I entered into my dental anesthesiology residency program with the full knowledge and understanding that I would not graduate as a “specialist” within dentistry. My rigorous, 3-year training program was spent in operating rooms, providing anesthesia for all types of surgical cases.
At home, on the train, and in the library, I was poring over pharmacology, physiology, and medical textbooks. I worked tirelessly to become the best anesthesia practitioner I could be so that one day I could safely provide anesthesia services for patients undergoing dental procedures.
My co-residents and I worked side by side with physician anesthesiologists to learn the art of anesthesia because we were genuinely passionate about the profession. There was no question that our training made us experts in the fields of medicine, pharmacology, physiology, and medical emergencies.
At the time, the ADA’s failure to recognize dental anesthesiology as a specialty shaped us into a small, resilient group of individuals who chose their profession because they loved it, not because of a title that came along with it. We fought hard to be recognized but never quit providing safe anesthesia care when we were overlooked.
As a group, the American Society of Dentist Anesthesiologists (ASDA) created standards of excellence with accredited residency training programs, board examinations, and continuing education courses. We adhere to the guidelines of both the American Society of Anesthesiologists and the Society for Ambulatory Anesthesia. As a result, we provide safe anesthesia that meets all pertinent quality-of-care standards.
In essence, the lack of a specialty title did not hinder dentist anesthesiologists. Yet, it hindered the public and patients from being made aware that a significant disparity in expertise and training existed.
The Recognition
On March 11, 2019, the National Commission on the Recognition of Dental Specialities and Certifying Boards (NCRDSCB) granted dentist anesthesiologists the recognition we have always deserved. However, for me, this title comes secondary to the importance of the awareness this will bring to patients regarding their safety and to dentists who have been left in the dark regarding the extensive training we pursue to provide safe anesthesia care.
First and foremost, patients should be made aware of the significant differences in expertise and skill levels when comparing a residency-trained dentist anesthesiologist and a dentist with far less training who provides limited anesthesia services.
There are times when it may be safer to utilize a 2-provider model with a separate dedicated anesthesiologist and dental care provider. This becomes especially important when work is being performed on children or on patients with more extensive medical histories while also working in the airway. A 2-provider model and a secured airway decrease the risk of airway emergencies and increase safety and the quality of care provided to our patients.
The availability of dentist anesthesiologists makes dental treatment a possibility for young children, patients with dental anxiety, gag reflexes, and children and adults with intellectual and developmental disabilities. Dentist anesthesiologists are often the unsung—and unrecognized—heroes of some of the most challenging dental cases. We deserve to be acknowledged for our diligence and skills, and I am thrilled the ADA now recognizes the challenges we undertake.
The Training
Dentist anesthesiologists undergo a rigorous 3-year training program requiring the completion of a minimum of 800 cases of deep sedation/general anesthesia in the operating room. We provide anesthesia for trauma, ENT, OB/GYN, general surgery, and oral and maxillofacial surgical cases. In other words, these cases are not restricted to dentistry alone.
Of the 800 cases, 125 of them must be provided to children aged 7 years and younger, and 75 of the cases must be provided to patients with special needs. By comparison, physician anesthesiologists are required to do 100 cases involving children 12 years old and younger.
Dentist anesthesiologists recognize that their main patient populations are pediatric patients and children and adults with intellectual and developmental disabilities. Therefore, the training is geared toward the intricate management of those types of cases. Children are not miniature adults. They require advanced training in airway and medical emergencies to provide safe anesthesia with an intravenous line and a secured airway in place.
This recognition by the NCRDSCB and ADA will also bring awareness to our field for dental students who are interested in medicine, pharmacology, and anesthesiology early on in their education. Because we haven’t been a recognized specialty until now, most dental students at the majority of dental schools are unaware that it is even a pathway they can pursue.
I hope this will bring more dentist anesthesiologists into the front lines of dental school education to begin opening students’ eyes to the specialty from the beginning. After all, the field of anesthesiology has always belonged to dentistry, and we can attribute that to Dr. Horace Wells. He was the Connecticut dentist who discovered anesthesia in the 1840s but was never granted that recognition and acknowledgment during his lifetime. He was only recognized for his discovery postmortem by the ADA and the American Medical Association.
Being passionate myself about the history of anesthesiology, I am excited to be alive during the time we did receive recognition, and I know that so many of us who fought for it are no longer with us to see it come to fruition. Today, I hope this has made them proud, and I thank them and our current and past presidents of the ASDA for their lifetime of dedication to this field.
Now, it is our generation’s responsibility to transform the face of anesthesiology within our own dental profession. I encourage the ADA to seize this opportunity to raise awareness among both patients and dentists about the benefits that dentist anesthesiologists provide with regard to patient safety.
Dr. Rozdolski is an assistant professor of dental medicine at Touro College of Dental Medicine at New York Medical College. She is a uniquely trained dentist anesthesiologist with a DMD from Tufts University School of Dental Medicine and has completed a general practice residency at Mount Sinai Medical Center and a residency in dental anesthesiology from Jacobi Medical Center/Albert Einstein College of Medicine. In addition to her teaching roles at Touro College of Dental Medicine and Icahn School of Medicine at Mount Sinai, she is also on the medical staff of the Department of Pediatric Dentistry at the Mount Sinai Hospital and holds private practices in New York and Connecticut, providing anesthesia services to both pediatric and adult patients. She can be reached at doctors@sweetdreamsnewyork.com.
Disclosure: Dr. Rozdolski reports no disclosures.
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