Note:  Below is information on the new sedation guidelines.  State of maine recently adopted new guidelines, which can be seen here.  What led to this can be seen below.  

 

The issue:

In October 2016, The ada house of delegates adopted new guidelines (Resolution 37) in an attempt to persuade the state dental boards to increase the educational requirements for certain aspects of sedation.  Unfortunately, the reality of the situation is that many general dentists will find these changes cost and time prohibitive.  So two things will happen, either less dentists will seek to obtain their moderate sedation permit (see below).  The second scenario is that they will obtain it but transfer the costs of the additional education to their patients, effectively decreasing the access to care for sedation general dentistry.  

In addition, the ability to provide minimal sedation will also be hampered (See below).

The issue has raised concern, especially in the general dentist community, as this change will make it more difficult for low-income patients to receive dental care in a low-anxiety manner.  IT is very important to note that these changes are unsubstantiated by science or incident, but political in nature (see fact sheet below).  

Please read below to see how this will impact dentistry for our Maine citizens.

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MISCELLANEOUS BACKGROUND ITEMS that led to 

Click here for a copy of the new 2016 ADA recommendations (Resolution 37).  ***NOTE:  ME AGD does not agree with these recommendations

Click here for a copy of the current Maine Sedation Guidelines (Adopted in 2009)

Click here for a fact check sheet on the validity of the science supporting resolution 37.

Click here for a summary of the fact check sheet, for easier review.

See this facebook page created to help create awareness of the issue and to help save Sedation Dentistry.

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Current Sedation Classification is the State of Maine

Minimal Sedation - Limit to one drug, one dose, per day.  No additional permit required above a ME dental license.  Intended for very light sedation.

Moderate Sedation - Level 1 - Enteral (Oral) - Permit required allowing combination of oral drugs and nitrous.  Intended for general dentistry and moderately complex dentistry.

Moderate Sedation - Level 2 - Parenteral (IV/IM) - Permit required allowing combination of IV/IM/Oral/gas sedation.  Intended for complex surgical dentistry (ie, oral surgery)

Deep Sedation - Reserved for hospital settings.  

*The overall issue here is that oral surgeons seek to limit general dentists from providing Level 1 sedation, and pushed the ADA into recommending level 1 and level 2 moderate sedation be combined into the educational requirements seen in Level 2.  

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Q and A's to help understand how this may impact General Dentists in Maine

 

Q1: I don't offer sedation currently, but I would like to. How does Resolution 37 affect me?

A1: If Maine adopts the guidelines recommended by Resolution 37, as recently approved by the ADA House of Delegates, minimal sedation will have a new, lower dosage restriction, referred to as the “MRD.”

The MRD is the manufacturer’s maximum recommended dose a patient can take at home unmonitored by a doctor. This translates into 10mg of Valium, 0.5mg of Halcion, and 4mg of Ativan. These are the most common drugs and dosages administered by dentists who provide minimal sedation.

If these dosages are exceeded, 60 hours of sedation training may be required. However, if a moderate enteral (oral) permit is acquired by Maine before the full incorporation of Resolution 37, a 24-hour sedation training course may grandfather you into a 60-hour moderate permit, saving time and money.

 

Q2: I offer nitrous oxide analgesia. How does Resolution 37 affect me?

A2: Use of nitrous oxide is not affected unless you want to add an oral sedative per A1 above. Nitrous oxide is the most commonly administered analgesic for dental procedures.  ME guidelines currently classify nitrous oxide as drug, meaning that a moderate sedation permit is required to combine nitrous and an oral sedative (or any other drug or medication) within the same day.  Resolution 37 does not appear to make any change to the current ME sedation guidelines.  

 

Q3: I offer minimal sedation. How does Resolution 37 affect me?

A3: Same as A1 above, IF Maine adopts the Resolution 37 guidelines as written.  The ME State Dental Board may write differently than recommended.  

Minimal sedation (defined in Maine as one drug, one dose, one day) is the second most commonly administered form of mild anesthesia for anxious and fearful dental patients in the United States. The recommendation seeks to limit how much medication can be prescribed.  

 

**Q4: I offer moderate oral sedation. How does Resolution 37 affect me?

**A4: This modality is the one most affected by the Resolution 37 guidelines.

If adopted verbatim by the ME Dental Board, you could be grandfathered as a moderate sedation provider. However, if you let your permit slip due to not meeting the recertification requirements, you may be forced to take the complete 60-hours of sedation courses.

 

Q5: I offer IV sedation. How does Resolution 37 affect me?

A5: This modality is largely unaffected by Resolution 37. If you are currently providing IV sedation, you should not expect any changes.

 

Q6: What can I do to help prevent these changes?

A6: You can contact the ME AGD to see how you can help.  A public hearing on this matter has yet to be scheduled, but ME AGD members will be notified and this website will be updated.  The ME AGD is currently trying to provide a statement to the ME Dental Board regarding our view on the matter.