fact check finds serious flaws in ada report concerning ... · cdel faq – fact check page 3 on...
TRANSCRIPT
![Page 1: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/1.jpg)
©GetTheScience.com
FactCheckFindsSeriousFlawsinADAReportConcerningSedationDentistry
TheAmericanDentalAssociationanditsCouncilonDentalEducationandLicensureissuedareport–“FrequentlyAskedQuestions–Resolution37”–designedtoinformADAmembersanddelegatesofthefactspertainingtoResolution37,aproposedrevisiontotheADA’sSedationandAnesthesiaGuidelines.WhatfollowsisasummaryofCDEL’sFAQandaFactCheckpreparedbyagroupofscientists,academics,anddentists–allADAmembers–whoareindependentofCDEL.Q.1.WhatwastheCouncil’sresponsetothedirectivesofthe2015HouseofDelegates?
CDEL’sCLAIMS:
• TheCouncilreliedonadetailedreport,titled“ReportontheRisksandBenefitsofUsingCapnographyinDentalPatientsUndergoingModerateSedation,”preparedatitsrequestbytheADA’sCouncilonScientificAffairs(CSA).
• TheCouncil“alsoconsideredcommentsreceived…”
THEFACTS:
The2015ADAHouseofDelegatesadoptedResolution77H,whichcalledonCDELtowork“incollaboration”withCSAtoconsiderthreeissuesembodiedinwhatisnowcalledResolution37.
1. AllowingdentiststohaveachoiceofoptionswhenitcomestomonitoringendtidalCO2formoderatesedation,“suchas:continuoususeofaprecordialorpretrachealstethoscope,continuousmonitoringofendtidalcarbondioxide,andcontinualverbalcommunicationwiththepatient.”
2. Therecommendedhoursandcontentofmoderatesedationcourses,includinga“possibleoptionofseparatecourserequirementsforenteralandparenteralroutesofsedation.”
3. TherationaleandguidelinesfortheuseofBodyMassIndexinconductingpatientevaluations,andthetimingofmedicalhistoryreview.
CONCLUSION:ThereissubstantialevidencethatCDELandCSAdidnotfulfillthe2015HouseofDelegatesmandate
![Page 2: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/2.jpg)
©GetTheScience.com
EVIDENCE:
• InitsFAQ,CDELpresentssummarizedevidencefromCSA’s“ReportontheRisksandBenefitsofUsingCapnographyinDentalPatientsUndergoingModerateSedation.”CDEL’spresentationincludeswhatitdescribesasthekeysummarystatement:“theevidencedemonstratesthatcapnographyinconjunctionwithstandardmonitoringimprovedsensitivityofdetectingadverserespiratoryeventsandreducestheriskofhypoxemiaduringmoderatesedationcomparedwithstandardmonitoringalone.”
CDELdoesnotrespondtothe2015HODresolutioncallingforCDELtoweighoptionsfordentistsotherthancapnography,suchasaprecordialorpretrachealstethoscope,whichmaybeequallyassafeandeffectiveascapnography,andpreferredbymanydentistsfortheireaseofoperationandcostsavings.
• EventhetitleoftheCSAreport,“RisksandBenefitsofUsingCapnography…”makesitabundantlyclearthattherisksandbenefitsofsuggestedalternativestocapnographywerenotreportedand,perhaps,notconsideredasmandatedbythe2015HOD.
• Whilethe2015HODmandatedthatCDELconsultwithCSAonthequestionofhowmanyhoursoftrainingformoderatesedationshouldberequired,andwhatthecontentofsuchtrainingshouldconsistof,neitherCDELnorCSAindicatethatanysuchcollaborationtookplace.Likewise,CSA’sownreportstotheADAofitsactivitiesincludesnomentionthatitwasconsultedandprovidedanopinionastothepossibleoptionofseparatecourserequirementsforenteralandparenteralroutesofsedation.
• DiscussingResolution37’sprovisionsforconsistentpatientevaluation
provisionsandtherationaleandguidelinesfortheuseofBodyMassIndex,CDEL’smakeszeromentionofconsultingwithCSAonthematter.Indeed,CDELcitesonlyitself,itsbeliefs,anditsinternaldiscussions–ignoringthe2015HODmandatethatitcollaboratewithCSA.Onceagain,inCSA’sownreportstotheADAofitsactivitiesprovidesnomentionthatitwasconsultedandprovidedanopiniononthisissue.
• AspartofthepubliccommentssubmittedtotheADApertainingtoResolution37,PamelaPorembskiD.D.S.,whoisthedirectoroftheADA’sCouncilonDentalPracticeinthePracticeInstitutesubmittedcomments
![Page 3: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/3.jpg)
CDELFAQ–FACTCHECK Page 3
onbehalfofamemberoftheCouncilonDentalPracticeonJuly7,2016:“Inmyopinion,andtheopinionofotherdelegates,thisadoptedresolution[HODResolution77H–2015]callsforevidencethatCSAhasstudiedtheavailablescience,literatureanddocumentationofallthreebulletpointsandhasmadeappropriateandscientificdeliberationtoCDELfortheirdeliberation…
“Giventheavailableevidence,thethreedocumentssubmittedtousfromCDEL,onecanonlyconcludethatCDELhasnotfulfilleditsmandateassetforthbythe2015HouseofDelegates.”
• InitsownFAQ,CDELacknowledgesinresponsetoQuestion#8:“…not
onecontrolledclinicalstudyhaseverbeenperformedtodemonstratetheoptimaltrainingtimefordentistswhoprovidemoderatesedation.”
• TheADA’spublishedpolicyonEvidence-BasedDentistry(EBD)isunambiguous:Evidence-based dentistry is an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences. ADAResolution37lacksbothevidence-basedsciencetosupportitsproposedrevisions,aswellastheclinicalexpertiseofdentists.ThevastmajorityofdentistsonbothADACouncils,CDELandCSA,donotusemoderatesedationtotreattheirpatientsandthushavelittleifanydirectexperiencewiththemethod.
Q.2.Whydoestheproposedguidelinenotoutlinetrainingbyrouteofadministration?
CDEL’sCLAIMS:
• TheCouncilcarefullystudiedthismatterandmaintainsthat“moderatelysedatedpatientsviaeitherrouterequirethesameattentivenessandmonitoring;thereshouldbenodifferenceinthetrainingrequirementsrelatedtoroutesofadministration.”
