Dental Assistants Pushing Propofol etc...

[Larry77]

I was talking to an oral surgeon friend of ours and we were discussing his sedation procedures that he does in his clinic. I was amazed to find out that while he is the one to start the IV's on the patients his dental assistant is the actual person who administers the propofol/fentanyl boluses.

He says that his assistants do go to a one afternoon training on how to recognize lethal arrhythmia's but do not get their ACLS or even BLS. He also says that his assistant is not allowed to administer meds without him in the room.

I talked to my wife about this who is a dental assistant and she says the way that dental gets away with this is that the assistants are working under the dentist's license, not their own.

I was just wondering if others thought this was an unsafe practice?

[JenniferRDH]

I've been in dentistry for 14 years and have seen good and bad. I for one follow my scope of practice to the letter and have never strayed. Not worth it for me or for my patient.

Please remember there is a huge difference between an oral surgeons office and a surgical suite, general vs. Conscious sedation. Remember nitrous oxide, 'laughing gas'? That is taken VERY lightly in most offices. I have seen patients on many occassions oversedated with it and it certainly can kill you. In my state, you must be a certified in order to administer nitrous. NEVER should it be started by an assistant let alone administering IV meds. In fact, an assistant is supposed to be certified to be able to be in the room to 'monitor' the patient while under sedation. How many times does that happen? Not many. It's as if Jane Doe walked in on Monday and in a lot of offices she could be starting you on nitrous Tuesday.

I am legally able to deliver nitrous. Again, assistants here NEVER should be giving locals. Not only being concerned with parasthesia, but what if she had administered lidocaine w/ epi into a vein? What if the patient had a pre-existing dysrythmia? Who knows.

Please, I urge everyone to be proactive and make sure that whom ever takes care of you, or your family, they are legally allowed to do so. Unfortunately it does vary state to state.

Anyone practicing outside of their scope should be reported to their state dental board.

[meandragonbrett]

Nobody is giving me general anesthesia but a CRNA or anesthesiologist. Sorry folks.

[AmandaBrittainy]

I disagree with them not being ACLS certified or at least BLS. However, Propofol has never worked on any of my patients so it doesn't scare me anymore. Fentanyl, that one is kind of iffy in my book.

[teeituptom, BSN, RN]

If im going to bee treated by a dentist or oral surgeon

I WANT DRUGS

[Dental Hygienist]

Hate to say this but Oral Surgery is a branch of dentistry. Dentists perform a residency, take boards and then are certified for oral surgery.

This is true. Oral surgeons are dentists first, then attend a separate graduate program for oral surgery THEN complete a residency. But they are dentists first.

However, their education is very complete. 4 years undergrad with a science focus/major, 4 years dental school resulting in a doctorate degree 1-2 years oral surgery education followed by 2-3 years residency before they can be qualified as an "Oral Surgeon"...not claiming that it's impossible for an incompetent doctor to complete all that training, but rest assured it's not just a regular dentist who learned oral surgery "on the job"

Now if you're talking about a regular dentist trying to do all these things on you or your kids; well I'd run like the wind! Oral surgeons are very well trained, then they must obtain FURTHER training and permits for the different levels of anesthesia. Many of them do employ RNs for starting IVs, delivering meds and monitoring post-op. If you are visiting a reputable oral surgery clinic you should be in good hands.

Maybe what is confusing is that some dental schools result in a DDS (doctor of dental surgery) and some dental schools result in a DMD (dental medical doctor)...the education is the same, it is a matter of semantics whether the school issues a DDS or DMD, often times west coast schools give a DMD....but they are still not a regular "MD" as you would normally think of it.

Hope that clears up some confusions!

[ERRNTraveler, RN]

I disagree with them not being ACLS certified or at least BLS. However, Propofol has never worked on any of my patients so it doesn't scare me anymore. Fentanyl, that one is kind of iffy in my book.

How has propofol NOT worked for your patients??? I've never seen it NOT work- some people just need more than others, but when it does work, it works FAST!