EDUCATION AND TRAINING OF DENTAL SEDATION IN A DENTAL GROUP - TAIWAN’S EXPERIENCE

Chih Hao Sung, Jia Yuan Liang, Eric Yil-Huei Yen, Kuo Tung Fan*

Center of HBO & Implant, Modern-Dental Medical Group, Taoyuan, Taiwan

*d94845002@gmail.com

Background and Aims

There is no systemic education and training of office-based dental sedation (OBDS) for dental students, dentists and anesthesiologists in Taiwan. Although very few dentists had practiced sedation in a small number of dental clinics for more than 20 years, OBDS was still unfamiliar to Taiwan’s lay-people and health providers. How to train dentists and anesthesiologists as dental sedationists is a big challenge for Taiwan’s medical academia.

Methods

The action research was designed and practiced in Modern-Dental Medical Group (MDMG). Presently there are four branch dental clinics with more than 50 doctors as well as 140 dental assistants and executive staff in MDMG which was founded in Northern Taiwan in 1987. Relative analgesia machine and target control infusion (TCI) pump were introduced separately in 2002 and 2011. Based on a marketing strategy without an isolated fee for OBDS, another anesthesiologist was invited to devise a series of programs to increase the quality and quantity of scheduled OBDS from Jul. 2011until now.

Results

According to clinic needs and conflicts occurred in daily practice, the education and training of OBDS were both modified and differentiated into 4 phases. During phase 1 from Jul. to Sep. 2011, the nursing workflow and manpower in OBDS were established, standardized and integrated into traditional dental workflow. During phase 2 from Oct. 2011 to Feb. 2012, the first course in education and training of OBDS, based on programs of dental sedation in advanced countries, began in the center of HBO & Implant in MDMG. In addition to N2O/O2 and TCI sedation, other methods, such as oral, intranasal, intramuscular and mixed sedation, and more regulated drugs, such as midazolam, ketamine and narcotics, were also adopted. During phase 3 from Mar. to Sep. 2012, the conception and workflow of OBDS were introduced to all staffs in MDMG. In addition, the neighboring dentists and anesthesiologists could join basic E&T and sign up for an advanced course. During phase 4 from Oct. 2012 until present, some trained senior dentists and dental nurses have been encouraged to practice OBDS independently, only in anxiolytic and moderate sedation levels, without supervision of an anesthesiologist. Nevertheless, the new and junior dentists have been required to learn basic education and training of OBDS before they attempt to treat sedated patients.

Conclusions

Different obstacles have been instead with surprised fruits these two years. More than 1,000 OBDS treatments have been performed, and many nervous patients requested it in dental implants, endodontics, pedodontics, or other oral surgeries. Both our staff and outsiders agree education and training of OBDS is a worthy investment to improve the professional image of MDMG. Most importantly, trained dentists have been empowered to practice OBDS as part of their profession, and dental nurses can now also think of themselves as a more important part of MDMG.

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HOW TO BUILD A TEAM FOR PEDODONTIC OFFICE-BASED INTRAVENOUS SEDATION

Kuo Tung Fan*, Chih Hao Sung, Eric Yil-Huei Yen, Jia Yuan Liang

Center of HBO & Implant, Modern-Dental Medical Group, Taoyuan, Taiwan

*d94845002@gmail.com

Background and Aims

For the pediatric dental patients, behavior management without pharmacological methods in dental clinic or general anesthesia with tracheal intubation in operating room is the main strategy practiced routinely by Taiwan’s dental and medical academia. Since the first office-based dental sedation (OBDS) was carried out about three decades ago in Taiwan, there has been little information related to training course or practice experience for how to build a team for moderate and deep level of pedodontic office-based intravenous sedation (POBIS). Nevertheless, it is worthy to accumulate experience in every POBIS and explore how to improve member ability and make a proper workflow in an ongoing process of POBIS team building.

Methods

This retrospective study was practiced in Modern-Dental Medical Group (MDMG). Presently there are four branch dental clinics with more than 50 doctors as well as 140 dental assistants and executive staff in MDMG which was founded in Northern Taiwan in 1987. Relative analgesia machine and target control infusion (TCI) pump were introduced separately in 2002 and 2011. The management of MDMG has devised a series of OBDS courses from Jul. 2011 until now. To build a POBIS team is one of several targets. Base on the 50 sedation appointments in dental clinics of MDMG, we made an overview and analysis with regard to members ability and workflow modification.

Results

The ongoing process of POBIS team building could be divided into 3 stages. During stage 1from Jul. to Dec. 2011, the POBIS team members, including a pedodontic dentist, dental assistants, sedation dental nurses, and a skilled sedationist/anesthesiologist, as the team leader, were recruited and accepted OBDS lecture courses. How to encourage traditional pedodontic dentists to join the POBIS team was a big challenge in this stage. During stage 2 from Jan to Dec. 2012, POBIS team began operation and succeeded in 25 sedation appointments. Our team members did not only identify their roles through following orders from the leader, but also improve their special skills and care coordination from the lessons of previous POBISs. The workflow of POBIS, from pre-sedation evaluation to post-emergence telephone follow-up, was integrated with different sedation methods and standardized in this stage. During stage 3 from Jan. 2013 to now, another 25 POBIS appointments have succeeded. Meanwhile, POBIS team members attempted to coordinate and collaborate just under the supervision from team leader. More importantly for team members, several events related to airway obstruction and emergency were overcome by themselves without the intervention or progressive orders from the sedationist/anesthesiologist.

Conclusions

Although it spent two years to succeed only 50 sedation appointments, the experiences of POBIS team building may be insufficient but still excited us and had attracted some outsiders such as anesthesiologists and pedodontic dentists to visit MDMG. The idea of second POBIS team in MDMG will germinate in the future.