J Oral Maxillofac Surg 53:1, 1995

Anesthesiology: Where Do We Go From Here?

It is odd that the issue of making anesthesiology a specialty of dentistry should have arisen in the sesqui- centennial anniversary year of the discovery of general anesthesia by Horace Wells because from its inception, the delivery of anesthesia has been, and continues to be, an integral part of the practice of all aspects of dentistry. In this regard, oral and maxillofacial sur- geons have played a major role not only by being among the main providers of such services, but also by being those who have done most of the teaching of this subject at the predoctoral and postdoctoral level. It is ironic that it was the oral and maxillofacial sur- geons who initially helped promote and support the development of residency programs for those dentists who were interested in making the delivery of dental services under general anesthesia an integral part of their practice and who subsequently believed that anes- thesiology should become a recognized specialty.

It is to the credit of those in organized dentistry that they realized that the services proposed to be provided by the proponents of a specialty in anesthesiology were already being adequately provided by thousands of gen- eral practitioners and other dental specialists, and that the needs of the public were being met in a safe and cost-effective manner. The overwhelming vote by the American Dental Association House of Delegates to reject the creation of this new specialty was an acknowl- edgment that the delivery of anesthesia is a defined part of every dentist's practice, and that the level of service is determined solely by educational background and training. It was also a strong indication that the legisla- tive process of the ADA really works. Although the concept of a new specialty was approved by the Council on Dental Education and the ADA Board of Trustees, in the end it was those who would be most affected, the membership, who made the final decision; and that is how a democratic process should function.

Now that the dust has settled, however, what role should the AAOMS play in the future of anesthesiol- ogy in dentistry? As Sir Winston Churchill once said, "The problems of victory are more agreeable than those of defeat, but they are no less difficult." This cannot truly be considered a victory unless there is a positive outcome. In making our case against a spe-

cialty in anesthesiology, we stressed the fact that the needs of the public were being adequately met. It is now our obligation to see that such services not only continue, but also that they continue to improve.

The basis for providing anesthesia services in a safe and effective manner is proper training, and we must maintain our role in this important area. By seeing that dental students become more proficient in all aspects of local anesthesia, inhalation analgesia, and oral seda- tion, as well as patient evaluation and management of medical emergencies, we will ultimately enable the practicing dentist to effectively manage a wider range of patients. We also need to see that more advanced training in anesthesiology remains available to those dentists who wish to provide services for special pa- tients in their offices, and that there is access to the hospital for these dentists when they have more com- plex patients who are best treated in such facilities. Finally, we need to continue our efforts to set appro- priate educational standards for training in various as- pects of anesthesiology and to establish proper criteria for evaluating and monitoring patients receiving seda- tion and general anesthesia in the dental office.

If anesthesiology in dentistry is to continue to flour- ish, however, we need to have an interest not only in education and training, but also in contributing to the knowledge in the field. Although we have recognized this in the clinical aspects of oral and maxillofacial surgery and have encouraged and supported research in these areas, anesthesiology has been sorely neglected in recent times, and this is reflected in the paucity of arti- cles in our literature. Just as anesthesiology represents a significant part of our practice, so must it represent a significant part of our research activity.

The use of anesthesia is an integral part of the total profession of dentistry. We, therefore, cannot allow interest in this area to become fragmented or diluted. To do so could result in a lowering of standards, a decline in our record of safety, and the potential loss of the right to provide such services. It is clear that the stakes are too high to permit past differences to interfere with future progress.

DANIEL M. LASKIN