Reader reaction: A dentist questions safety paradigms

This letter was written in response to A child's death and the power of the dental lobby, which CALmatters published on April 13, 2016.

“There is no evidence that dental anesthesia under this model of care carries a greater risk than dental care with a second anesthesiologist present,” Alicia Malaby, spokeswoman for the California Dental Association (CDA), wrote in an email.

The CDA does not claim there is evidence that the single operator-anesthetist model is safe, only that there is no evidence that it is unsafe -- a very different standard. Certainly very different than the standard it advocates when considering allowing dental therapists to operate in the state.

In 2012, when the California Senate was considering a proposal aimed at improving dental care for underserved children by, among other proposals, authorizing a project to explore new workforce training and delivery models such as dental therapists, the CDA's support included its admonition that “A rigorous scientific study on the safety, quality and cost-effectiveness of allowing certain procedures, such as fillings, to be performed by non-dentists is needed. It is not appropriate for California to create any kind of provider without this assurance, and therefore CDA is opposed to any changes in scopes of practice until such compelling data exists.”

Apparently, the CDA feels the risk of therapists performing treatment under the supervision of dentists requires far greater verification of safety than the risk of dentists performing treatment while simultaneously administering and monitoring general anesthesia. 

Does this approach accurately reflect the risk/benefit differences between these two paradigms?

Steven Krauss, DDS, MPH, MBA

Woodmere, NY