Many valid points concerning the issues of infringement by allied dental personnel on dental practitioners were raised in Dr. Lawrence Meskin’s editorial, "Forever Vigilant" (June JADA).
Dr. Meskin used the experiences of physician anesthesiologists and independent nurse anesthetists to illustrate what might happen in dentistry. I believe that the medical experience could impact dentistry in another, more serious way.
As a dentist anesthesiologist, I have been trained to recognize subtle deviations from the norm that, if left unchecked, could result in catastrophe. The repeated denial of the need for an anesthesiology specialty in dentistry by the ADA House of Delegates in recent years has heightened my awareness for subtlety.
The current oversupply of physician anesthesiologists has resulted in a migration away from traditional practice modalities (that is, hospital-based practice). If nurse anesthetists are granted independent practice, the increased competition will force more physician anesthesiologists into alternative methods of practice (that is, out-patient office-based practice).
Where will they go? Medicine is certainly trending toward more and more outpatient and office-based procedures. Physicians even have a professional organization, the Society for Office-Based Anesthesia, specifically for this type of practice.
Medical cases alone cannot fulfill the needs of this group. Dentistry is seen as an uncharted, underdeveloped area of practice for physicians. It is only a matter of time until they enter our profession in full force.
Already in my own community, there is a large group of physician anesthesiologists actively promoting their services in the dental marketplace. Once they gain a foothold, it is only a small step for them to declare that "anesthesia is the practice of medicine" and that only physicians are qualified to administer anesthesia to dental patients.
What safeguards are in place to prevent this? Dr. Meskin correctly states that we must be vigilant to ensure that the dentist/patient relationship is not compromised. Yet dentistry turns a blind eye to a great potential infringement upon this relationship.