• AreviewofCEcourseswasconducted:atleast11providerscurrentlymeetorexceed60hoursofinstructionand20patientexperiences.
![Page 4: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/4.jpg)
©GetTheScience.com
THEFACTS:
• TheADAhaspledgedtosetitspracticeandeducationalguidelinesbasedonevidenceandscience.
“Thepracticeofevidence-basedmedicinemeansintegratingindividualclinicalexpertisewiththebestavailableexternalclinicalevidencefromsystematicresearch,”theADAstatesinitspublishedpolicystatement.Carefulstudyofthematter–whichCDELassertsasitsjustificationforconcludingthat“thereshouldbenodifferenceinthetrainingrequirementsrelatedtoroutesofadministration”–fallsfarshortofconstitutingevidence-basedsubstantiation.(NotethatthevastmajorityofCDELmembersdonotprovidemoderateenteralsedationtotheirpatients.)Dentalresearchersandscientistswhohavepublishedonthetopicof“routeofsedation”haveconsistentlyconcludedtheexactoppositeofCDEL’scontention:Therearescientificallydemonstratedcrucialdifferencesintheresponseofpatients,andthusthesafetyprecautionsandnecessarytraining,whendentistsuseenteralversusparenteralroutesofsedation.See:http://GetTheScience.comtoreviewjustsomeofthepublished,peer-reviewedarticlesonthistopic.CDELdoesnotprovidecitationsandreferencestopublished,peer-reviewedstudiesthatsupportitscontentionandconclusions.
• Resolution37effectivelyblursthelinesbetweenminimalsedationascurrentlydefined,andmoderatesedation.Asaresult,evendentistswhoconfinetheirpracticestoprovidingminimalsedationmayberequired–inordertofullycomplywiththeguidelinesproposedinResolution37–toundergo60hoursofIVsedationtraining.
• WedonotknowwhatmethodCDELusedtoassertthat“atleast11providerscurrentlymeetorexceed60hoursofinstructionand20patientexperiences.”[Threeofthe11CEcourseproviderslistedbyCDELdonotlistIVsedationcourses:UniversityofAlabamaatBirmingham,AugustaUniversity,andDOCSEducation.]
CDEL’sassertionseemsillogicalonitsfacesincecurrentADAguidelinespertainingtotrainingformoderateenteralsedationcallforonly24didactic
![Page 5: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/5.jpg)
CDELFAQ–FACTCHECK Page 5
hoursand3patientexperiences(alongwithtenclinicalexperiences,ofwhichsevencanbevideos.)
CDELseemstobereferringtoexistingeducationalprogramsaimedexclusivelyatlicensingrequirementsfordentistswhowillprimarilyprovideparenteralsedation.Therearefewerthan150seatsperyearavailablenationwidetodentistswhoseektoacquiresuchparenteralsedationtraining.Therearenoknowncoursesofferedbyanycredibleeducationalinstitution,for-profitornonprofit,thatprovide60hoursofdidactictrainingand20livecasestothosedentistswishingonlytobecertifiedtoprovidemoderateenteralsedation.ShouldResolution37beapprovedbythe2016ADAHOD,the8(verified)parenteralCEcoursesthatCDELcites–basedoncurrentenrollmentcapacity–wouldrequireapproximately200yearstocertifythemorethan30,000dentistswhocurrentlyadministerenteralmoderatesedation,andtheirsuccessors.
[ForMore,SeeQuestion#7andtherelatedFACTCHECK.]
CONCLUSION:TherecommendationsofCDELdonotcomportwiththeADA’sPolicyonEvidence-BasedDentistry,lackingpeer-reviewed,science-backedsubstantiation,orclearclinicalevidence.ShouldCDEL’srecommendationsbeadoptedbytheADA2016HOD,therewillnotbenearlyenoughcoursestomeetthedemandofdentistswhowillneedtobecertifiedascompetenttoadministermoderateenteralsedation.
Q.3.Whyistheconcomitantadministrationoftwodifferentoralmedicationsconsideredmoderatesedation?
CDEL’sCLAIMS:
• TheCouncilstatesthatpotentiationcreatesaneteffectthatisgreaterthantheMRDofeachdrugalone.Itcitesthe2012ADAGuidelinesforTeachingPainControlandSedationtoDentistsandDentalStudents,whichstatethatgivingenteraldrugsabovetheMRDisconsideredmoderatesedation.“Therefore,exceedingtheMRDisalreadyconsideredtobemoderatesedation.”CDELsaysitcouldfindonlythreepublishedpapersrelatedtopotentiationand
![Page 6: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/6.jpg)
©GetTheScience.com
oralsedation:from1986,2007,and2009.Twoofthethreepaper’sofferindirectsupportforitsposition.
THEFACTS:
• CDELagainfailstoadheretotheADA’sownpolicyonevidence-baseddentistry,whichclearlystatesthatintheabsenceofsufficient“clinicallyrelevantscientificevidence,”itmustrelyon“thedentist’sclinicalexperienceandthepatient’streatmentneedsandpreferences.”The1986,2007,and2009studiesareinsufficienttojustifytheproposedchangesembodiedinResolution37,whichCDELtacitlyacknowledges.YetCDELentirelyignorestheextensiveclinicalevidencethatspeakstothedemonstratedsafetyandefficacyofusingpotentiationincompliancewithexistingADAguidelines,meetingtheneedsandpreferencesofliterallymillionsofdentalpatients.ShouldResolution37beapprovedbythe2016HOD,theimpactonroutinedentalprocedureswouldbeunquantifiable.Beforeadentistcouldadministerapatienttwodrugsofanytypeandpotency,thedentistwouldhavetoreceivetheequivalentofanIVsedationpermit:i.e.aminimumof60hoursofinstructionandatleast20individually-managedpatients.CONCLUSION:AdoptingResolution37anditsrestrictionsontheadministrationoftwodifferentoralmedicationswithoutextensiveadditionaltraining,violatestheADA’spolicytoactinaccordancewiththe“patient’streatmentneedsandpreferences.”Thescientificjustificationformakingitmuchharderfordentiststousepotentiation–currentlyawidespreadpractice–isskimpyatbest.
Q.4.Howdothe2016proposedGuidelinesdifferfromtheversionconsideredbythe2015ADAHouseofDelegates?
