More emergency training needed for dentists doing sedation, says expert
An expert who trains dentists in critical care says allowing a dentist to both administer a general anesthetic and perform a surgical procedure — a practice currently permitted in Alberta — "is a disaster waiting to happen."
"To have someone tunnel visioning in on surgery while also trying to maintain the breathing of the patient is a disaster waiting to happen," said Michael Dare, an associate clinical professor in the faculty of dentistry at the University of British Columbia.
That scenario is more dangerous if dental offices do not have staff adequately trained in emergency situations or backup staff to assist if something goes very wrong during the administration of an anesthetic, he said.
Dare's comments come after a CBC inquiry found that Alberta and Ontario are the only provinces where a dentist can both administer a general anesthetic and perform a dental procedure. The Royal College of Dental Surgeons of Ontario recently launched a formal review that's looking at the practice.
"Time and time again the stories sound very similar in that staff did not watch their breathing well enough and the patient ends up in a severe respiratory arrest," Dare said. "Time and time again, they're inadequately prepared to respond to the emergency... They don't deal with (emergencies) on a regular basis, like in-hospital staff. So when one occurs it's often very poorly managed."
Incident put anesthesia in spotlight
The use of general anesthetic in dental facilities came into the spotlight in Alberta after a four-year-old girl stopped breathing for an unknown amount of time after being given general anesthetic in an Edmonton dental office. The family of Amber Athwal says she is permanently brain-damaged after the September incident.
Months before the Athwal case happened, the Alberta Dental Society of Anesthesiology invited Dare to speak at a conference in Edmonton. He expects a frank and hard discussion when he presents to the group on Friday.
"I see a total lack of respect for how serious these drugs are and how easily you can get into a dangerous situation," he said, about dental professionals.
"There are many good practitioners in the dental professions delivering high levels of care. But the unfortunate part is we have too many outlying practitioners."
Dare, who is also a registered nurse and runs a private business to train dentists in emergency care, has been a vocal critic of standards set out by the country's provincial dental societies and colleges when it comes to anesthesia and sedation.
The standards are not the same as those that exist in hospitals where, he says, facilities are better equipped to deal with crisis scenarios.
For example, Canada's dental colleges do not require the same highly-sensitive monitors that are standard in hospitals to monitor breathing, he said.
Health minister, dental college refuse comment
Anesthesiologists interviewed by the CBC have said that their main task when administering general anesthetic in hospital is to ensure a patient's airways are kept clear — a patient who is"put under" loses the reflex to cough out any liquid that may enter.
Anesthesiologists who work in hospitals say they have one task: to keep a patient safe by monitoring breathing, heart rate, and blood pressure when a patient is unable to regulate those functions themselves.
The Alberta Dental College and Association did not respond to an interview request for this story but sent a written statement first issued when the Athwal case was initially publicized. The organization said "general anaesthetic procedures in dentistry are very safe."
Health Minister Sarah Hoffman has refused to comment on the regulations that govern Alberta's dentists.But Alberta Liberal Leader David Swann, a medical doctor, said Hoffman is ultimately responsible for ensuring medical regulations are adequate.
"Ultimately the responsibility for public health and safety falls to the minister in relation to professional work," Swann said. "While there has been a hands off approach, it appears there's an inconsistency now between the policy of the dental association and that of the rest of the country.
"I would expect as a minister to hear from the college about the standard and the review and the decision they're going to make as quickly as possible around this."
