Office-based dental anaesthesia gaining ground over hospital-based

The procedural differences between dentist and physician anaesthesiologists have recently been examined by US researchers.

Their findings are published in the current issue of Anesthesia Progress.

Dentist anaesthesiologists are a unique medical provider. Their training is related more closely to medical anaesthesiologists than to dentists in that they do not receive clinical training in dental or oral surgery.

During their three-year residency program, dentist anaesthesiologists receive most of their training in a hospital-based setting, performing a minimum of 800 cases of general anaesthesia, of which at least 125 must be performed on children younger than age seven. However, very little is known about the post-residency practice characteristics of dentist anaesthesiologists.

Using two main dental databases, the National Anesthesia Clinical Outcomes Registry (NACOR) and the Society for Ambulatory Anesthesia Clinical Outcomes Registry (SCOR), for dental and oral surgery procedures, the researchers from the Indiana University School of Dentistry in Indianapolis, Brigham and Women’s Hospital in Boston, and the University of California at San Diego, compared 7,133 office-based procedures performed by dentist anaesthesiologists with 106,420 in-hospital procedures provided by physician anaesthesiologists.

The information from the SCOR database focused on office-based settings, while NACOR included hospital-based. The data showed that in both groups children six years and younger were the predominant recipients receiving anaesthetic dental treatment (two-thirds of NACOR patients; three-fourths of SCOR patients); however, the average age for SCOR was approximately nine years and for NACOR approximately 12 years.

The researchers also found a 46 per cent longer surgical time for the cases from the NACOR database versus those from the SCOR.

Both databases noted that early childhood caries (tooth decay) was the main diagnosis for the dental procedures needing anaesthesia.

In reviewing the data, the researchers found a clear correlation between early childhood caries and the need for anaesthesia during dental procedures. Given that this is the most common disease among children six years and younger, paediatric dentists need dentist anaesthesiologists.

Overall, there is a consistent trend with more dental anaesthetic procedures being performed in an office-based setting, particularly for paediatric dentistry.

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3 Comments

  1. Unfortunately the US training and experience cannot be extrapolated to the Australian scene.
    Dental sedationists are trained very differently to medically qualified anaesthetists in Australia.
    In Australia, the rise in popularity of office based dental procedures under general anaesthesia has occurred because a select group of dentists and oral and maxillofacial surgeons invested in appropriate equipment, trained their staff and used medically qualified anaesthetists to provide the facilities and quality of service without compromise.
    We now have a situation where standards are being questioned as the services being offered by some have led to a deterioration in the quality, safety and standard of care which patients deserve and have a right to expect.

    1. I’ve worked and trained in both the US and Australasia. Your sweeping statements about training and equipment cannot be extrapolated. Most private dental clinic procedures are done with the use of conscious sedation, not full general anaesthesia. Historically, dentists have been providing these services with appropriate training and equipment as long as doctors. The 3 year programs are excellent in the US. Training here is adequate for the level of sedation offered.

  2. The risks of Australian dentists simultaneously performing dental treatment and conscious sedation/sleep dentistry in their business premises without an anaesthetist present to monitor the patient (e.g. see Cauchi, 2010) should be disclosed before they consent to the procedure).
    See – Cauchi, S. ‘Sleep dentistry promotion wrong, expert warns’, The Sydney Morning Herald, July 25 2010. http://www.smh.com.au/national/sleep-dentistry-promotion-wrong-expert-warns-20100724-10pqz.html

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