CDEL’sCLAIMS:
• TheCouncilstatesthat2015’sResolution77and2016’sResolution36arevirtuallyidentical.Themainexceptionisthatthe2016proposedrevisionseliminatereferencestosedationandanesthesiaforchildren.CDELandtheADAdeferexclusivelytotheguidelinessetbytheAmerican
![Page 7: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/7.jpg)
CDELFAQ–FACTCHECK Page 7
AcademyofPediatricsandtheAmericanAcademyofPediatricDentistry(AAPD).
THEFACTS:
• CDELfailstoofferanexplanationforthischange.CDEL’sabdicationofresponsibilityforprovidingitsownpediatricguidelinesraisesimportantunaddressedquestions:1. TheAAPD’sguidelinesgivedentiststheoptionofmonitoringsedation
patientsusingcapnographyorprechordialauscultation.Whythen,doesCDELinsistonmorestringentmonitoringregulationsforadults(capnography)thanitdoesforchildren,whoaregenerallyatgreaterrisk?IfCDELisseriousaboutprotectingpublicsafety,shouldn’tthatapplytoallmembersofthepublic,regardlessoftheirage?
2. Manygeneralpractitionersprovidepediatricsedation,yetarenotmembersofAAPDandhavenotcompletedaPediatricresidency.CDELandResolution37leaveADAgeneraldentalmemberswithoutpediatricsedationguidance.Why?
3. TheCDELproposalmuddiesthewaterwhenitcomestothedefinitionof“children.”Whatageisachildforthepurposesofdentaltreatments?TheADApreviouslydefinedachildas13yearsoryounger.Ithasrescindedthatdefinition.CDELandtheADAnowpuntthequestionofagetotheAAPD,whichinturn,basesitsdefinitionontheAmericanAssociationofPediatrics’(AAP)definition.AAPdefinesachildasanyoneunder21yearsofage.Assuch,isa20-year-oldpatienta“child,”andifso,mustgeneraldentistsnowobtainPALScertificationinadditiontoACLSformoderatesedation?CDELismumonthesequestions.
CONCLUSION:LiketheexplanationforvirtuallyeverycomponentofResolution37,politicalposturing–notscience–appearstobethesolemotivationforCDEL’sdecisiontoallowtheAAPDtosetallguidelinesforpediatricsedation.CDELdoesnotevenfeignascience,evidence-based,orclinicalrationaleforallowingdentistsflexibilitywhenitcomestotheirchoiceofmethodsformonitoringsedatedchildren(capnographyorprechordialauscultation),butnotadults.
![Page 8: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/8.jpg)
©GetTheScience.com
Q.5.InwhatwayswerethedentalanesthesiologycommunitiesnotifiedthattheGuidelineswereunderrevision?Wasthereanopportunitytocommentontheproposal?
CDEL’sCLAIMS:
• TheCouncilnotesthatitheldateleconferenceofferingin-personandphonedopportunitiestotestifyonApril21,2016.Italsoprovidedtwowrittencommentperiods.Theteleconferenceandcommentopportunitieswerepromotedviamultiplechannels,includingdirectemailnotification.CDELlists18dentalanesthesiologycommunitiesofinterestasthosethatwerecontactedandinvitedtoparticipate.Atotalof33writtenandoralcommentswerereceivedand“systematicallyreviewedbytheCouncil.”
THEFACTS:
• CDELoffersnoexplanationforwhytheonlycommunitiesofinterestthatitcontactedwere“anesthesiologycommunities.”Certainly,thosecommunitiesneededtobeincluded.YetthecommunitythatwillbemostgreatlyimpactedifResolution37isapproved,namelypatients,wasnotnotifiedofthehearingorcommentperiods,andwasnotinvitedtoshareitsviews.AstheADA’s“PolicyonEvidence-BasedDentistry”makesclear,thetreatmentneedsandpreferencesofpatientsmustbeconsideredwhenestablishingpracticeguidelines.Forthesecondconsecutiveyear,CDELundertooknostudytodeterminetheimpactResolution37wouldhaveonpatients,patientsatisfaction,andaccesstocare.[ForMore,SeeQuestion#12andtherelatedFACTCHECK.]TheADA’smissionistobepatient-centered,workingforthe“improvementoforalhealthforthepublic.”YetthepublicwasdecidedlyexcludedfromCDEL’sdeliberations.
![Page 9: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/9.jpg)
CDELFAQ–FACTCHECK Page 9
• CDELprovidesnodetailsaboutitssystematicreviewandhowitwasconducted.WereallrespondentstreatedequallyordidtheCouncilgivemorecredencetosomegroupsandlesstoothers?
Ofthe18groupsinvited,oneinparticular,AcademyofGeneralDentists(AGD),representsthelargestnumberofdentistswhoarelikelytofeeltheimpactofResolution37,shoulditbeapprovedbythe2016HOD.AGDmembersnumbermorethan40,000,andaftertheADAitself,AGDisthelargestdentalassociationintheUnitedStates.TheAGDstronglyopposesResolution37andtheadditionalburdensitwouldplaceonitsmembersandpatients.AGDtestifiedtothatandsubmitteddetailedwrittencommentstoCDEL.AGDmembersregularlyusemoderateenteralsedationinthetreatmentoftheirpatients,unlikemostothermembersofCDEL’scommunitiesofinterest.CDELdoesnotdisclosehowits“systematic”reviewofthetestimonyandwrittencommentsofthecommunitiesofinterestweighedtheAGD’scommentsandthevastclinicalexperiencerepresentedbyAGDmembersversus,forexample,theargumentsoftheAmericanAssociationofDentalBoards,theAmericanSocietyofAnesthesiologists,orStateBoardsofDentistry–alsoconsideredbyCDELcommunitiesofinterest.[ForMore,SeeQuestion#8andtherelatedFACTCHECK.]ItshouldbenotedthatwhilemostmembersofCDELarealsomembersoftheAmericanAssociationofOralandMaxillofacialSurgeons(AAOMS),whichstronglysupportsResolution37,AAOMSisnotlistedamongthecommunitiesofinterestthatCDELcontacted.
CONCLUSION:Cosmetically,CDELmadeanefforttosolicitthecommentsandtestimonyofexpertsonthetopic.Butsomeofits“experts”werefarlessinformedonthetopic–andrepresentedfarlessclinicalexperiencewithsedationdentistry–thanothers.
Importantly,CDELrepeatedits2015postureintotallyexcludingpatientsfromitscommunitiesofinterestandfailingtomakeevenacosmeticattempttostudythepracticalandfinancialimpactthatResolution37,ifapproved,willhaveonpatientsandtheiraccesstocare.
