This Topic: