AUGUST 8, 2025
Originally published by our sister publication Anesthesiology News
Significant variance in state regulations governing dental anesthesia—typically administered using the “one provider” model—has led to confusion and inconsistency regarding proper techniques, and may even compromise patient safety, according to a review of current guidelines in the United States.
The significant gaps and inconsistencies in regulations—as well as deviation from guidelines put forth by
Originally published by our sister publication Anesthesiology News
Significant variance in state regulations governing dental anesthesia—typically administered using the “one provider” model—has led to confusion and inconsistency regarding proper techniques, and may even compromise patient safety, according to a review of current guidelines in the United States.
The significant gaps and inconsistencies in regulations—as well as deviation from guidelines put forth by societies such as the American Society of Anesthesiologists (ASA), American Dental Association (ADA), and American Association of Oral and Maxillofacial Surgeons (AAOMS)—have serious implications for dental practitioners and staff as well as patients, primary care providers, regulatory agencies and researchers (J Patient Saf 2025;21[4]:258-281).
“The lack of consistency of rules and regulations, as well as the difficulty of extracting information, presents an opportunity to greatly improve patient safety,” said Kara Barnett, MD, the director of anesthesia services at Memorial Sloan Kettering Monmouth, in Middletown, N.J.
“As anesthesiologists, patient safety is our number one priority,” she said. “The current state of dental requirements is not doing enough to protect our patients.”
The publication, authored by Barnett and colleagues, reviewed existing guidelines and regulations for office-based dental anesthesia among all 50 states, as well as the ASA, ADA and AAOMS.
In some cases, even finding a state’s dental anesthesia regulations can be challenging. Information on state dental board websites is often not well organized or readily accessible, and occasionally relies on terminology that is variable and outdated. Permit requirements and practitioner qualifications for the administration of anesthesia differ from state to state.
“This is particularly concerning since the ‘one provider’ model means the dentist or oral surgeon is providing the sedation and conducting the procedure at the same time,” Barnett said.
Requirements regarding patient monitoring vary significantly, particularly relating to whether auxiliary personnel are needed in addition to the dental practitioner. Continuous pulse oximetry is required in 36 states, but is not required in four. And capnography is required in 27 states, recommended in seven and not commented on in the regulations posted by four states.
Definitions regarding sedation and general anesthesia vary among states, as well as ASA, ADA and AAOMS guidelines. In 33 states, four categories of sedation and general anesthesia are defined. However, only 17 states define all four sedation categories consistent with the ADA, and only four states are consistent with the ASA and AAOMS definitions. Patient selection criteria vary widely, and 42 states lack recommendations regarding preoperative fasting.
Reporting of adverse events (AEs) is also mandated inconsistently across states. In 27 states, reporting deaths, hospitalizations and other AEs is required. However, 10 states have provided no commentary regarding anesthesia-related AEs, and no state requires the reporting of near-miss events.
“Because there is no universal requirement to force recordkeeping, and when state requirements for reporting adverse events vary or just do not exist, we have no idea just how safe/unsafe things really are. So that is a big part of the problem,” Barnett said.
“People don’t realize the importance of laws governing anesthesia, and what’s lacking in most of the U.S. regarding dental anesthesia,” she continued. “Undergoing a procedure with a dentist is far different than having one done in an ambulatory center.”
Rita Agarwal, MD, a clinical professor of anesthesiology at Stanford University, in California, echoed that sentiment.
“This is a very important study in helping more physicians and other medical personnel understand the significant differences between sedation and anesthesia that is practiced by dental practitioners compared to the way sedation and anesthesia is practiced by medical professionals,” she said. “There is absolutely no difference in the way a body responds to medications based on the location that it is administered. It makes no sense to have different rules and regulations for dentistry than for medicine.”
Leaving these unclear and often conflicting policies in place, Agarwal added, puts patients at great risk.
“There are no safety nets, no backup systems, and no recordkeeping or gathering of necessary data,” she said.
The study, Barnett said, is intended to raise awareness regarding the need for tighter dental anesthesia regulations and to educate healthcare professionals as to existing risks.
“It comes down to us being proponents of patient safety and wanting to make sure that everyone is getting adequate and safe care and monitoring no matter the procedure,” she said.
By Ethan Covey
Agarwal and Barnett reported no relevant financial disclosures.
