Dear Oral Health and Professional Colleagues:
Re: Registration: It’s Not All Bad editorial
In my February 2016 editorial, I was privileged enough to share some of my thoughts and opinions regarding my proposal for an adjustment to some of the provinces’ method of knowing which dentists provide sedation services to their patients. Included in that statement were numerous reasons for my position. I also included a scenario wherein a hypothetical dentist providing sedation could avoid registration in a province where it is not required for minimal conscious sedation but is required for all other levels. Specifically, the scenario discussed the use of 0.5 mg of triazolam, and how this, in some cases, could be argued as providing only minimal conscious sedation and then how that dentist could avoid registration. I stated that technically, there was (arguably) no violation. I also stated that I thought it was a bad idea, perhaps I didn’t make myself clear enough. Shortly after the February issue’s publication, I was contacted by my home province’s registering body looking for clarification on my scenario. To me, this actually illustrated my point, that when one leaves enough grey area in regulations, someone will be there to explore the loophole(s); chalk it up to the universal Law of Unintended Consequences. Still, clarification was requested, so here it is: In Ontario and several other provinces, the routine administration of 0.5 mg of triazolam (or an equipotent dose of a different drug) is, by definition, considered as intending to produce moderate conscious sedation. Any dentist doing this, under Ontario’s guidelines, should register with the Royal College of Dental Surgeons of Ontario. Simple as that.
I still think that the system is flawed in Newfoundland, Nova Scotia, New Brunswick, Ontario, and British Columbia, and I may not have a flawless solution. Having said that, I also don’t want to be seen as having provided a recipe for the avoidance of well-intentioned guidelines. To the dentists operating in the sedation “shadows” you are part of the dental community, make it easier for all of us and register please.
Respectfully submitted for patients’ safety. OH
Peter Nkansah
