Child dental anesthesia needs regulation

Dear Editor:

A large number of corporate dental practices (Kool Smiles, Mississippi Smiles, and Happy Smiles) operating in Mississippi have been performing general anesthesia on children in their offices for a few years. These corporations operate over 15 clinics, some in Jackson, Tupelo, Biloxi and rural areas.

There have been formal complaints filed with the Mississippi Board of Dental Examiners about this practice and, to date, the board has taken no action against them.

The dental clinics are flying in dentist anesthetists from out of state to administer general anesthesia. The group that is coming to our state was involved in an in-office incident that led to the death of a young boy in Yuma, Ariz. in 2017.

The Dental Board has held many public hearings, and has received testimony and documentation from physician anesthesiologists, pediatricians, and pediatric dentists about the possible safety problems with this practice since July 2018.

At this time, the many safety problems revolve around credentialing of the itinerant dentist anesthetists, the safety of the equipment, credentialing of all anesthesia providers, the lack of training and protocols for assistants in the dental offices, the lack of transfer agreements with local hospitals, the lack of specific medications used for anesthesia emergencies, the safety and inspection of portable monitors and anesthesia machines, and the lack of specific anesthesia permits for the dentists themselves.

Multiple anesthesia specialists have pleaded with the board to impanel a committee of experts to study the problems of safety, especially with children, since July 2018. After seven months, the board finally acquiesced to form this panel, consisting of a single physician anesthesiologist, a dentist anesthetist, two pediatric dentists, two oral surgeons, and a periodontist. They have also heard from the president of Mississippi’s CRNA organization.

The panel is working diligently to write the highest safety standards for the performance of general anesthesia in dental offices, especially concerning children. However, there are many controversies within the different specialties that will require difficult decisions regarding credentialing, training, and the need for additional trained personnel in the dental offices. There will be new regulations about all of this, and the inspection of offices will need to be performed according to national, rather than local standards.

The committee probably has at least four more months to write recommendations to the board. Then the board will be required to have a series of public hearings for comments and then vote on the recommendations. After that, the recommendations will need to go to the Mississippi Secretary of State, and then to the Mississippi Occupational Licensing Review Commission, and this group will have to have public comment meetings prior to its recommendations.

This entire process will undoubtedly take from six to 12 months to complete. In the meantime, unsafe practices, especially on children, will continue to take place throughout the state in multiple dental offices.

I plead with the Dental Board to place a moratorium on general anesthesia in dental offices until the board finishes its regulations regarding safe anesthesia practices. To do otherwise is to place our state’s most vulnerable citizens, its children, at risk of serious injury and death. As the board is aware of the fact that there is no guarantee at this time of regulated safe practices of anesthesia in dental offices, ignoring this danger is incongruous with their mission of safeguarding the health of Mississippi’s citizens.

 

Heddy-Dale Matthias, MD

 

 

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