ADA News

Three years in the making, a new continuing education course for dentists that focuses on proper monitoring and airway management for dental office sedation and anesthesia will debut this fall in two parts.

Sedation update: American Dental Society of Anesthesiology members who are facilitating the ADA's first CE course on proper monitoring and airway management demonstrate a simulation exercise for ADA President Ron Tankersley (center) during ADSA’s annual meeting May 1 in Key Biscayne, Fla. From left are Dr. Daniel Becker; Dr. Karen Crowley, ADSA president; Dr. Tankersley; Dr. Morton Rosenberg, ADSA treasurer; and Dr. James Phero.

Recognition and Management of Complications During Minimal and Moderate Sedation is geared toward all dentists who administer minimal or moderate sedation in their offices. ADA CE Online will host Part I of the course in July. Part II, a hands-on course, will take place in five-hour sessions on Oct. 28-29 at ADA Headquarters. Participants must complete Part I before taking Part II.

The course has been in development since the ADA updated its anesthesia guidelines documents in 2007. At the time, one of the only training options available to dentists who chose to administer minimal and moderate sedation was Advanced Cardiac Life Support. ACLS training, however, does not emphasize complications related to sedation, such as airway obstruction and respiratory depression.

When the ADA House of Delegates approved the new anesthesia guidelines documents, the ADA Foundation provided a grant for the development of a new CE course for dentists that would focus on proper monitoring and airway management and serve as a complement to ACLS training. The Anesthesia Research Foundation of the American Dental Society of Anesthesiology received the grant to develop the course.

The course faculty—Drs. Morton Rosenberg, Karen E. Crowley, James C. Phero and Daniel E. Becker—are some of dentistry's most distinguished experts in sedation and anesthesia. They also have expertise in a range of other relevant issues, including dental education, emergency management, pharmacology, simulation education and patient safety.

Course emphasizes sedation, proper monitoring and airway management The goal of Recognition and Management of Complications During Minimal and Moderate Sedation is to train the practicing dentist in the proper recognition and management of respiratory complications that may be associated with the use of moderate sedation. Particular emphasis is on proper monitoring and airway management. There are two parts: Part I (three CE units) is an electronically mediated didactic component that participants will complete via independent study before taking Part II. Part II (five CE units) is a live, five-hour presentation consisting primarily of laboratory exercise and clinical simulations. Part II will be offered three times at ADA Headquarters Oct. 28-29. To take the course, participants must hold current certification in Basic Life Support at the health care provider level, which includes experience with bag-mask ventilation and automated external defibrillators. Part I will be available on ADA CE Online (www.adaceonline.org) in July. To register for Part II, participants must have successfully completed Part I within the previous 6-12 months. Registration for Part II will take place on ADA.org in September. Attendance in Part II is limited. Course fees have not been determined; however, ADA members will receive a discount rate on Parts I and II.

"For the American Society of Anesthesiologists class II and III patients, the preponderance of medical emergencies related to sedation and general anesthesia are related to difficulties with the airway," said ADA President Ron Tankersley, who participated in an ADSA simulation course for oral and maxillofacial surgeons earlier this month and called it a true learning experience.

"The course's pragmatic approach is relevant to what dentists actually do in their offices and, therefore, will maintain their interest," said Dr. Tankersley. "This practical approach should result in dentists retaining the important information and principles necessary for them to appropriately handle medical complications when they occur in their offices."

"This is going to be an important educational offering to enhance the profession and protect the public," said Dr. Rosenberg, professor of oral and maxillofacial surgery and associate professor of anesthesia at the Tufts University Schools of Medicine and Dental Medicine, and a member of the workgroup that developed the course. "This offering encourages dentists who are educationally qualified to continue to have the right and privilege to administer minimal and moderate sedation to dental patients."

The course the Anesthesia Research Foundation delivered to the ADA Foundation in 2009 was well-researched through two pilot courses and two proof of concept courses, Dr. Rosenberg added.

"It's very dynamic and kept changing as we came to understand the educational backgrounds and needs of dentists administering minimal and moderate sedation," said Dr. Rosenberg. "We learned a lot from the debriefing we did for pilot course participants."

"We were very honored to be chosen to develop this for the ADA," said Dr. Crowley, a workgroup member and an oral and maxillofacial surgeon in private practice in Londonderry, N.H. Dr. Crowley said she brought the private practitioner perspective to the course development.

"Members of the workgroup all had different experiences, and they all culminated in this course," she said. "We developed something that is academically sound and very practical."

Part I is an electronically mediated didactic component that participants will complete via independent study on ADA CE Online before taking Part II.

Part II consists of a pre-assessment, task training, high fidelity activities and a post-assessment. The task-training portion covers oxygen/ventilation, airway adjuncts, monitoring and drugs. The high fidelity activities use the SimMan manikins that are programmed with scenarios on hypoventilation/apnea and obstruction (allergy/asthma). Participants work in teams first, then individually, to rescue their "patients."

"Overall, it's an arduous, intense course, but I think that patients are well-served by practitioners taking this as a baseline for sedation delivery," said Dr. Crowley.

"We're very encouraged about the ADA initiatives in patient safety regarding the need for our sedation practitioners to recognize and manage airway and ventilation rescue," said Dr. Phero, professor of clinical anesthesiology, pediatrics and surgery, University of Cincinnati Academic Health Center College of Medicine. Dr. Phero has served as faculty anesthesiologist at The University Hospital in Cincinnati for the past 31 years.

The contemporary approach to teaching a clinician to manage a critical situation begins with applying intellectual learning and task training, said Dr. Phero. But having the knowledge to manage a situation and being able to perform the tasks to manage the situation are two different things in a medical crisis.

"The ability to train for optimal performance in the team setting utilizing the resources of all the team members has been made possible by high fidelity simulators," said Dr. Phero, who is also vice chair of the Research Committee of the Society for Simulation in Health Care.

"The hands-on portion of the course features technologically advanced high fidelity simulators that are programmed to mimic rare and difficult emergency health conditions and situations that a dentist administering minimal and moderate sedation might encounter in practice, such as loss of airway and asthma," said Dr. Phero. "These lifelike adult simulators teach the team to use all their knowledge and skills to produce a positive outcome, as would be done in the dental office."

The team-training concept is based on the way aviation pilots were trained in World War II, said Dr. Phero.

"The pilots were given a bad scenario in the cockpit, then they had to come up with a productive solution while working as a team," he explained. "One person does not have as good an outcome as when you have a team. Medicine adopted this approach and called it crisis resource management. The ADA course incorporates this format in a very powerful and meaningful manner for the participants."

The course workgroup credits Dr. Becker with developing the original curriculum for the course.

"Our original ADSA curriculum was a huge asset for developing the ADA course," said Dr. Becker, associate director of medical education for the general practice dental residency at Miami Valley Hospital in Dayton, Ohio. He also provides intravenous sedation services for dental practices in the Dayton-Cincinnati area.

"More and more dentists are beginning to utilize moderate sedation, and the ADA is to be commended for addressing the educational needs for this practice," said Dr. Becker, who would one day like to see principles of moderate sedation and the content of this course "appreciated as a required educational core in dental schools during undergraduate training."

Though, as Dr. Becker indicates, it's a logistical challenge to provide simulation training, the Council on Dental Education and Licensure's Committee on Anesthesiology is in the process of identifying course faculty and sessions for similar courses to take place beyond 2010.

"The teaching methods and technology used in this course address airway management more comprehensively than I've seen before," said Dr. Tankersley. "I congratulate the workgroup for so effectively bringing those elements together. This is an excellent example of the dental family working collaboratively to develop standards that are most appropriate for our profession."