An achievable goal with far-reaching benefits
There are several reasons why dentists—both newly graduated and seasoned clinicians—seek to expand their offerings to include sedation dentistry, not the least of which is the opportunity to make a positive impact in the lives of high-fear patients.
What some may not realize, however, is that the rapidly evolving regulatory environment makes achieving your sedation certification a timely consideration.
Why sedation dentistry?
A growing percentage of the population avoids dental treatment because of anxiety and fear. Somewhere between 50%–80% of adults in the United States have some degree of dental anxiety, ranging from mild to severe.1 More than 20% of dentally anxious patients do not see a dentist regularly, and anywhere from 9%–15% of anxious patients avoid care altogether.2 When these patients have a “trigger moment” that forces them to seek treatment, they often present with serious issues that have accumulated over years of little to no professional dental care. Their treatment plans are complex, and the time investment needed to treat all the issues is much higher than average.
Sedation dentistry is often the most painless solution, allowing a dental office to complete a significant amount of treatment during a single sedation appointment: extractions, restorations, implants, bone augmentation, periodontal therapy, etc. Sedation dentistry opens the opportunity to make a substantial difference in the lives of these high-fear patients. The amount of care that can be completed when the patient is sedated often has a profoundly positive effect on each patient’s self-confidence.
The business side
With sedation qualifications, you can market yourself and your practice to a wider audience and generate revenue from a wider range of services, including to patients needing invasive procedures you might otherwise refer out to specialists.
The ability to combine oral and IV sedation will make your day more efficient and allow you to reach and satisfy the needs of medically complex patients and patients who do not respond quickly enough, or long enough, to oral sedatives alone.
For those taking the route of joining an already established practice, securing one’s sedation certification can make a lot of sense. Established dentists are more likely to hire an associate with sedation certification than one without. In many areas of the country, sedation certification (especially moderate sedation, such as IV certification) is competitive, rare or nonexistent, giving you greater negotiating power.
The winds of regulatory change
Ever since the revised ADA Guidelines for the “Use of Sedation and General Anesthesia by Dentists” came out in October 2016, regulatory changes have been rapid, with requirements varying from state to state.
According to these guidelines, the administration of “local anesthesia, sedation and general anesthesia is an integral part of the practice of dentistry.”
Currently, at least 18 states specifically reference the guidelines in their regulations, and other states are in the process of reviewing them in contrast to their current regulations. While the ADA Guidelines may be considered the national standard, some states have adopted even more restrictive regulations, and many others are poised to follow suit. More and more states are adopting guidelines requiring advanced sedation certification, regardless of route of administration, whether enteral (oral) or parenteral (intravenous).
Recent changes in Utah exemplify a nationwide trend: Dentists who provide oral sedation to their fearful and anxious patients are losing their ability to do so unless they obtain an IV sedation permit. Early in 2020, Utah will eliminate Class II and Class III sedation permits entirely. The only way for dentists to continue offering oral sedation with more than one drug in Utah will be to complete 60 hours of fresh didactic study and 20 live cases. No exceptions.
What level is right for you?
There are two levels of continuing sedation education (a third level—deep sedation/general anesthesia—requires a residency).
Minimal sedation: Requires a 16-hour minimum training, laying the foundation for providing safe and comfortable dental care using nitrous oxide with a single-drug oral sedative. There are a number of training options, including those integrating online instruction, for gaining minimal sedation certification. However, because this level is restricted to a maximum recommended dose (MRD) as printed in FDA-approved labeling for unmonitored home use, the chances of success, particularly with medically complex or analgesic-resistant patients, are significantly hampered.
Moderate sedation: There are no dosage restrictions for moderate sedation (one can exceed the MRD), which increases the opportunity to help patients for whom minimal sedation would not suffice. Moderate sedation certification requires a minimum of 60 hours of didactic instruction, plus at least 20 live-patient experiences as recommended by ADA Guidelines and most state dental boards.
Included in the moderate sedation category is IV sedation certification, which qualifies dentists to provide comfortable and effective treatments for patients needing elevated care and pain management. Upon completion of an IV program, the dentist should have the knowledge, clinical skills and qualifications to properly select and safely administer effective parenteral and enteral minimal and moderate sedation in outpatient dental settings. IV sedation certification covers everything short of deep sedation or general anesthesia and allows the dentist to continually adjust the level of sedation.
States differ in their requirements to practice sedation dentistry—regulations vary, and changes are regularly occurring. Providers who are certified in IV sedation may be in higher demand in these states and their ability to provide sedation is better protected against regulatory changes.
How do I get certified?
To obtain your IV certification, follow best practices by seeking out a continuing education course that is CODA-accredited. A significant number of state regulatory bodies require the certificate be issued by a CODA-certified institution to qualify for a permit.
Certification programs are offered by various organizations in three main formats:
- Those providing the didactic and clinical portions over several long-weekend visits to a training site.
- Courses requiring a multiday, one-time visit (usually 10–14 days).
- Flexible and convenient courses that provide a home-study option for the didactic portion and a separate, on-site clinical training that can be completed in as little as four days over a long weekend.
With the current regulatory climate, dentists who delay seeking out sedation certification may also delay opportunities. Because regulations are continuing to change in states across the country, studying for and obtaining an IV sedation certification could be the most important and productive decision for a practicing dentist. The benefits to one’s practice, in terms of increasing their treatment-providing opportunities and potential to grow the business, alone make certification worth looking into.
1. Kamin V. Fear, stress, and the well dental office. Northwest Dent. 2006; Mar-Apr; 85(2):10-1,13,15-8
2. Randall C, Shulman P, Crout R, McNeil D. Gagging and its associations with dental care-related fear, fear of pain and beliefs about treatment. J Am Dent Assoc. 2014 May; 145(5):452-457