The Oregon Board of Dentistry recently announced that it would require capnography for moderate sedation of dental patients as of July 1, 2013 (the deadline has since been moved to December 28). The decision is part of a growing trend among health care organizations to improve the safety of patients undergoing sedation.
My background in dental monitoring during and after surgery is limited so I thought I would take some time to research the details of the announcement.
- What do other state dental boards require or recommend?
- What was standard practice in Oregon before this latest announcement?
- What other dental organizations require capnography for moderate sedation?
This article describes what I learned and uncovers what still needs to be researched.
What do other state dental boards require or recommend?
Most state dental boards mirror guidelines provided by the American Society of Dentist Anesthesiologists or the American Dental Association (ADA) who recommend continuously monitoring end tidal CO2 (EtCO2) for moderate sedation and require it for intubated patients receiving general anesthesia or undergoing deep sedation.
Moderate sedation, sometimes called “conscious sedation” by some state dentistry boards, means that the patient can purposefully respond to verbal or tactile stimulus during the operation. Deep sedation may require painful stimulus to prompt a reaction.
To me, some questions still arise about state policies about monitoring and sedation.
For example, if the policy set forth by a state dental board recommends that dentists follow the guidelines provided by the ADA, and these guidelines require continuous EtCO2 monitoring for intubated patients, are dentists required by policy to monitor patients or are they merely recommended to do so? What degree of flexibility is available to the dentist?
I’m currently researching the answer. If you can offer any guidance, please help in the comments below.
What was standard practice in Oregon before this latest announcement?
For the Oregon Board of Dentistry to require capnography for moderate sedationa practice that is only recommended by the ADAis a step forward for detecting respiratory failure among dental patients and for reducing the risk for adverse events among patients in need of moderate sedation. Previously, Oregon followed the ADA’s guidelines of recommending capnography for moderate sedation.
For greater patient safety, other dentistry boards are encouraged to follow Oregon’s lead to ensure no patient experiences respiratory depression during sedation. Capnography provides the earliest detection of respiratory depression and should be used for patients moderately and deeply sedated.
What other dental organizations require capnography for moderate sedation?
Beginning in 2014, the American Association of Oral and Maxillofacial Surgeons (AAOMS) will require capnography for moderate and deep sedation. Oral and maxillofacial surgeons remove teeth, prepare jaws for denture construction, and treat facial fractures, lacerations, and other injuries such as cleft lip.
The AAOMS is following the lead of the American Society of Anesthesiology and the American Heart Organization in mandating capnography for moderate sedation. Other dental boards and governing bodies may follow suit to meet the new standard of care.
Based on my research about end tidal CO2 monitoring in dental settings, I applaud the Oregon Board of Dentistry for its step forward. Monitoring with capnography may save lives. With this new requirement, dental appointments in Oregon will become safer for patients.
On a side note, I look forward to meeting everybody tomorrow night at A Promise to Amanda Foundations first fundraiser and awareness campaign. Be sure to say hello!