Safe Sedation Techniques Undergo Battle in Washington State

Bellow is a letter that I sent to the Department of Health this week. The Department is reviewing dental sedation regulations in the state of Washington. Sedation is a method where patients that are undergoing complex and invasive dental procedures or those that are afraid of the dentist can have their care done comfortably and safely. It's one of the things that has allowed me to rescue dozens of patients in my personal practice.

There are some small and sane changes needed in the regulations in this area such as mandatory blood pressure and pulse oximetry monitoring for safety. However, in the name of "public safety" my oral surgery brethren in the profession, in their boringly and yet oh so predictable manner, want the rules so radically rewritten they they would deny these safe sedation techniques to most doctors simply so that their (oral surgeons) pocketbooks can stay engorged by increased surgical referrals.....and they say it's about public safety....more like safety of their cash flow....sickening but true. If you can't tell this really gets under my skin!

I encourage any patient be they from my practice or any other dental practice in the state that has had oral conscious sedation which got them through dental care that they would have otherwise avoided having to write to the board to tell how oral conscious sedation benefited them and to request that these techniques be kept easily accessible for the citizens/patients in Washington State. You can write Lisa Anderson at the Department of Health/DQAC at PO Box 47867 Olympia, WA 98054 e-mail: lisa.anderson@doh.wa.gov and fax 360.664.9077

Oh, and BTW, I have the added training that these "good ole' boys" are demanding the board require so my patients need not worry......even if the most obnoxious proposals become a reality I will still be allowed to legally perform all of the methods I currently use to get even the most debilitated and fearful patient back to dental health comfortably and safely.

Dental fear is such a big problem and so many patients need these methods so very badly that by reducing the number of doctors who can provide treatment with these methods will force these fearful patients to suffer needleesly! And that ain't about public safety.......

To Your Smile,
Dr. McAnally

Why is It Important to Keep Oral Conscious Sedation Regulations Sane & Reasonable in the State of Washington?

Dear Ms. Anderson,

…here’s why……a true story. Laura, a new patient, came to me after avoiding the dentist for over a decade. 2 other dentists attempted to manage her anxiety with nitrous oxide which was completely ineffective. Out of desperation, she has seen an oral surgeon over 10 years ago because she heard “they knocked people out” and hoped that he would help her find a solution. She was put down by this surgeon who told her that “regular dental treatment is done without sedatives.” Now a decade later, she has many fractured teeth that could have been prevented if she had been offered oral sedation services. Her treatment costs are over $35,000. While it is great that she can now get her care done comfortably with safe oral conscious sedation, how much better would things have been if this was done for her 10 years ago? How much less savings would she spend on her dental care? How much less time from work would be needed for her dentistry? If the board raises the requirements for oral conscious sedation to the same level as IV sedation and removes this safe technique from the hands of many doctors offering sedation services, more Laura’s will be denied their care and suffer needlessly.

I’m fortunate to have had training in IV and oral conscious sedation at my University of Washington Hospital residency program. In 1993 we were trained in what WAS a new yet effective adult oral conscious sedation method using Triazolam; documented as safe and effective by Dr. Quarnstrom at the UW. Now after at least 15 years the technique is no longer new and has been shown to be safe and effective in tens of thousands of cases nationwide. Should doctors using these techniques be trained in BLS and required to use NIBP and pulse oximetry—absolutely. Should they need the same training as a doctor that is IV certified--absolutely not.
Since 1993, I have personally used this method for hundreds of sedations for procedures ranging from routine hygiene visits to complex bone block grafts. I found in the mid 1990’s that for the vast majority of cases, an IV technique was seldom necessary thanks to this method. I have never had an adverse incidence of respiratory depression or other adverse medical occurrence. I know of no other method of conscious sedation demonstrating the same record. In fact, there has never been an adult death with this method of sedation—again how many techniques can boast the same? My patients thank me for getting them through their appointments comfortably but in reality they should be thankful for the availability of this safe method of anxiety relief in many dental practices.


Finally, I would ask that the board keep any changes deemed necessary in the regulations regarding oral conscious sedation “sane” and not simply bend to the whims of the oral surgery interest. Please keep public safety in the land of rationality. The surgery interests oh so typical cry of “wolf” (their version of public safety) is nothing more than a very predictable and blatant grasp at protecting and improving their economic interests since many generalists that use this technique to perform oral surgery would be forced to refer more patients if this safe method is taken away from them.


Thank you for your time and interests in protecting the public and I trust that you will keep this matter in the land of “sanity.”


Best regards,
Dr. James R. McAnally