![Page 10: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/10.jpg)
©GetTheScience.com
Q.6.Manydentistsholdsedationpermitsissuedbyastatedentalboard.Aredentists’sedationpermitsinjeopardyiftheproposedrevisedADAGuidelinesareadopted?
CDEL’sCLAIMS:
• TheCouncilmaintainsthatthestatelegislaturesanddentalboardsalonehavetheauthoritytoestablishpermit/licenserequirementsbywhichdentistswithanesthesiapermitsorlicensesmustabide.“Thestateboardsdeterminetherequirementsfordentistswhoadministersedation,nottheADA.”
THEFACTS:
• CDEL’sanswerisdisingenuousatbestandmorelikely,outrightdeception.Inmanystates,theADAguidelinesarepartoftheregulatorylanguage,sotheyautomaticallybecomegoverninglaw.Inotherstates,itisallbutaforegoneconclusionthatthedentalboardwillembracetheADAguidelinesandthelegislaturewillvotethemintolaw.ThetruthfulansweristhatifResolution37isapprovedbythe2016HOD,withinafewyears,thousandsortensofthousandsofdentistsnationwidewillberequiredbylawtoobtainnew,stricter,sedationpermitsorsimplystopofferingmoderateenteralsedationtotheirpatients.
CONCLUSION:WhiletheADA,technically,doesnotsetstatestandardsforthosewhoadministersedationandanesthesia,itsguidelines,asadoptedbytheHOD,dobecomelawalmostautomaticallyinmorethanhalfofthestates.ManythousandsofdentalpermitswillbeinjeopardyifResolution37isapproved.
Q.7.WhatCEopportunitiesareavailabletomeethisnewguideline?
CDEL’sCLAIMS:
• TheCouncilsaysitis“aware”ofatleast11CEcourseswithahands-oncomponentthat“may”offerthecoursecontentanddurationasproposedinResolution37.
![Page 11: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/11.jpg)
CDELFAQ–FACTCHECK Page 11
CDELaddsthatitis“confident”thatprovidersofCEonthesubjectofsedationandanesthesiawillenrichtheireducationalofferingstocomplywiththenewguidelines,shouldResolution37beapprovedbythe2016HOD.
CDELgoesontolistthe11courseproviders,includingnon-profitandfor-profiteducators.
THEFACTS:
• GiventhatResolution37,ifapprovedwillrequirethetrainingorretrainingoftensofthousandsofdentists,CDEL’sobviouslackofhardresearchtobackits“confidence”thatcoursesexistorwillbecreatedtomeettheeruptivenewdemandishighlyquestionable.NordoesCDELweighinonthequestionhere,oranywhereinitsFAQ,ofhowmuchsuchcourseswillcost,howmanydaysawayfromtheirpracticedentistswillneedtotaketofulfillthecourserequirements,whattravelexpenseswillbenecessarytoattendthecourses,andwhatdentistsshoulddowhentheyareunabletofindavailableseats.[ForMore,SeeQuestion#12andtherelatedFACTCHECK.]AsnotedintheFACTCHECKforQuestion#2,the8verifiedCEcoursesthatCDELreferences(outofthe11CDELerroneouslylisted)refertoexistingeducationalprogramsaimedexclusivelyatlicensingrequirementsfordentistswhowillprimarilyprovideparenteralsedation.Therearefewerthan150seatsperyearavailablenationwidetodentistswhoseektoacquiresuchparenteralsedationtraining.Moreover,thecoursesareNOTdesignedtopreparedentiststoprovideenteralsedation.Therearenoknowncoursesofferedbyanycredibleeducationalinstitution,for-profitornonprofit,thatprovide60hoursofdidactictrainingand20livecasestothosedentistswishingonlytobecertifiedtoprovidemoderateenteralsedation.CDELmadenoefforttoexplainwhat,specifically,courseprovidersshouldteachduringthe36hoursofadditionaldidactictrainingthatResolution37wouldrequire.(Neithertheadditionaltrainingnecessarytooperatecapnographyequipment,northeadditionalfocusonrescuingpatientsfromalevelofsedationdeeperthanintended,requires36hoursontopofthe24hourscurrentlyrequiredby
![Page 12: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/12.jpg)
©GetTheScience.com
existingADAguidelines,veterandentaleducatorspointout.Formoreinformation,seethetranscriptoftheNationalDentalTownHallheldonOctober10,2016,featuringapaneloffourdentalluminaries.Thetranscriptisavailableat:http://tinyurl.com/Dionne-Transcript.)CONCLUSION:Therearenotandwillnotbesufficientcourses(fordecadestocome)tomeettheneedsofthedentalprofession,shouldResolution37anditsstrictersedationpermitrequirementsbeapproved.CDEL’s“confidence”isnotbasedonathoroughinvestigationofthecapabilitiesofCEproviders.
Q.8.IprovidedcommenttoCDEL;whywasmyadviceoverlooked?
CDEL’sCLAIMS:
• TheCouncilanswersthatwhileit“didnotagreewithallpointsmade,”allinputwassystematicallyreviewedandconsidered.
Inresponsetothefeedbackitreceived,theCouncilacknowledgesthat“themajorityofevidence”itreliedoncameintheformofexpertopinion.
Itfurtherexplainsthat“notonecontrolledclinicalstudyhaseverbeenperformedtodemonstratetheoptimaltrainingtimefordentistswhoprovidemoderatesedation,”addingthatsuchastudy“maybenearlyimpossibletofundorconductortobeclearedbyaninstitutionalreviewboard.”CDELpointstoitsowncouncilmembers’“expertiseincontemporaryeducationalprinciples,”adding,“WerelyonourAnesthesiologyCommitteeexperts…toevaluateanesthesiologyinformationandprovideCDELwiththebestrecommendations.”
THEFACTS:
Whiletherearenotrandomizedcontrolledtrialsorpublished,peer-reviewedstudiesthatbearoneverysingleaspectofADAResolution37,thereare–contrarytoCDEL’sassertion–numerousscientificandevidence-basedjournalarticlesdetailingresearchthatcontradictsCDEL’sposition.
![Page 13: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/13.jpg)
CDELFAQ–FACTCHECK Page 13
See:http://GetTheScience.comtoreviewjustsomeofthepublished,peer-reviewedarticlesonthistopic.Also,notethecitationsofotherrelatedresearchatthebottomofeacharticlepostedatGetTheScience.com.CDELfailstoprovidecitationsorreferencestopublished,peer-reviewedstudiesthatsupportthemajorassertionscontainedinResolution37.
