The Illinois Society of Pediatric Dentists (ISPD) recently achieved an important legislative victory in the area of dental sedation permits. They faced a challenge in that the Illinois Department of Financial and Professional Registration (IDFPR- aka the state dental licensing board) took a position on the training requirements for a pediatric dentist to obtain a permit to administer moderate sedation that was inconsistent with established Commission on Dental Accreditation (CODA) educational standards. IDFPR filed an administrative rule that would require documentation of 20 intravenous (IV) cases as the demonstrated technique for administering moderate sedation, in order for a pediatric dentist to obtain a moderate sedation permit. As a result, pediatric dentists in Illinois would be unable to obtain this permit, limiting access to care.
After unsuccessful efforts to fix this proposal at the IDFPR level, pediatric dentists and UIC faculty members Drs. Flavia Lamberghini (Illinois Public Policy Advocate) and David Avenetti (UIC chair of pediatric dentistry and NorthCentral Society of Pediatric Dentistry executive director) strategized with ISPD leadership about a legislative solution. ISPD obtained technical and legal assistance from the AAPD, developed a task force led by Dr. Mary Hayes, and ultimately engaged a state-level lobbyist to work on the issue in collaboration with the Illinois State Dental Society and other key stakeholders.
These efforts led to advocacy with key legislators, development of a legislative fact sheet, and the introduction of a bill (SB2822) to remedy the problem. The fact sheet included the following synopsis:
“This is very problematic for pediatric dentists in Illinois and around the country as none of the 80+ US (CODA) approved pediatric dental programs require experience in 20 or more cases of moderate sedation using intravenous techniques. The Commission on Dental Accreditation (CODA) is the gold standard for dental education and is the basis and standard in dental schools across the country. Every dentist in the country must graduate from an (CODA) approved program in order to get a license to practice dentistry. For dental specialty purposes, CODA requirements are tailored for that specialty, patient base and are structured to promote patient safety and access to care.
The proposed rule change by the Department would exacerbate the current shortage of providers capable of treating children in Illinois, posing a challenge for pediatric dental care, especially to those patients with a high degree of decay and from the underserved Medicaid population. Starting an IV on a scared four-year-old can be tricky if not impossible for the most experienced pediatric provider, whether medical or dental. When treating the oral health needs of children, there are numerous behavior management techniques that pediatric dentists use. These techniques vary based upon the treatment needed and the behavior management for children. Moderate sedation is an extremely valuable treatment modality for this population as it allows pediatric dentists to care for this vulnerable population that also experiences significant dental fear and situational anxiety.
As part of their training, pediatric dental residents complete a minimum of 50 patient encounters in which sedative agents other than nitrous oxide are used, but may include nitrous oxide in combination with oral medications. These sedative agents can be administered via any route. With children, it is common practice for pediatric dental specialists to use oral or intranasal medications to achieve moderate sedation. In addition, all residency programs are required to train their residents to be able to effectively recognize and manage deeper levels of sedation if necessary. In doing so, pediatric dentists are trained to be competent in starting an IV as well as obtaining intraosseous access (IO). All residents are also certified in Pediatric Advanced Life Support (PALS) and are effectively prepared to manage sedation emergencies.”
SB 2822 codifies the national standards and eliminate the Department’s ability to require arbitrary and unfounded permit requirements on pediatric dentists. The training standards adhered to by CODA, the ADA and the American Academy of Pediatric Dentistry (AAPD) have been carefully structured to promote patient safety and access to care for the children who need this care the most. These guidelines and standards are consistent with both medical and dental pediatric care, developed with physicians at the American Academy of Pediatrics (AAP). There are no statements in any of the aforementioned documents which single out the intravenous IV route as the required route for moderate sedation in the pediatric patient.
The good news is that SB2822 was approved by both the Senate and House of the Illinois General Assembly in May, and signed into law effective July 1, 2024 as P.L. 103-0628*.
For any questions, please contact Chief Operating Officer and General Counsel C. Scott Litch at 773-938-4759 or slitch@aapd.org.
*https://www.ilga.gov/legislation/publicacts/103/PDF/103-0628.pdf.