At times, as an oral health therapist or dental hygienist/therapist, the everyday pressures of practice can make it difficult to stay on top of your professional competence.
Relative analgesia (RA) nitrous oxide
It is important to recognise the variability of effects that may occur with sedative drugs, however administered, and that with over-sedation, airway obstruction or cardiovascular complications may occur at any time.
Anxiolysis includes minimal sedation through single low dose oral or inhalation-type medications for treating anxious patients, but not inducing a state of conscious sedation.
Dental hygienists/therapists and oral health therapists do not have the prescribing authority required under state and territory drugs and poisons legislation to administer nitrous oxide, even if they have been trained to do so.
The dentist is the practitioner with the prescribing authority to administer the nitrous oxide, so the dentist is accountable for the effects of the scheduled medicine on the patient. But as a dental hygienist/therapist or oral health therapist, you have a duty of care to your patients just as dentists do. Therefore, as the treatment provider to a patient under RA, it would be your dual responsibility to ensure the dentist is adequately monitoring the patient throughout their treatment.
Although the Dental Board of Australia does not give specific advice on how workplaces structure the delivery of their dental services, it would be hard to demonstrate the dentist’s adequate accountability for a patient’s safe monitoring if they aren’t even in the same room.
All dental practitioners exercise autonomous decision making within their particular areas of education, training and competence, and need to ensure they provide the best possible care for their patients.
If something went wrong and the dentist was not attributed adequate accountability, it would leave you – the treatment provider – in a vicarious position. Potentially, it may be deemed that you have breached your duty of care to your patient for not ensuring a safe environment, whereby the administrating dentist has personally maintained adequate monitoring.
Dentists using RA should follow the ADA guidelines for the Administration of Nitrous Oxide Inhalation Sedation in Dentistry.1
As dental hygienists/therapists or oral health therapists, we can only practise within a structured professional relationship with a dentist, not as independent practitioners.
Therefore, the structured professional relationship provides the framework for appropriate referral and management to the dentist when the care required falls outside the scope of practice of the dental hygienist/therapist or oral health therapist.
Conscious sedation is a combination of medicines to help a patient to relax (a sedative) and to block pain (an anaesthetic) during a medical or dental procedure. Interventions to maintain a patient’s airway, spontaneous ventilation or cardiovascular function may be required in exceptional circumstances.
The Dental Board of Australia has adopted a registration standard for conscious sedation for dentist and dental specialists. There are entry-level competencies expected of dentist and dental specialists before they can practise in the area of conscious sedation.
Currently, oral health therapists and dental hygienists/therapists are unable to apply to become endorsed dental practitioners in the area of conscious sedation. You would be in breach of the Dental Board of Australia if found providing treatment in this area.
The Dental Board of Australia advises:
“A dental practitioner MUST NOT direct any persons whether a registered dental practitioner or not to undertake dental treatment or give advice outside that person’s education or competence.”
1Australian Dental Association, The Administration Of Nitrous Oxide Inhalation Sedation In Dentistry