• CDELoffersnoexplanationforhow–intheadmittedabsenceofevenonecontrolledclinicalstudy–itsettledonResolution37’s250%increaseintherequirednumberofdidactichoursthatwillgoverndentistswishingtoprovidemoderateenteralsedation,shouldthe2016HODapprovethenewguidelines.[Resolution37alsoincreasesthenumberofcasesrequiredtobecertifiedformoderateenteralsedationby100%andlivecasesby667%.]
• CDELpresentszeroevidencesubstantiatingthatthecurrentADAguidelines,adoptedbythe2007and2012HOD,areinadequatetoprovideforpatientsafety.
• CDELindicatesthatitfavoredtheexpertopinionsofitsownmembersandmembersofCDEL’sAnesthesiologyCommitteeoverthoseofotherexpertsandorganizationsthatsubmittedtestimonyandwrittencommentsopposedtoResolution37.
Doingso,onceagain,fliesinthefaceoftheADA’s“PolicyonEvidence-BasedDentistry,”whichdoesnotplacetheexpertiseofADAmemberswhoareappointedtovariousADACouncilsandCommitteesaheadofscience,peer-reviewedresearch,theclinicalexperienceofdentists,orthetreatmentneedsandpreferencesofpatients.ServiceonADACouncilsandCommitteesisvitaltotheorganizationbutdoesnotconfersuperiorknowledgeorexpertiseonCouncilandCommitteemembers.• AmongthosewhoseexpertviewsandclinicalexperienceCDELconsidered
butfeltsufficientlycompetenttoignoreinpartorinfullare:
o AcademyofGeneralDentistryrepresentingmorethan40,000dentists,includingthelargestnumberofdentistsofanydentalgroup(otherthantheADA,itself)thatalreadyusemoderateenteralsedationintheirpractices.
o AmericanAcademyofPediatricDentistryrepresenting9,900memberswhoserveasprimarycareandspecialtyprovidersformillionsofchildren
![Page 14: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/14.jpg)
©GetTheScience.com
frominfancythroughadolescence.
o AmericanDentalSocietyofAnesthesiologyrepresenting5,000memberswhoprimarilyengageinthepracticeofanesthesiologyindentistry,eitherlocalorgeneral.
o AmericanSocietyofDentistAnesthesiologistsrepresentingapproximately4,500dentistswhohavecompletedaminimumoftwoyearsoffull-timepostdoctoraltrainingindentalanesthesiology.
o DOCSEducation,whichhastrainedmorethan20,000dentistsinsedationdentistrytechniquesthatcomplywithexistingADAguidelinesandstateregulations.Morethan20millionAmericanshavereceivedcarefromDOCSEducation-traineddentists,whoconformtothecurrentADAGuidelines,withoutincident.
o RicklandG.Asai,DMD,11thDistrictADATrusteerepresentingAlaska,Idaho,Montana,Oregon,andWashington.Dr.Asai,anadvocateforaccesstoaffordabledentalcare,isoneofeightADATrusteeswhoinAugust2016votedagainstallowingResolution37tocomebeforethe2016HOD.
o TheCaliforniaDentalAssociationrepresentedbyGayleMathe,CDAPublicAffairs.
o IdahoStateDentalAssociationrepresentedbySusanMiller,executivedirector,andJohnE.HiselJr.,DDS.
o TexasAcademyofGeneralDentistryrepresentedbyBrookeElmore,DDS,FAGD,TAGDAdvocacyCouncilChair.
o Dr.MarkWalker,chairofaneight-membertaskforceorganizedbyDr.LindaWilliamsandcomposedofrepresentativesfromeachofthefivestatesinADADistrictXI.Dr.Williams,CaucusChair,ADADistrictXI,submittedseparatewrittencommentstoCDEL.
o RaymondDionne,DDS,PhD,aleadingpainscientistanddentaleducatorwhohaspublishedmorethan100scientificmanuscriptsrelatedtohisworkonpainandpaincontrol.Hiscareerincludesmorethan20yearsofprivatepracticeexperienceandmorethan30yearsofclinicalresearch.HewasaninvestigatorintheNationalInstituteofDentalandCraniofacialResearchfor25years,wherehealsoservedasChiefofthePainandNeurosensoryMechanismsBranchandClinicalDirector.
![Page 15: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/15.jpg)
CDELFAQ–FACTCHECK Page 15
o FredQuarnstrom,DDS,FASDA,FAGD,FICD,FACD,CDC,whohastaught253nitrousoxidesedationcoursesand117oralconscioussedationcourseswithorwithoutnitrousoxidesedation.Dr.Quarnstromhaspublishedmorethan50papersonsedationandwrittenchaptersinthreebooksonfearandpaincontrol.
o AnthonyCarroccia,DDS,MAGD,ABGD,ageneraldentistwhopossessesaComprehensiveConsciousSedationPermitinTennesseeandservesontheTDACommitteeforAnesthesia,SedationandScopeofPractice.Dr.Carrocciateachesnitrousoxide-oxygenmonitoringcoursestoassistantsandadministrationtohygienists.In2009,Dr.CarrocciawasnamedtheNationalSedationSafetyDentistoftheYear.
o MartinElson,DDS,ImmediatePastPresidentoftheRhodeIslandOralandMaxillofacialSurgeonsandChristyD.Durant,Esq.,LegalCounselfortheRhodeIslandOralandMaxillofacialSurgeons.
o RockyL.Napier,DMD,FACD,FICD,FPFA,amemberoftheAmericanAcademyofPediatricDentistryandAmericanAcademyofPediatrics,andPresident-ElectoftheSouthCarolinaDentalAssociation.Dr.Napierprovidedmorethan$640,000offreeanduncompensatedcarein2015alone.
CONCLUSION:CDEL’srelianceonitsownmembers,membersappointedtoitsAnesthesiologyCommittee,andhand-selectedoutsideexpertsraisesimportantquestionsofbias.WhydidCDELgivetherecommendationsofcertainindividualsandgroupslegitimacytothetotalorpartialexclusionofotherclearlyqualifiedexpertsandorganizations,suchasthoselistedabove?CDELoffersnospecificswhatsoeveraboutwhatits“systematic”evidentiaryreviewprocessconsistedof,nordoesitprovideadetailedlistofpublishedcitationstosupportisconclusionsandrecommendations.ThelackoftransparencyinCDEL’sprocess–especiallyafterinvitingpubliccommentandtestimony–underminestheCouncil’scredibility,andcallsintoseriousquestionthescientific,evidence-basedvalidityofResolution37.
