Who provides your sedation?

In short: minimal sedation may be given by your dentist. Moderate ("conscious") sedation may be given by a dentist who holds a Dental Board of Australia endorsement for conscious sedation, or by a medical practitioner such as an anaesthetist. Deep sedation and general anaesthesia are given by an anaesthetist. Whoever provides it should be able to manage the sedation if it becomes deeper than planned.

The people in the room

Dentists who provide sedation

Sedation by dentists is an established, regulated part of dental care in Australia. The Australian Dental Association’s policy on conscious sedation says a dentist with sufficient training and experience may provide minimal sedation. For moderate sedation, a dentist must be endorsed by the Dental Board of Australia and have completed a Board-approved program of study. The Board publishes this as its endorsement for conscious sedation registration standard. The Better Health Channel describes such a dentist as having advanced training in sedation.

If your dentist is giving the sedation themselves, it is reasonable to ask whether they hold the endorsement and who else will be monitoring you while they are working on your teeth.

When a separate sedationist is needed

ANZCA’s guideline on procedural sedation, PG09(G), sets out when the person doing the procedure should not also be the person managing the sedation. Where anaesthetic agents are used for sedation, it states that “a separate sedationist with age-appropriate skills, competencies and experience is essential” (section 7.5). For “sick patients or complex procedures”, it says “the sedationist should be an anaesthetist” (Appendix III).

The reasoning is practical. A dentist concentrating on a difficult extraction cannot also watch every breath, and sedation can deepen without warning.

What a specialist anaesthetist is

A specialist anaesthetist is a medical doctor who has completed specialist training in anaesthesia. In Australia this is recognised by Fellowship of the Australian and New Zealand College of Anaesthetists (FANZCA) and by specialist registration in anaesthesia with Ahpra. ANZCA notes that only anaesthetists who have met its training or assessment requirements may use the post-nominals FANZCA.

For dental treatment, an anaesthetist’s role usually includes:

• assessing your health and medicines before the day
• explaining the plan, the risks and the alternatives, and obtaining your consent
• giving and adjusting the sedative or anaesthetic medicines
• monitoring and supporting your breathing and circulation throughout
• managing your recovery and deciding when you can be discharged into the care of a responsible adult.

ANZCA’s patient information notes that deeper sedation, which can affect breathing and heart function, is given by an anaesthetist. For a general anaesthetic for dental treatment, the Australian Dental Association’s policy requires an appropriately qualified and registered practitioner.

How to check a practitioner

• Ahpra register. Search the practitioner’s name on the Ahpra register of practitioners. It shows their registration type, any specialty, and any endorsements or conditions.
• ANZCA fellowship. ANZCA’s information about specialist anaesthetists links to its fellowship directory, where you can check whether an anaesthetist is a FANZCA.
• Ask directly. A practitioner should be comfortable telling you their qualifications and role.

Questions to ask

Where this guide’s author fits

Sleep Dental is published by Dr Walid Aly, a Specialist Anaesthetist (FANZCA) in Victoria. When an anaesthetist such as Dr Aly provides sedation or anaesthesia for dental treatment, they are the separate practitioner responsible for it, so the dentist can concentrate on the treatment. You can read about Dr Aly and check his registration yourself.

In an emergency, call 000. This information is general and does not replace advice from your treating practitioner.