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By Karen Fox

A dentist begins treatment on a 20-year-old patient with a soft-tissue impacted third molar. Anxious about the procedure, the patient has received oral sedation. Immediately after the dentist administers local anesthesia, the patient has difficulty breathing.

What is the dentist's next intervention? Administer epinephrine? How long will the effects of epinephrine last? Can the dentist tell if the patient is breathing on his own? At what point does he call 911?

That scenario and ensuing questions were put to a group of dentists participating in a proof of concept course on airway management for dentists who routinely administer sedation and anesthesia. The American Dental Society of Anesthesiology Research Foundation Inc. developed the course and held a pilot testing program Dec. 8 in Chicago, which enabled ADA representatives and staff to observe.

After the ADA updated its anesthesia guidelines in 2007, the ADA Foundation launched a competitive grant program and later awarded the grant to the ADSA Research Foundation to develop a course that trains dentists to recognize, treat and prevent complications and emergencies related to sedation and general anesthesia, with special emphasis on airway management. When fully completed, the course could serve as an alternative to Advanced Cardiac Life Support training, which involves interventions concentrating on cardiac arrhythmias.

"As opposed to traditional ACLS courses, this course is directed toward the needs of the moderate sedation provider," said Dr. Morton Rosenberg, a member of the ADA Council on Dental Education and Licensure's Committee on Anesthesiology and an ADSA/ADA liaison on the development of the new course.

"Studies show that many of the complications or adverse events associated with moderate sedation center on ventilation and oxygenation," said Dr. Rosenberg. "It is evident that a course in airway rescue for dentists would be of great import."

Last month's course consisted of a hands-on workshop that required the testing group to perform a pre-assessment on high-fidelity human simulation technology, task training (including oxygen/ventilation, airway adjuncts, monitoring and drugs) and a post-assessment. Using the Sim-Man manikin programmed with several scenarios on hypoventilation/apnea and obstruction due to allergy or asthma, participants were required to work as a team and individually in "rescuing" their patients. The course also has an online component that was completed prior to the workshop.

"I was quite impressed by how well ADSA put together this course," said Dr. James Hupp, a CDEL member who observed the proof of concept course in Chicago.

"The instructors are preparing clinicians to perform a complex set of skills and do so in an efficient manner," added Dr. Hupp. "They were able to get all of the participants ready to demonstrate those skills at a level of competency, which is very difficult to do. This is a set of skills that will be greatly valued in the interest of patient safety for those who choose to sedate patients." 

Dr. Michael Nassar, a general dentist from Waterford, Mich., was one of the test-group participants.

"The instructors were phenomenal for the attention to detail provided in this skill set," said Dr. Nassar. "The course was very well organized in terms of timeframes. First of all, you don't have time to get bored, and second, it requires total immersion into the knowledge base. Total immersion is what makes you absorb it. By the end, everyone was able to rescue a patient in respiratory arrest and respond appropriately within 30 to 45 seconds, and that says a lot for the trainers."

The final step of the course's content development takes place this spring. Dr. Jade Miller, chair of CDEL's Committee on Anesthesiology, said the ADA is determining how to best deliver the course.

"The ADSA Research Foundation has done an outstanding job in the development of this course," said Dr. Miller. "As dentists, we are fortunate to have our colleagues with the expertise in airway management and emergency management be the initiators of this course.