![Page 16: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/16.jpg)
©GetTheScience.com
Q.9.Whyisthenewdefinitionofoperatingdentistproposed?
CDEL’sCLAIMS:
• TheCouncilsaysthatchangingthedefinitionto“operatingdentist”from“qualifieddentist”–asproposedinResolution37–isintendedtobringclarityinthefaceofsomestatelegislaturesandregulatorswhohavesetspecificdefinitionspertainingtotheclinicaloperativedentistwhoworkswithananesthesiaprovider.CONCLUSION:ThisisachangethatappearsbenignandunlikelytoimpactADAmembersortheirpatients.IftheredefinitionwasproposedseparatelyfromtheotherprovisionsofResolution37,itisunlikelythenewterminologywouldfacemeaningfulopposition.
Q.10.HowmanystatescurrentlyrequiredentiststomonitorexpiredCO2viacapnographyduringmoderatesedation?
CDEL’sCLAIMS:
• TheCouncilnotesthatatleast15states“mention”capnographyintheirlawsorindentalboardpolicyformoderatesedation,“eitherasarequirement,amonitoringoption,orasaproposedregulation.”
THEFACTS:
• CDELcouldhave,butchosenotto,describealongwitheachofthe15statesitciteswhetherthementionsarespecificallyaboutmonitoringasarequirement,option,orproposal.Itmakesadifference,especiallyinclarifyinganissueascontentiousasResolution37.
GivenCDEL’sopenadvocacyforResolution37,itissafetoassumethatifamajorityofthe15statesnotedbyCDELcurrentlyrequirecapnography,CDELwouldhavesaidasmuch.
CONCLUSION:Thirty-fivestatesdoNOTcurrentlyevenmentioncapnographyasamonitoringoption.Moreover,CDELfailstoinformADAmemberswhichstate
![Page 17: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/17.jpg)
CDELFAQ–FACTCHECK Page 17
orstatesabsolutelyrequireit.CDEL’slackoffulldisclosureonthismattersmacksmoreofapanelofbiasedadvocatesthananimpartialcouncilofexpertstryingtopresentunbiasedfactstothe2016HOAandotherADAmemberssothattheycanmakeaninformeddecision.
Q.11.Whatistheapproximatecostofacapnography?Q.12.Willthesenewguidelinesincreasethecostofdentalcareordecreaseaccesstocareforsomepatients?
CDEL’sCLAIMS:
• TheCouncilstates,“ingeneral,acapnographcanrangeinpricefrom$800-$3,000.”[Question11]
CDELthencitesitsownestimatetoconclude,“Theequipmentneededtomonitorend-tidalCO2shouldnotappreciablyincreasethecostofdeliveringmoderatesedationordecreaseitsavailabilitytopatients.”[Question12]CDELlabelsthe$800-$3,000equipmentcostas“areasonableinvestmenttoidentifymorerespiratorycomplicationsandsupportriskmanagementandpatientsafety.”
• CDELstatesunequivocally,“Thereisnoevidence*demonstratingthatthecostofcarewillincrease,thatpatientaccesstosedationwilldecreaseorthatthenumberofsedationpermitswilldecrease”shouldthe2016HODapproveResolution37.
THEFACTS:
• CDELdeliberatelyignoresthesalientfactthatthecostofcapnographyequipmentistheleastonerousofthecostsassociatedwithResolution37.ShouldResolution37beapprovedbythe2016HOD,dentistswhowishtoprovidetheirpatientsmoderateenteralsedationwillhavetobuythecapnographyequipment;trainthemselvesandtheirteamonitscorrectusage;paytuitiontoenrollina60-hourcoursetoqualifythemtoprovidemoderateenteralsedation;beawayfromtheirpracticeforanextendedtimeto
![Page 18: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/18.jpg)
©GetTheScience.com
completethecourseanditsrequirementtoparticipatein20livetrainingcases;andpayfortravel,meals,andhotelshouldthecoursebeofferedinan‘away’venue. CDELalsodoesnotcalculatethecoststodentistsofbeingunabletoprovidemoderateenteralsedationtopatientsifthedentistsareunabletoenrollinacourseonatimelybasis,eitherduetothedentists’ownschedulingconflicts,orthelackofavailabilityofsufficientCEproviders.
• CDELcanonlyclaim*that“thereisnoevidencedemonstratingthatthecostofcarewillincrease”becauseitmadenoeffortin2015or2016toconductevenasuperficialeconomicimpactstudytodeterminetherealcostsofResolution37todentists,andhowthosecostswillbepassedalongtopatients.WhiletheADA’smission,since1859,hasbeentobea“patient-centered”association,CDEL’sassertion–withoutoneiotaofsupportingevidence–thatResolution37willnotimpactthecostoravailabilityofcaredishonorsthatmissionstatement.Oneneedn’tbeaneconomisttounderstandthatwhendentistsarerequiredtoinvestheavilyinadditionalout-of-officeeducation–suchasrequiredbyResolution37,impacteddentistswillneedtofindawaytorecouptheirexpensesandlostproduction.Charginghigherfees,withtheconcomitantburdenthatplacesonpatients,iscertaintoreduceaccesstocare.GivenResolution37’srequirementsthatincreasethenumberofdidactichoursrequiredtoprovidemoderateenteralsedationby250%;thenumberofcasesby100%;andthenumberoflivecasesby667%;itisonlylogicaltobelieve–despiteCDEL’sunsupportedcontention–thatmanydentistswillopt,instead,tosimplystopobtainingsedationpermits.*In2015andagainin2016,TEAM1500issuedasummaryofitsowneconomicimpactstudyforecastingtheeffectondentistsandpatients,shouldADAResolution37(originallycalledResolution77)beapproved.ThestudywasconductedbetweenJuneandSeptember2015,drawingondataandcalculationsobtainedfromacross-sectionofpracticingoralhealthcareprofessionals,dentalschoolacademics,regulatoryexperts,andfinancialforecasters.ThestudywasheadedbyDeanRotbart,aPulitzerPrize-nominatedfinancialjournalistandformerinvestigativereporteratTheWallStreetJournal.
