More U.S. periodontists offering IV sedation

The concerted efforts of U.S. dental schools to offer more IV sedation training for periodontists have had a significant impact on the profession, according to the results of a survey published in the Journal of Periodontology (November 28, 2011).

About half of all periodontists currently provide IV sedation, and recent graduates are more likely to offer and administer it, according to the study authors, from the University of Iowa College of Dentistry.

The trend reflects the American Academy of Periodontology's (AAP) efforts to encourage postgraduate periodontal programs to expand IV sedation training in the early 1990s, they said.

"In the early 1990s, representatives from the periodontal profession anticipated [an] upcoming shift in services provided by periodontists, as an increased demand and need for conscious sedation in periodontics was expected," the authors wrote.

In 1994, the AAP began offering faculty training courses in conscious sedation, and representatives from 49 of the 52 U.S. postgraduate programs participated, they noted.

"The academy had a push in 1993 where it offered courses for faculty to be trained in training residents in IV sedation," explained lead study author Ben Tingey, DMD, a third-year resident at the University of Iowa College of Dentistry. "The division point we used for some data was 1996 because that would be the first year that residents could have completed a three-year program after the AAP's push."

Prior to the national survey, a pilot project was done locally at the University of Iowa.

Steven Clark, DDS, a co-author of the current study, also had an interest. "Dr. Clark is one of our big teachers in IV sedation," Dr. Tingey explained. "He felt we should look and see if all this talk about IV sedation is making a difference in private practice -- are periodontologists using all this training we're providing?"

Moderate response rate

The pilot project's results were promising, and in the follow-up effort, an 18-question survey was sent to 1,596 active periodontists in all U.S. regions. The survey contained questions related to IV sedation training, current use of IV sedation, periodontal residencies, year of graduation, current practice location, medications used, cost of malpractice, and questions regarding perceived patient desire for sedation and treatment.

Of the 1,596 active periodontists who received the survey, 596 (37%) responded.

"When you compare it to a lot of other dental surveys done by the ADA, the response rate is normal," Dr. Tingey said. "I recognize that 37% is a weakness, though. Most surveys prefer 60% to 70%."

After 22 retirees were excluded, 574 surveys were analyzed. The average graduation year was 1989; two-thirds of the survey respondents completed residency prior to 1996, and the average length of practice was 20 years.

"I think we had a good response in equality between those completing residency before 1996 and those after," Dr. Tingey said. "It's probably not overly biased in one way, although there could be some for those who don't provide [IV sedation]."

Those changes are evident in the data collected. While 49.8% of all respondents offer IV sedation in their practice, 64% of respondents who completed residency after 1996 offer it. Nearly half of the periodontists who graduated after 1996 personally perform IV sedation in their practice, while only 28% of those graduating prior to 1996 administer it.

"I was anticipating that more would be using it now, as it seems that a lot of procedures have become more invasive," Dr. Tingey noted. "I'm hoping as an academy and a profession that we can also provide more anxiolysis."

Of the entire sample, 34.1% of the survey respondents personally provide IV sedation, and 50% provide it personally or through another doctor, most commonly a dental anesthesiologist. During their training, periodontists averaged 31 IV sedations and roughly 4.5 per month in practice. Midazolam and narcotics were the most commonly used IV sedation agents.

Other patterns

The researchers also noted a pattern in the number of training IV sedations that led to use in practice.

"This critical number was 30," they wrote. Only 36% to 40% of respondents who provided 10 to 29 IV sedations in training now use IV sedation in practice, compared with 61% to 77% of those who provided 30 or more IV sedations in training, they noted.

Patterns arose regionally as well. "It was interesting to see how those trained at the federal programs, the military, who have always had a lot more training in IV sedation affected the results," Dr. Tingey said. District 8, which included all periodontists of the Federal Dental Services, averaged 96 IV sedations in training, while the second-highest district averaged 47.

Patients' tendency to request sedation was examined as well; 42% of survey respondents said it was "hardly ever" requested. However, about one-third said they receive a request for IV sedation at least weekly. In addition, patients' opinion of IV sedation was favorable, according to the survey results; 70% of respondents felt that IV sedation increased patient acceptance of treatment, while 30% felt it had no impact.

Of the survey respondents who choose not to provide IV sedation, 35% checked "no need," 25% checked "additional stress," and 24% checked "patients do not request it" in response to their reasons for not offering it.

Dr. Tingey emphasized his support for sedation training, despite the fact that many periodontists do not currently use it and may not see the need for it.

"I think it's essential that they get the training, whether or not they use it," he said.