With all of the recent publicity regarding morbidity in dental offices related to sedation and anesthesia, it got me thinking about the acuity of care being delivered in dental offices and the lack of enforcement of NFPA 99 and 101 code. In full disclosure, I am both a dentist and anesthesiologist.
In today's day and age, there has been increasing demand for sedation dentistry. General dentists are providing more and more advanced sedation options, including multiple oral drug cocktails to total intravenous (IV) anesthesia. Historically, in dentistry this was only provided by specialists such as oral and maxillofacial surgeons. In all fairness though, this trend is also occurring in medicine with the prevalence of office based surgery as well.
This got me thinking though because most dental offices have historically been treated as Level 3 Medical Gas systems. I believe this is based on the old notion that dentists are providing treatment with laughing gas. In addition, many inspectors and fire department officials do not check to make sure these offices are in compliance. On multiple occasions I have asked such individuals for clarification of the code. The reply I receive is usually that it is up to the practitioner or that every dental office is a Level 3 by default.
With the increase use of sedation and anesthesia, the risk profile has changed. Under current NFPA 99 guidelines, it appears by my understanding that any Healthcare facility performing deep sedation or general anesthesia is now a Category 1 facility. One might argue under previous standards that an oral surgeon's office or sedation dentist's practice was a Level 2, as the procedures are non life threatening and the patient can be allowed to emerge in the event of an electrical or medical gas failure. By this logic, dental facilities should be held to a more stringent standard than a Category / Level 3; they should at least be built to a Level 2 standard it seems.
In my experience, it seems like this is not the case though. Can someone with a greater expertise than my own help clarify? Is dentistry and office based surgery really just flying under the radar? Are the standards silent due to the fact that less than 4 people can be incapacitated at any time (I believe that is the number that triggers more strict guidelines for Ambulatory surgery center criteria)?
Thanks in advance!