Dear VA Dental Board,                                                                                                                 August 29, 2018

Regulations Governing the Practice of Dentistry [18 VAC 60 ? 21]

I am writing to voice my opposition to the proposed changes with oral conscious sedation. Our office has been oral sedation certified for almost 3 years and we have treated over 150 sedation patients without any incident. This is already a proven safe modality of treatment when the current regulations are followed.  These patients are people that have avoided dental treatment for years – sometimes decades - due to their great fear of dentistry and often of needles. The availability of oral sedation has made it possible for them to move forward with care to improve their health and eliminate infection.

 We generally use a combination of nitrous and Triazolam – generally about .5mg of Triazolam and sometimes up to.75mg if the patient is large. The proposed limiting of dosage and limiting sedation to just one medicine would limit the successfulness of sedation.  The dosage of Triazolam that is needed for sedation varies according to the patient’s size, other medicines they are taking and their reaction to the sedation medicine. However, by using nitrous in combination with Triazolam, we don’t have to use as much Triazolam.  By limiting the dosage or only allowing one of the meds, that will mean some patients are not adequately sedated to eliminate their anxiety about dental care and they will not have a comfortable, positive experience. 

Our patients mostly choose oral sedation because they don’t like an IV needle and the cost for oral sedation is significantly lower which makes access to dental care more affordable.  If there are concerns about any specific incidents, then that office should be visited to make sure the current guidelines are being adhered to. If more training is needed, then more training is a better way to increase patient safety rather than restricting the dosage of sedation meds. When the current guidelines are correctly followed, oral sedation is safe and allows access to care for many people that otherwise wouldn’t get dental care.

I would like to voice my feeling that this regulation would actually limit patient safety because people may not seek needed dental care if they have to have IV sedation. I feel these restrictive guidelines are not needed and do not increase patient safety and add a barrier to access of care for many people.

Thank You,

Dr Joseph McIntyre DDS

Smiles for Life Dental Care

115 Oakwood Drive

Bridgewater, VA 22812

540-828-2312