![Page 19: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/19.jpg)
CDELFAQ–FACTCHECK Page 19
AmongTEAM1500’sfindings:
o Higherdentalfeesandlongerwaittimestoseeaqualifieddentistwilldrivepatientsawayenmasse.Withinfiveyears,anestimated250,000patientswhocurrentlyvisitadentistonaregularbasiswillstopgoing.
o ThecostoftrainingrequiredbyResolution37willrunashighas$50,000ormoreperdentist,whentuition,travel,andlostproductivityareincluded.
o Thetotalnumberofdentistsavailabletoprovidesedationdentistrywill
declineby5%to7%annually,factoringintheretirementandattritionofexistingdentists.Withinfiveyears,thenumberofgeneraldentistswhoarequalifiedtoprovidemoderateenteralsedationcoulddeclinebymorethan30%nationwide.
TEAM1500,formedin2006,advocatesonbehalfofpatientsandaccesstoaffordablehealthcare.TEAMisanabbreviationofTrustforEqualAccessMedicine.Thegroupisacoalitionofmorethan1,500healthcareprovidersandothersconcernedwithpatients’rights.
CONCLUSION:CDEL’sfocusonthecostofcapnographyequipmentinthesetwoFAQquestionsisaformofmisdirection.Itisthetrainingcosts,lostproduction,andrelatedtravelexpensesthatneedconcerndentists,notonlyfortheirowneconomicwell-beingbutalsoforthefinancialwell-beingoftheirpatients.
CDEL’scontentionthat“thereisnoevidence”demonstratingtheeconomicimpactondentistsandtheirpatientsignoresathree-monthindependentanalysisundertakenbyaformerWallStreetJournalreporterandapatients’rightsgroup.In2015and2016,CDEL,itself,madenoeffortwhatsoevertoconductastudytogaugethelikelyimpactofResolution37onpatients.
Q.13.WhenandwhyweretheSedationandAnesthesiaGuidelinesdeveloped?
CDEL’sCLAIMS:
• TheCouncilstatesthattheGuidelines,whichhavebeenrevisedtentimessincetheywerefirstestablishedin1971,areintendedto“assistdentistsinthedeliveryofsafeandeffectivesedationandanesthesia.Therevisions“reflectemergingpracticeandscientificprinciples.”
![Page 20: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/20.jpg)
©GetTheScience.com
THEFACTS:
• TheexistingADAGuidelinesgoverningtheuseandteachingofsedationandanesthesiawerelastsignificantlyrevisedin2007andapprovedbythe2007HOD.(In2012,theGuidelineswereminimallyrevisedagainbytheHOD.)Incompliancewiththe2007/2012Guidelinesandapplicablestateregulations,tensofmillionsofpatientshavereceivedmoderateenteralsedationtreatmentssafely,effectively,andwithoutincident.The2007/2012Guidelines,inaccordancewiththestatedpurposeforsuchguidelines,doreflectemergingpracticeandscientificprinciplesandarewidelysupportedbythedentistswhoregularlyadministermoderateenteralsedation.
• TherevisionstotheuseandeducationguidelinesproposedinResolution37,unlikethoseadoptedin2007/2012,doNOTreflectemergingpracticeandscientificprinciples–andtheyareopposedbyvirtuallyalldentistswhoactuallyadministermoderateenteralsedationtopatients.Moreover,thereisnosupportivesciencewhatsoeverforthepreponderanceoftherecommendedrevisions,andCDELhasnotproducedanysupportiveevidence-basedresearchtosubstantiateitsrecommendedGuidelinerevisions.TheexistingpracticeandclinicalevidencepertainingtosedationandanesthesiaoverwhelminglynegatetheneedforResolution37.TherevisionscontainedinResolution37wereconceivedanddraftedbyoralsurgeons,academics,andotherADAspecialistswhodoNOTprovidepatientsmoderateenteralsedation.TheseCouncilandCommitteemembersdonotqualifyasrepresenting“emergingpractice”clinicians.CONCLUSION:CDEL’scharteristoupdatetheADA’suseandteachingguidelinesforsedationasneeded.InResolution37,CDELhasproposedbroadunneeded,unjustified,andscientificallyunsoundchangestotheexistingADA2007/2012Guidelinesthathaveproven–aboveandbeyonddispute–toprotectpatientswhendentistsadministermoderateenteralsedationinaccordancewiththeexistingGuidelines.
![Page 21: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/21.jpg)
CDELFAQ–FACTCHECK Page 21
Q.14.WhatistheprocessforproposingrevisionstotheHouseofDelegates?
CDEL’sCLAIMS:
• TheCouncilnotesthatinkeepingwithadirectivefromtheHouseofDelegates,itreviewstheADA’ssedationandanesthesiaguidelineseveryfiveyears.Itcites“changesinpracticeandscience”toexplainthereasonstheguidelineshaverecentlybeenupdatedmorefrequently.CDELnotesthatalongwithitsAnesthesiologyCommittee,itsseeksinputfromthe“anesthesiacommunitiesofinterest.”ItfurtherexplainsthatitsAnesthesiologyCommittee,whichcarefullystudiestheissuesandprovidestechnicalandscientificinputtoCDEL,includes“representativesfrom”:
o AmericanAcademyofPeriodontologyo AmericanAssociationofOralandMaxillofacialSurgeonso AmericanDentalSocietyofAnesthesiologyo AmericanSocietyofDentistAnesthesiologistso AmericanSocietyofAnesthesiologistso AmericanAcademyofPediatricDentistry
Thisyear,CDELadds,amemberoftheADA’sCouncilonScientificAffairsalsoparticipatedincommitteemeetings.CDELwritesthatit“considerstheCommittee’srecommendationsandcirculatesproposedrevisionstoitsdentalanesthesiologycommunitiesofinterest.”
THEFACTS:
• ThecompositionofCDELanditsAnesthesiologyCommitteeisheavilyweightedtowardoralsurgeonsandotherspecialists,andgreatlyunderrepresentedbygeneraldentistsandthosewhoregularlyusemoderateenteralsedationinaclinicalsetting.
ThereisnomandatefromtheHouseofDelegatestoexcludegeneraldentists.NordoestheHODdictatethatinconsideringitsactions,CDELshouldonlyrelyon“dentalanesthesiologycommunitiesofinterest.”ThedominanceofspecialistsontheCommitteewarpstheobjectivityoftheentireprocess.Thelackoftransparency,especiallyasitpertainstothespecific
![Page 22: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/22.jpg)
©GetTheScience.com
changesin“practiceandscience”thatCDELcites,invitesquestionsastowhetherCommitteemembersareactingsolelyinthebestinterestsofpatientsafety.
