The International Federation of Dental Anesthesia Societies presented the 10th International Dental Congress on Modern Pain Control on July 5-7, 2003, in Edinburgh, Scotland. Professor Eliezer Kauffman from Israel presided. The British Society for the Advancement of Anesthesia in Dentistry organized the Congress under the expert direction of Dr. Chris Holden, Andrea Wraith, and many others. Over 400 participants attended from a total of 28 countries. There were numerous simultaneous sessions on a wide variety of topics so that participants could pick and choose how best to hear as many topics of interest as possible.
Coming from a country where office anesthesia, for diagnostic and surgical procedures, both medical and dental, is a major part of the healthcare industry, it was very disconcerting to interact with individuals who were directly affected by the British General Council’s abolishment of general anesthesia from all dental offices, even when administered by a board-certified physician anesthesiologist (consultant anesthetist). Why did this occur, and what can be done to ensure that other countries do not experience a similar fate?
Apparently, the British system years ago wisely decided that general anesthesia was beyond the scope of dental-student training, and therefore medical anesthetists stopped training essentially all dentists in this modality. Unlike in the US, where graduating dentists could enroll in the once numerous hospital general anesthesia residencies available at that time, most British dentists were forced to learn general anesthesia from their older partners by on-the-job training. Although many of these dentists received excellent anesthesia mentoring from their office colleagues, some did not. There were no standardized and objectives, no didactic or clinical criteria for training, and no accreditation standards to be enforced.
As training became less formalized the British government’s national healthcare system simultaneously markedly decreased reimbursement for dental anesthesia, and many dentists used this as an excuse not to purchase the recommended monitors and modern anesthesia safety equipment. With less education, inadequate monitoring equipment, and no government licensing of general anesthesia providers, some highly publicized poor outcomes occurred, and this forced the General Dental Council to eventually ban all dental-office general anesthesias. Some physician anesthetists also contributed their share of dental-office anesthesia misadventures either because they had been pushed out of hospitals for incompetence and consequently sought employment in dental offices or because the lack of adequate safety equipment and monitors were contributing factors. Political influences also undoubtedly were involved in the General Dental Council’s decision to ban office anesthesia.
If other countries hope to avoid a similar fate, it is obvious that proper training in accredited general anesthesia residency programs for general dentists is the most important key to maintain our profession’s ability to independently provide all levels of anesthesia in dental offices. Proper training combined with strict enforcement of dental anesthesia practice standards for adequate patient evaluation, equipment, personnel, monitoring, and record keeping should prevent what occurred in Great Britain.
History can and often does repeat itself for those who do not learn from those who made mistakes before. Let us strive to protect this vital area of dental practice by earning the privilege to continue to practice office general anesthesia by continually upgrading the quality of our educational programs and practice of anesthesia and not by merely hoping to hold on to the status quo.
Dr. Joel M. Weaver is Editor-in-Chief, Anesthesia Progress
