Office-Based Dental Anaesthesia Gaining Ground over Hospital-Based in USA
Dentist anaesthesiologists are a unique medical provider. Their training is related more closely to medical anaesthesiologists than to dentists in that they do not receive clinical training in dental or oral surgery.
During their three-year residency programme, dentist anaesthesiologists receive most of their training in a hospital-based setting, performing a minimum of 800 cases of general anaesthesia, of which at least 125 must be performed on children younger than seven years of age. However, very little is known about the post-residency practice characteristics of dentist anaesthesiologists.
Researchers from the Indiana University School of Dentistry in Indianapolis, Brigham and Women’s Hospital in Boston, and the University of California at San Diego recently published a study in the current issue of Anesthesia Progress that examines the procedural differences between dentist and physician anaesthesiologists. Using two main dental databases, the National Anesthesia Clinical Outcomes Registry (NACOR) and the Society for Ambulatory Anesthesia Clinical Outcomes Registry (SCOR), for dental and oral surgery procedures, the researchers compared 7,133 office-based procedures performed by dentist anaesthesiologists with 106,420 in-hospital procedures provided by physician anaesthesiologists.
The information from the SCOR database focused on office-based settings, while NACOR included hospital-based. The data showed that in both groups children six years and younger were the predominant recipients receiving anaesthetic dental treatment (two-thirds of NACOR patients; three-fourths of SCOR patients); however, the average age for SCOR was approximately nine years and for NACOR approximately 12 years. The researchers also found a 46 percent longer surgical time for the cases from the NACOR database versus those from the SCOR. Both databases noted that early childhood caries (tooth decay) was the main diagnosis for the dental procedures needing anesthesia.
In reviewing the data, the researchers found a clear correlation between early childhood caries and the need for anaesthesia during dental procedures. Given that this is the most common disease among children six years and younger, with more than 4.5 million cases developing each year, paediatric dentists need dentist anaesthesiologists. The researchers also found that the overall cost of paediatric dental procedures with anaesthesia performed in a hospital-based setting has increased between three and four times than that of 20 years ago. Currently, an 84 per cent cost savings is found when anaesthesia is administered in an office-based setting.
Overall, there is a consistent trend with more dental anaesthetic procedures being performed in an office-based setting, particularly for paediatric dentistry. The researchers have found that, “The anaesthesia care provided by dentist anaesthesiologists is also separate and distinct from anaesthesia provided by oral and maxillofacial surgeons. Oral surgeons are the only other dentists who can legally administer general anaesthesia in the US; however, they receive approximately six months of general anaesthesia training. Dentist anaesthesiologists provide care to younger patients for procedures of longer duration using an independent anaesthesia provider model versus oral and maxillofacial surgeons who use the operator-anaesthesia model for shorter procedures on older patients.”
More research in this field is necessary because the data collected from the SCOR and NACOR are fairly limited as to the amount of information that is collected from providers on a volunteer level. The researchers concluded that despite the limitations on data collection, they are confident that, “Office-based anaesthesia rendered by dentist anaesthesiologists is clearly a unique and efficient mode of anaesthesia care for dentistry.” They also believe that the increasing trend in office-based procedures with dentist anaesthesiologists will continue.