The painful transition period in sedation regulations

A watchdog report

by CAGD Advisor, Guy Acheson, DDS, MAGD

The BIG NEWS from the November Dental Board of California (DBC) meeting is the results of two studies of pediatric dental sedation deaths and changes to sedation regulations and permits. There are new definitions of levels of sedation, there are new names for sedation permits, new requirements for personnel and training, and of course new fees. It is going to be a painful transition period for dentists who do sedation.

Senate Bill 501 was passed in 2018. It required the DBC do an investigation of all pediatric dental sedation-related deaths, propose changes in regulations to reduce pediatric dental sedation-related deaths, and to report all this to the Legislature in January 2022. The DBC released their findings and proposed changes at the November board meeting.

The DBC has completed two different studies of deaths related to pediatric dental sedation; a 2016 study that covered January 2010 thru December 2015, and the current study that covered January 2017 thru June 2021. The 2016 study found nine pediatric deaths with only two cases that involved a violation of the Dental Practice Act. The 2021 study found only three pediatric deaths and no violations of the Dental Practice Act. Fortunately, the trend is for many fewer deaths.

The DBC is proposing that sedation permits will expand with requirements for pediatric endorsements to treat children. Now there are only three categories of sedation: minimal, moderate, and deep sedation/general anesthesia. For the first time, there will now be separate endorsements for sedating children. Within deep sedation/general anesthesia there will be an endorsement for persons less than seven years of age. Moderate sedation (intravenous sedation) will have a pediatric endorsement required for treating patients less than thirteen years of age AND a different pediatric endorsement for treating patients less than seven years of age. Adult oral conscious sedation will stay the same with patients needing to be thirteen years of age or older. Pediatric minimal sedation is required for oral sedation on patients less than thirteen years of age.

The pediatric endorsements will require specific training in pediatric sedation. Usually, this would be through a pediatric residency but I am sure equivalent independent courses will become available. There will be no grandfathering of people who currently deliver pediatric sedation. The educational requirements will become mandatory at the dentist’s next sedation permit recertification office evaluation. In addition, providers must provide evidence of currency in pediatric sedation by listing at least twenty cases of pediatric sedation during every two-year dental license renewal.

It will be interesting to see how all this impacts access to care for children who require sedation for restraint. The educational requirements for moderate pediatric sedation are just part of a pedodontist’s training but for general dentists who treat children the double endorsements will be a high hurdle. If we had easy access to hospitals this would not be such a problem but hospital operating room time is very limited and my practice is booked six to nine months out for an operating room case. Not much help when a child has an abscessed tooth now.

That is the most important information to know for now. As always, if you have questions please reach out to me. [email protected]

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