The “Forever Permit®” for Your Dental Practice

Many surprising benefits await general dentists, endodontists, and periodontists who complete the training necessary to obtain their IV Sedation permits. Increasingly, state regulators require IV Sedation permits for all dentists who moderately sedate their patients, whether enterally or parenterally.

The winds of change are upon the dental profession. And although they are casting a dark cloud over thousands of sedation dentistry practices, there is – read on – a silver lining.

The Cloud:

Veteran doctors – men and women who’ve worked for years to establish successful practices – especially those serving fearful patients or those needing extensive restorative work – overnight are being told by their state regulators that they are no longer “qualified” to provide moderate enteral sedation.

Like an infection, tighter regulations are spreading from one state to another. Ohio, Michigan, Pennsylvania, Florida, Iowa, and Nevada are among the early ones to adopt stricter rules for sedation dentistry. Dentists in New York, Virginia, Louisiana, North Carolina, and West Virginia are more recently affected. And even more states are showing signs of following suit.

In short, despite a vast amount of clinical and scientific evidence to the contrary, regulators have bought into the fallacious argument that sedation is sedation, regardless of the route of administration. As such, they’ve reasoned, the didactic and clinical training requirements for moderately sedating a patient should be the exact same, whether the dentist is administering the sedation enterally or parenterally.

The American Dental Association, urged on by a small group of oral surgeons and other influential members, adopted new sedation guidelines a year ago – Resolution 37 – that recommend 60 hours of IV classes and 20 live-patient experiences for all dentists who wish to provide their patients moderate sedation, regardless of the route of administration.

In the majority of these “Resolution 37” states, it makes zero difference how many dozens or even hundreds of patients a dentist has already treated safely, effectively, and without incident, using moderate oral sedation. Nor does it make a difference how many related courses – including BLS, ACLS, and PALS – a dentist has completed.

If dentists in these states don’t return to the classroom and successfully complete a 60-hour IV course, they can no longer provide moderate sedation to any of their patients. Period.

We call an IV sedation permit “The Forever Permit®” because the training necessary to obtain one meets the current and anticipated moderate sedation standards for all 50 states.

The Silver Lining – Part I:

As a child, many of us had the experience of our parents pushing us to eat one vegetable or another, which we thought foul, but they argued was “good for us.” As adults, we realize they were right.

In like fashion, taking a 60-hour IV sedation course, when all that the majority of sedation dentists want to do is continue to provide their patients moderate enteral sedation as they always have, is foul. But as hard as it may be to swallow, there actually are two important reasons why Resolution 37 regulations are “good for us.”

The first reason we’ve dubbed, “The Forever Permit®.” Like Forever® postage stamps, that can always be used for first-class mail regardless of future postal price increases, once you do bite the bullet and obtain your IV sedation permit, you’re set for the duration of your professional life.

Does that mean that you will never again have to take a continuing education course? No. Of course, not.

We call an IV sedation permit “The Forever Permit®” because the training necessary to obtain one meets the current and anticipated moderate sedation standards for all 50 states. It is a type of dental practice continuation insurance. It ensures you, as much as is humanly possible to do, that your foundational sedation training will never again be questioned for its adequacy, nor so cavalierly annulled.

Regardless of which state you practice in, once you obtain your IV Sedation training from a quality provider – (yes, DOCS Education) – you will be able to continue offering moderate enteral sedation without interruption.

The Silver Lining – Part II:

The comparatively few general dentists who already have advanced training in enteral sedation, as well as IV sedation permits, have found that their IV training has served them and their patients well.

Both of DOCS Education’s lead instructors for our IV Sedation course – Anthony S. Feck, DMD, who oversees classroom training, and Jerome Wellbrock, DMD, MAGD, who supervises clinical training – “blend” enteral and IV sedation in treating many of their patients, especially those who are fearful of seeing a dentist.

With an IV permit in hand, the enteral protocols used and taught by Drs. Feck and Wellbrock, are very similar to those taught in DOCS Education’s basic and Master Series advanced adult oral sedation classes.

A properly trained dentist, with an IV sedation permit, can safely titrate the sedative until the patient is comfortable and pain-free.

After carefully screening the patients for suitability, the patients are prescribed an oral sedative to take the night prior to an appointment, and then administered another oral sedative in office about one hour before the actual procedure.

The improvement begins – both for patients and doctors – when the dentist is able to start an IV line on the patients, even those who fear needles, once the patients are in a relaxed state, thanks to the oral sedatives.

The IV line permits the trained dentist to more closely regulate the amount of sedatives administered to the patient, and because the administration is now parenteral, it creates its desired effect on the patient more rapidly than can an enteral sedative.

With oral sedatives, dentists may – as necessary – administer incremental doses of sedation during a procedure, up to a state-regulated maximum dosage. If that maximum dose is reached, and the patient is not sufficiently sedated, the dentist has no choice but to cease treatment for that day and schedule a subsequent appointment.

