In recent years, oral conscious sedation (OCS) has taken the dental industry by storm. That this has happened should come as no surprise, as OCS offers dental patients their long sought-after equivalent of the Holy Grail: the prospect of pain-free dental treatment.
Over time, OCS has become increasingly more popular, safe, and efficient. Yet paradoxically, it has also become more regulated, scrutinized, and criticized.
Many among OCS’s increasingly more vocal collection of critics have derided it as "sleep dentistry" – a flagrantly deceptive label, as patients generally remain conscious while receiving this treatment. In implying that patients are put to sleep during OCS, the term not only fails to acknowledge the complexity of the procedure, but also fiendishly suggests that the patients are being placed in a potentially unsafe situation.
Initially, the ADA looked favorably on the proliferation of sedation dentistry, even praising its "remarkable record of safety." However, there since appears to have been a sudden and inexplicable turnaround in the association’s outlook on the matter, as it has spent the last two years overhauling its regulations to increase the extent of training required in order for a dentist to be considered qualified to practice OCS. A number of state dental boards have followed suit, likewise toughening their restrictions on OCS practitioners. The result of these actions has been to reduce the number of dentists able and willing to offer OCS to patients.
This apparent crackdown on sedation dentistry is being done under the guise of public safety concerns. However, despite an array of speculative criticisms, studies show that OCS actually poses less risk to a patient’s well-being than the typical anesthetic treatment one would receive in a hospital. Furthermore, it offers a wealth of benefits to both patients and practitioners alike. Patients that might otherwise be deterred by the traditionally accompanying pain and discomfort will be far less reluctant to visit the dentist and receive necessary and perhaps overdue treatment; meanwhile, the influx of such new and willing patients has the potential to substantially increase the profitability of a dentist’s business.
Given thus, the question then arises: what is the real driving force behind the suppression of sedation dentistry? In answering that question, many dentists claim there is a sinister ulterior motive at work: politics.
Since its inception, sedation dentistry has threatened the practices of such industry specialists as anesthesiologists and oral surgeons. These specialists’ businesses thrive on their ability to offer exclusive services at lofty prices. Sedation dentistry, however, enables general practitioners to offer many of those same services, such as tooth extractions, and at more affordable prices, thus forcing the specialists to either lower their own prices in order to compete with those of OCS practitioners or face the possibility of being driven out of business by them. In response, these specialists have lobbied the ADA and state dental boards hard to ensure that the growth of sedation dentistry is stemmed by the implementation of unnecessary and overbearing regulations.
The advocacy group Trust for Equal Access Medicine (TEAM) 1500 blasted the efforts to suppress sedation dentistry, claiming that they unfairly discriminate against underprivileged patients by depriving them of a very desirable, beneficial, and economical form of dental treatment.
"Team 1500 believes that these unjustified regulations disproportionately impact the poor and minorities and raise the cost of quality medical and dental care for everyone," read a statement issued by the group. "By imposing unnecessary regulatory hurdles on the general practitioner, the ADA and the state dental boards that rely upon the ADA to help establish their regulations, are making it more difficult for members of the public at large to have access to safe, affordable, quality oral healthcare."
Recent polls show that a majority of dentists either already offer OCS or have a desire to do so. That sedation dentistry is becoming increasingly difficult, and in some cases impossible for them to practice is a source of much anger and frustration for many of them.
"The recent rule changes advocated by the ADA are ridiculous," one anonymous dentist declared in a website blog, echoing a sentiment shared by many of his colleagues.
"We need regulations," another dentist acknowledged, "but not the knee-jerk, specialist-protectionist, overreaction that is being fabricated by the ADA."
"Oral surgeons and others are increasingly obstructive in their efforts to block sedation in any form by non specialists," wrote yet another dentist. "They ignore the safety record established by general practitioners who have provided many thousands of sedations over the last 12 years."
One dentist even attempted to rally his fellow practitioners with a figurative call to arms: "Currently OCS is surrounded by an entanglement of special interest groups. It is time we as dentists who have been certified be able to provide this safe and time-proven technique of patient care!"
Dental consultant Jim Du Molin succinctly summed up the views of many dentists on the matter. "Oral conscious sedation may be the most controversial topic in dentistry right now," he said. "It hurts me to think of how many patients won’t get dental care if the ADA’s new guidelines – engineered by the surgeons – go into effect. Is it really in patients’ best interest to limit their dental options?" |