Dentistry and Intubation in over 240 Characters
An April 1st tweet from Dr. Eugene Gu raised the possibility of dentists intubating patients in hospitals. The subsequent comments of Dr. Gu’s tweet acknowledge the public’s concern that suddenly dentists would be allowed into hospitals to perform medical procedures such as intubating patients.
On the surface of just living in isolation and reading this tweet, then of course anyone would be concerned about the prospect of dentists suddenly performing procedures outside a dental office and within a hospital. But let’s take a closer look with greater than 240 characters.
As the need for front line health care workers increases, California has started a major and urgent expansion of its medical workforce. Governor Newsom issued an executive order encouraging health care workers to join the California Health Corps.
California should be commended for recognizing the enormity of the current pandemic and the immediate risks to front line hospital staff. The concerns of illness, injury, exhaustion, fatigue are all very real for front line healthcare workers.
With respect to dentistry it is important to appreciate certain aspects of dentists’ education and training to reassure the public to some degree.
There are many different types of dentists and many different types of residency training programs. Most people are aware of their family dentists, the oral surgeon who takes out their wisdom teeth, and the orthodontist who straightens teeth; fewer are aware of the endodontist who performs root canals and the periodontist who performs gum grafts. These are all oversimplifications of what dentists do on a regular basis.
The American Dental Association (ADA) currently recognizes 10 specialties in dentistry (Dental Anesthesiology; Dental Public Health; Endodontics; Oral & Maxillofacial Pathology; Oral & Maxillofacial Radiology; Oral & Maxillofacial Surgery; Orthodontics and Dentofacial Orthopedic;, Pediatric Dentistry; Periodontics; and Prosthodontics. Meanwhile, Canada recognizes 9 specialties.
After 4 years of dental school, some dentists pursue additional training through residency training. This is similar to the medical training model except that in the US and Canada, there are not enough residency training spots for every graduating dental student.
The most obvious dental specialty with excellent training in intubations would be Dental Anesthesiology. Most dental anesthesiologists would remind anyone who would care to listen that Horace Wells, a dentist, along with his apprentice William T.G. Morton, first demonstrated the use of nitrous oxide for sedation during a dental extraction in 1845.
The second most obvious choice would be the oral and maxillofacial surgeon who would need to know how to resuscitate a patient during and after a complex maxillofacial surgical procedure.
There is one other group that receives hands-on instruction on intubations: the GPR or general practice residency. A GPR is a 1-2 year program accredited by the Commission on Dental Accreditation (CODA) that trains dentists on all aspects of dentistry including hospital dentistry or in-patient care as well as ambulatory care.
GPR training includes rotations in maxillofacial surgery, otolaryngology, oral medicine, facial pain, internal medicine, oncology, and anesthesia. Like medical residency training, there are emergency on-call shifts, literature reviews, lectures, and presentations in addition to clinical care.
The hospital training learning objectives include how to take a proper medical history, physical examination skills and ordering/interpreting appropriate laboratory testing.
The anesthesia rotation is designed to improve knowledge and experience on evaluating the preoperative anesthesia patient; gain competence and efficiency in venipuncture; knowledge in airway management; monitoring the unconscious patient; patient recovery following anesthesia/procedure; improving knowledge on the medications used in anesthesia as well as their side effects; and hands-on experience with intubations.
Keep in mind the goal of a GPR program is to teach new dental graduates all aspects of dentistry and to be comfortable working in the hospital setting.
I am not suggesting that dentists replace first line health care workers. I am not suggesting all GPR trained dentists should intubate patients. Dentistry has long evolved from whatever “drill and fill” stereotype one might have.
Dentists provide CPR; treat oral, facial, and cranial injuries; collect samples; provide or assist in anesthesia; start IV lines; and know how to deal with anxious patients. We can assist in triage, gathering medical history, record keeping, and infection control.
The current COVID-19 pandemic is taxing the hospital system in unimaginable ways. Some experts in mass disaster response planned for this. Dentistry as a profession has unique skills that would provide beneficial support in certain settings. I know several colleagues who are more than willing to help and have the training to assist. Some of us could even intubate if needed.