• CDEL’swordingmightbeinterpretedtoindicatethattheAnesthesiologyCommitteeiscomprisedofdesignated“representativesfrom”thevariousanesthesiologygroupsitslists–meaningthattheoutsidegroupsselectedamembertorepresentthem.It’sunclearifthisisthecase.
AnotherinterpretationofCDEL’swordingisthatmembersoftheAnesthesiologyCommitteearealsomembersofthevariousoutsideanesthesiologyassociations,butnotofficiallydesignatedrepresentativeofthosegroups–andwithoutanysuchofficialstanding.
• The800-poundgorillaintheroom,whichCDELfailstoaddressinitsresponsetothisquestionandthroughoutits15-QuestionFAQ,iswhyCDELisfocusingon,andmakingrecommendationspertainingto,moderateenteralsedation,whentheoverwhelmingmajorityofdentalfatalitiescitedinthegeneralnewsmediaoverthepastdecadehavetakenplaceinpracticesusingdeepsedation/generalanesthesia–notmoderateenteralsedation.Ifthereisanyareaofdentistrythatcriesoutforcloserscrutinyandpossiblystrictertrainingandpracticeguidelinesitisdeepsedation/generalanesthesia.Oralsurgeryisthesoledisciplineinallfieldsofmodernmedicinethatallowsdoctorstoadministerdeepsedation/generalanesthesiawhilealsoperformingtheprocedure.LegislatorsinCaliforniaunanimouslyapprovedabillinAugust2016,popularlyknownasCaleb’sLaw,thatspecificallywouldestablishacommitteetostudythesafetyofpediatricanesthesia.Thebill’ssponsorshavestatedthattheyfindit“disconcerting”thatoralsurgeonsarenotrequiredtotreatpatientsusingaseparateanesthesiaprovider.Caleb’sLawdoesnotconcernmoderateenteralsedation.YetCDELanditsAnesthesiologyCommittee,comprisedprimarilyoforalsurgeons,doesnotevenraisetheissuesthatareatthecenterofCaleb’sLawandtragediesimpactingdentalvictimsinoralsurgeons’officesnationwide.Why?
CONCLUSION:CDELdoesnotappeartobeactinginthebestinterestsofalldentistsandtheirpatientsasitsonlypriority.CDEL’sarbitraryinclusionofsomeexpertsandevidence,andexclusionofothers,taintsitsrecommendationsandconclusions.
![Page 23: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/23.jpg)
CDELFAQ–FACTCHECK Page 23
Themostseriousissuefacingprofessionaldentistryandpublicsafetysurroundsdeepsedation/generalanesthesia–notmoderateenteralsedation.TheverycredibilityoftheADAasachampionofevidence-basedscienceandpublichealthisthreatenedbyCDEL’sactionandtheduplicityofResolution37.
Q.15.WhatinformationwasusedtodeveloptheproposedrevisedGuidelines?
CDEL’sCLAIMS:
• TheCouncilrespondsthatitsCommitteeonAnesthesiology“reliedoncurrentstandardsofcare,guidelinesofothermedicalanddentalorganizations,thescientificliterature,currentstateregulationsforsedation,andtheexpertiseofpractitioners,academiciansandstatedentalboardmembers…”
THEFACTS:
• Tensofthousandsofdentistsregularlyusemoderateenteralsedationintheirpractices,inaccordancewithexistingADAguidelinesandfullcompliancewithstateregulations,safelyandwithoutincident.TheexpertsthattheCommitteeonAnesthesiologyandCDELreliedupon,withscantfewexceptions,havelittleifanyexperiencewithmoderateenteralsedation.Asaresult,asmallgroupof“textbook”expertsisattemptingtodictatetoamultitudeofADAmemberswithsubstantialclinicalexperiencehowtobestprotecttheirpatients.
Anyefforttoreflexivelyimposesedationstandardsfromthemedicalcommunityonthedentalcommunityismisguided.Dentistryhasalonganddistinguishedrecordofsettingthestandardforsafe,effective,sedationandanesthesia.Manydentalsedationstandards,includingthecommonuseofNitrousOxide,donotconformtomedicalstandards.Likewise,dentistrystandsaloneamongallmedicalfieldsinpermittingasingledentisttoadministerdeepsedation/generalanesthesiawhilealsoperformingtheprocedure.AmongalltheexpertsCDELcites,notasinglegrouprepresentingthosewhoregularlyusemoderateenteralsedationsupportsResolution37ormaketheargumentthatrevisionstotheexistingADAsedationguidelinesareessentialtoprotectpatientsafety.
![Page 24: Fact Check Finds Serious Flaws in ADA Report Concerning ... · CDEL FAQ – FACT CHECK Page 3 on behalf of a member of the Council on Dental Practice on July 7, 2016: “In my opinion,](https://reader033.vdocument.in/reader033/viewer/2022050205/5f58c8cfbd4a8048e5228a1a/html5/thumbnails/24.jpg)
©GetTheScience.com
Thoughit’sdoubtfulthatCDELintendstoinsultthelargegroupofdentistswhocurrentlyusemoderateenteralsedationintheirpractices,CDELignoresthetruth:ThesededicateddentistswhousemoderateenteralsedationwouldbetheveryfirsttodemandchangesintheexistingADAguidelinesiftheyfelttheirpatientswereatrisk.
• CDELassertsthat“currentstandardsofcare,”“thescientificliterature,”and“currentstateregulations”areamongthesourcesthattheCommitteeonAnesthesiologyanditreliedon.
Wefindnoobjectiveevidencetosupporttheassertionthatthesethreesources,inparticular,offervalidationoftherevisionsproposedinResolution37.Onlythoseexpertswhodon’tprovidetheirpatientswithmoderateenteralsedation–andhavenoprofessionalexperienceadministeringit–appearconvincedthattheexistingguidelinesgoverningthiscommonformofsedationareinsufficient.
CONCLUSION:CDELfailedtoweighorplacesufficientweightonthevastclinicalexperiencesofthetensofthousandsofdedicateddentistswhoregularlyusemoderateenteralsedationintheirpractices.Instead,theCouncilturnedto“textbook”expertswhoseemcompelledtorecommendthechangesproposedinResolution37forchangesakealone.ThereisnopublichealthcrisisinenteralsedationdentistryandnocompellingneedforResolution37.
[EndofDocument]