Not so with IV sedation. A properly trained dentist, with an IV sedation permit, can safely titrate the sedative until the patient is comfortable and pain-free. While prudence dictates that dentists take care not to over-sedate a patient using an IV, dentists have much greater flexibility in deciding what the appropriate IV sedation dose is for each patient.

Sedatives administered by IV have another advantage over enteral sedatives: they do not linger as long in a patient’s system. And should a patient ever require a benzodiazepine or opiod reversal agent, such as flumazenil and naloxone, the IV line allows the dentist to quickly administer the antidote.

Additional Benefits:

Without a doubt, a sedation dentist who goes through the trouble of obtaining an IV Sedation permit, will be able to attend patients who in the past the dentist had to refer out.

This includes ASAIII+ patients who suffer from asthma, diabetes, bleeding disorders, and other serious medical conditions. The DOCS Education IV Sedation course instructs dentists how to treat such patients and incorporate the appropriate IV sedation protocols. (The course also covers American Heart Association advanced airway management and qualifies for ACLS certification.)

Moreover, patients who previously had to be referred out because their emotional or mental state was not conducive to having them wait in the chair until an enteral sedative calmed them sufficiently, will often respond well to the rapidly effective IV sedation. (Having taken an oral sedative the night prior to the appointment – and perhaps an hour before the treatment begins – boosts the efficacy of the parenteral sedative and thus reduces the time necessary to calm an extra-anxious patient.)

Even for those dentists who have NO PLANS to incorporate IV sedation into their existing practices, the in-depth physiological, pharmaceutical, scientific, and clinical education that is required of those taking the IV Sedation course makes every graduate a much, much better-prepared general dentist.

Practical Considerations:

Many dentists, especially those who currently only use moderate enteral sedation on occasion in their practices, will have a choice as to whether to take the DOCS Education IV Sedation course. Other dentists, especially those whose patient population would be devastated should they lose the right to utilize moderate enteral sedation, will have little choice but to register – sooner or later – to qualify for an IV permit.

How much of a disruption it is to take the DOCS Education IV Sedation course is a matter of perspective.

Even those dentists who live in a state that hasn’t adopted the stricter Resolution 37 regulations, and isn’t yet showing signs of embracing them, cannot trust their future, and the future of their patients, to hope.

Yes, to complete the didactic portion of the course, 60 hours, requires a dentist to attend two 4-day sessions, which are held at the Oregon Health & Science University School of Dentistry, which has joined with DOCS Education to provide a dynamic curriculum. After completing the classroom portion, dentists will also have to spend an additional three days at a select clinical location (in the United States or Mexico) to obtain their 20 live-patient experiences.

That’s eleven days total (over a period of three months), no easy commitment for any dentist with a thriving practice.

Looked at from an alternative perspective – one that more and more dentists are adopting – the IV Sedation training is, indeed, a Forever Permit®, one that will improve the dentists’ skillset, prove especially helpful to their patients, and prevent state regulators from summarily pulling the plug on their moderate enteral sedation practice.

Even those dentists who live in a state that hasn’t adopted the stricter Resolution 37 regulations, and isn’t yet showing signs of embracing them, cannot trust their future, and the future of their patients, to hope.

The real poison pill that is Resolution 37 – and the state regulations that echo it – is that there are very few courses offered anywhere in the country each year that can qualify a dentist for an IV Sedation permit, and far fewer still that are quality courses, such as the one offered by DOCS Education.

By the time a general dentist, endodontist, or periodontist, realizes that his or her state dental board is headed inextricably in the Resolution 37 direction, the wait list to register for a bona fide IV Sedation course may be two, three, or even more years long. That’s far too long to prevent a thriving sedation practice from “going dark.”

The next DOCS Education IV Sedation course, to be held at OHSU and led by our outstanding team of instructors, will take place March 22-25, 2018 and April 12-15, 2018. Maximum seating for this highly anticipated class is 24.

Other providers may also have seats available in the first half of 2018, and may even offer a somewhat lower tuition, but no other continuing education school offers DOCS Education’s proprietary pedagogy and proven track record for faculty excellence.

Editor’s Note: We encourage any dentist who wants to ensure his or her ability to continue to provide patients with safe and effective moderate enteral sedation to review our course description at http://docseducation.com/catalog/iv-sedation-certification and register now, while seats remain.

You may also phone one of our course advisors at 866-391-2906. Should the Spring 2018 class close, or if you are unable to arrange your schedule to attend that course, please ask to be placed on the wait list for future classes in 2018 and 2019.

DOCS Education members who have questions about their specific state regulations are welcome to contact our regulatory counsel, John P. Bitting, Esq., at no charge. John is the nation’s only full-time dental regulatory attorney. He can be reached at john@DOCSEducation.com.

As part of its suite of membership privileges, DOCS Education makes John Bitting available to provide definitive, clear-cut answers to a variety of legal questions concerning state-by-state training, licensing and permit requirements; standard-of-care protocols and equipment requirements; patient complaints; dental board investigations; and advertising standards.

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The information contained in this, or any case study post in Incisor should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 106 Lenora Street, Seattle, WA 98121. Please print a copy of this posting and include it with your question or request.