Proposed sedative rule change exasperates Maine’s dentists

Posted Sept. 12, 2008, at 8:34 p.m.

AUGUSTA, Maine — Maine dentists are irate over proposed changes to state rules governing the use of in-office oral sedation for their patients. At a public hearing Friday before the Board of Dental Examiners, dentists said the board’s stringent policies are making it harder to bring qualified family dentists to the state and undermining Gov. John Baldacci’s commitment to improving access to dental care.

Dr. Daniel Steinke, who has offices in Dover-Foxcroft and Sorrento, took the board to task for not including general-practice dentists in drafting the new regulations, for protecting the interests of certain dental specialists over the public good, and for creating a climate of hostility toward general dentists.

“We [in Maine] have an access-to-care issue. We can’t have regulations that are more restrictive than everyone else,” Steinke said in his emotional rebuke to the board. “This state has a reputation of being unfriendly to dentists.”

Since dental board members are appointed by the governor and since Baldacci has identified expanding access to dental care as a priority of his administration, Steinke said dentists will “force” Baldacci to listen to their concerns that Maine increasingly is seen as a hostile and restrictive place to practice.

A spokeswoman in the governor’s office said Friday that Baldacci is aware of the dust-up at the dental board, but that he is not prepared to get personally involved.

At issue is a set of board-drafted rules proposed for the use of “moderate oral sedation,” the practice of giving fearful patients a dose of mild anti-anxiety medication, usually in tablet form, to take before coming to the office for dental work. The American Dental Society recently overhauled its recommendations for all levels of sedation and anesthesia. But for moderate sedation, in which patients are drowsy but able to be roused and able to follow instructions, the Maine board has proposed more intensive rules than the ADA recommends.

General dentists, many of whom have taken specialized training in the safe administration of oral sedation, have argued that these new rules would make it harder to be certified to use moderate sedation in their offices and that patients unable to be treated for anxiety by their family dentists would either go without care or be forced to seek even basic dental care from specialists such as oral surgeons, who already meet the proposed standards.

Chief among the worries of general dentists is a proposed requirement that they use an electrocardiogram device to monitor the heart activity of patients under moderate sedation. Steinke and other dentists at the hearing said this requirement would increase anxiety in patients whose nerves are already on edge. Acquiring the medical device also would impose a significant cost to small practices, resulting in higher charges to patients and fewer dentists willing to offer the service.

But the real problem, Steinke said, is that “there has never been a question about the safety of moderate oral sedation.” Out of more than a million documented uses nationwide in recent years, there have been no patient deaths and no more than a handful of minor adverse reactions, he said.

No other state requires dentists to use ECG monitoring for patients under moderate sedation, he said.

Steinke accused the two oral surgeons on the board, president Jeffrey Fister of Bangor and David Moyer of South Portland, of “playing off each other to convince other board members of the danger” of using moderate oral sedation. He called on the other board members, who include dentists, hygienists and a denturist, to seek information from nonboard dentists and other colleagues before voting on the proposals.

Several other dentists at the hearing also took aim at the electrocardiogram proposal, as well as at other proposals not included in the ADA recommendations.

During a break in the hearing, Steinke said Maine has an emerging national reputation for being hostile to dentists. For example, most states will welcome new graduates who have passed a licensure exam from another region of the country, but Maine insists all new graduates take and pass the New England regional exam as well, he said. Additionally, Steinke said, the Maine board is known for being “extremely aggressive” in disciplining dentists over minor complaints.

No one testified in favor of the proposed rule changes, and board members did not respond to the testimony during the hearing. Fister declined to comment after the hearing. A spokesman for the Department of Professional and Financial Regulation said the board would reserve its comments for its next meeting, scheduled for Oct. 10. All meetings of the board are open to the public.

The Board of Dental Examiners will take public testimony of the proposed rule changes until Oct. 9. The changes can be found on the board’s Web site, www.mainedental.org. Testimony may be dropped off at 161 Capitol St. in Augusta, mailed to 143 State House Station, Augusta 04333-0143, or e-mailed to dental.board@maine.gov. The board’s telephone number is 287-3333 and its fax number is 287-8140.

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