Alberta dental association suspends single operator model for deep sedation, anesthesia

Alberta dentists won't be allowed to perform deep sedation or general anesthesia while also performing a dental treatment while a review takes place. Global News

The Alberta Dental Association and College decided Oct. 28 to “immediately suspend” the practice of allowing one dentist to provide deep sedation or general anesthesia while also providing dental treatment.

Until now, in Alberta, dentists, by themselves, could sedate patients and perform a dental procedure at the same time. If a patient requires surgery at a hospital, an anesthesiologist must be present during the procedure.

Dr. Randall Croutze, CEO of the Alberta Dental Association and College, confirmed the decision to suspend the practice Monday.

“That the Alberta Dental Association and College immediately suspend the single operator model of simultaneously providing deep sedation or general anesthesia and dental treatment by dentists registered in Alberta during the ongoing review of the Dental Facilities Accreditation Standard of Practice,” Croutze said.

He said the college has an ongoing commitment to public protection and public safety and it is always looking at what is best for patients.

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The issue of sedation, he said, started being looked at over a year ago.

Croutze could not say how long the review might take, explaining that the ministry of health, as well as stakeholders, would be involved in the review process.

In a statement, the association said “effective immediately” the practice would no longer be allowed.

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“The Alberta Dental Association and College regularly reviews its policies and practices,” Croutze said. “More than a year ago, we implemented a review of sedation practices across the province. While this process is ongoing, changes to our policy will take effect immediately.”  

“High quality dental care is integral to the continued health and safety of Albertans. Regular reviews ensure we can effectively incorporate changes to best practice guidelines along with emerging oral health evidence and is an ongoing process for the ADA&C’s Dental Facilities Accreditation Standard of Practice.”

READ MORE: Dental sedation expert ‘frustrated beyond imagination’ over anesthesia rules 

A dental sedation expert has been arguing for those rules to change.

Michael Dare wants a machine that measures carbon dioxide and makes sure a patient keeps breathing during sedation to become mandatory. He also wants it to be illegal for dentists to perform procedures alone. Despite lobbying various professional organizations, those changes have not been made.

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Four-year-old Amber Athwal slipped into a coma during a dental procedure and has been in hospital since Sept. 7. Her father told Global News she is opening her eyes but still does not respond to her parents.

Her family says doctors told them an MRI showed the girl has a brain injury, although the severity of the injury has not yet been established.

READ MORE: Edmonton family says little girl left in coma after dental visit

The Alberta Dental Association and College continues to investigate Athwal’s case. Croutze has not said when that review will be complete.

“In terms of timeline,” Croutze said, “we want to balance our ability to provide a thorough review and have the correct information.”

According to the dental regulatory authority, there were 44,680 dental procedures in Alberta that required general anesthesia in non-hospital facilities in 2015. Of those, it said 36,003 were performed on adult patients and 8,677 were performed on pediatric patients.

Rules regarding sedation vary by province.

The minister of health said Monday she hadn’t been informed directly about the decision by the dental college but, in light of what has happened, she supports the move.

“It seems like this is a reasonable step while they do the review and determine best steps, but obviously protecting patients’ health and well-being should be the number one priority,” Sarah Hoffman said.

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She added the college provides oversight and outlines best practices. It also has a significant role in “policing and supporting” its membership, Hoffman said.

With files from Fletcher Kent and Kendra Slugoski, Global News

*EDITOR’S NOTE: This article originally stated rules allowed dentists in both Alberta and Ontario to provide deep sedation while also performing a dental procedure. The Royal College of Dental Surgeons of Ontario clarified its standards of practice dictate there must be a minimum of three people in the operatory at all times when sedation and general anesthesia is used.
“This includes the dentist/sedation provider, a trained RN or RT and the dental assistant. Additionally, the Standard requires the patient to be monitored at all times in recovery by either the dentist, or a trained RN or RT.”

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