News: CJ Exclusives

Bill requiring clearer dental sedation rules headed to governor

State audit had chided dental regulators for lax oversight of anesthesia protocols

William Potter, spokesman for the North Carolina Dental Society, speaks on behalf of a bill clarifying rules on dental sedation at a July 14 meeting of the Senate Health Care Committee. (CJ photo by Dan Way)
William Potter, spokesman for the North Carolina Dental Society, speaks on behalf of a bill clarifying rules on dental sedation at a July 14 meeting of the Senate Health Care Committee. (CJ photo by Dan Way)

A bill instructing dentists to ignore some new state rules on sedation raised red flags in committee with Sen. Floyd McKissick, D-Durham, though supporters of the the bill said the problem was a lack of clarity in the rules. The measure wound up passing the Senate and the House without opposition.

House Bill 1145, “Disapprove Dental Examiner’s Rule,” would allow revisions to clarify the rules governing the use of sedation during dental procedures. The bill, which had passed the House on June 8 by a 115-0 vote, passed the Senate June 15, 48-0. It now awaits the signature of Gov. Pat McCrory.

“The bill was written with the advice and consent of the counsel for both the [North Carolina State] Board of Dental Examiners, and the North Carolina Dental Society, and it has their support and approval. So this is not a controversial bill. I do not know of any opposition,” Rep. Bert Jones, R-Rockingham, a dentist and the bill’s primary sponsor, told a June 14 meeting of the Senate Health Care Committee.

Even so, McKissick expressed his objections to the committee. “I know of a specific case where somebody passed away from sedation surgery because the person was oversedated,” McKissick said.

“This was a 72-year-old man who just went in to have a couple of teeth extracted,” McKissick said. “So I’m deeply concerned about anything that’s going to delay the ability of the Dental Board to go ahead and to put into effect reasonable rules and regulations that would avoid that type of untimely death of that gentleman down in Eastern North Carolina.”

That fatality was one of two that figured into a March 2015 audit by the Office of State Auditor that criticized the Dental Board’s oversight on administration and safety procedures related to anesthesia.

“Clearly, the Board of Dental Examiners and the Dental Society are extremely conscientious when it comes to our patients’ health and safety,” Jones said.

He agreed with McKissick that “it is certainly important” dental practitioners have the training, skills, and equipment to manage sedation techniques safely, and to be able to identify and manage any emergency that might occur.

“I believe that the rules that are in place do that,” he said, and they encourage the use of minimal sedation whenever possible. But some of the rules are unclear. “We’re not adequately defining what minimal sedation might be.”

“As a practicing dentist I am completely in favor of this,” said Sen. Jim Davis, R-Macon. He said the rules updates are being pursued partly in response to the death that McKissick referenced.

William Potter, representing the North Carolina Dental Society, told committee members that the bill under consideration was produced in a conference with him, Dental Board Chief Operating Officer Bobby White, and the head of the legislative drafting office.

“Everybody recognized that it needed to be dealt with in a broader sense” after objections to the original rules were raised, Potter said. Most of the issues under contention involve the administration of nitrous oxide.

“We don’t oppose this House bill,” White told Carolina Journal during an interview on Wednesday.

“We’ve had sedation rules in place in North Carolina in some shape or form for 25 years,” White said.

“It’s been a very safe and effective means of practice for a lot of dentists, and “such a valuable treatment modality for people who are anxious” by enabling them to overcome their fears, and to seek dental care they might otherwise avoid, White said.

Prior to the two deaths two years ago related to dental sedation, no dental patients had died as a result of sedation, White said.

“The board went back and reviewed its rules to see where it could make improvements that would lessen the risk of patient harm,” he said. “We’ve been at the process for about two years. We had listening conferences all over the state, had public hearings when the rules were published.”

The committee “worked pretty diligently on these rules,” White said.

As in other medical professions, there’s a continuum of sedation in dentistry.

On the lowest end of the scale a patient might take a Valium pill prior to coming to the dentist’s office, and might receive nitrous oxide while at the office. That is “extremely safe, practically no problems reported, no adverse occurrences” from that, White said.

With minimal sedation the patient is more relaxed. “You’re conscious, you maintain your reflexes, you can respond to stimuli,” White said.

General sedation is “where you’re completely out of it, and you’re on a ventilator. You’re so sedated you have to be in a hospital setting,” White said.

“We looked at all of these rules across the continuum, and published the rules we thought would be most efficacious,” he said.

But the Dental Board received 10 objections when the regulations were passed by the Rules Review Commission. Those were primarily from those who practice on the lowest and safest end of the spectrum.

“They raised a good point, saying, ‘You’re putting too much of a burden on us. We’ve practiced safely for 25 years with no incidents, and we don’t think there are any additional rules that need to be put in place,’ ” White said. “The evidence is there have been no problems in that area.”

He does not anticipate any revisions being approved this year.

“I would say by this time next year we would should have things worked through the committee,” after which rules would be published for public comment prior to a vote, White said.