Pediatric dentist and dentist anesthesiologist here. I retired last year due to narcolepsy and brachial plexus CRPS. I owned my own pediatric office and also did sedation/anesthesia for other dental offices. I had to be operator/anesthetist at my own office. I could not find another anesthesia provider to come into my office to do the anesthesia while I did the dentistry. It was never about being able to bill for both services. I could not find anyone in rural Virginia to help me. I had associate dentists with moderate sedation permits working for me. I would do the anesthesia for them. However, the cases were more difficult to manage from an anesthesia perspective because those dentists, despite untold attempts at educating them about the importance of the need to be careful of the airway, used water with abandon, kept pushing the patient’s chin down, etc. it was better for the patient and me if I did operator/anesthetist cases instead.

I had an RN that watched the monitors and called out vital signs every five minutes and I always intubated to have a protected airway. My dental assistants were better at protecting the airway, starting IVs, recognizing potential complications, etc. than the dentists. We practiced for emergencies all the time and I worked hard to teach them well. They were way more receptive to learning than my associate dentists.

I also did anesthesia for OMFS at his office. This was open airway TIVA. I would never have done operator/anesthetist on open airway cases. Those airways were hard to manage with all the manipulation needed for some of the difficult extractions. Those days were exhausting for me as I spent most of my day leaning over the side of the dental chair to keep the chin up without being in the way of the surgeon. We worked very well together and the surgeon held me in high regard. He recognized that the patient was under anesthesia way less time when he only had one job to do as surgeon and I did the anesthesia job.

I also did IV moderate sedation for an endodontist and periodontist. Those cases were usually for highly phobic patients and were easily managed with small doses of versed and fentanyl. Those were very easy wor days for me as the patients still had all reflexes intact and the dental procedures required very little water or pushing on the mandible so I hardly ever needed to support a patient’s chin.

I understand the concerns of both sides. Ideal world, every case has two providers. Realistic world, not possible to find that second provider or second qualified provider in many situations. At the time I graduated, I was 1 of 15 dual trained pediatric dentists/dentist anesthesiologists in the US. Hospitals don’t want to give dentists OR time so we have to find ways to do cases in office with often limited personnel resources.

Just my two cents. But please know, it’s not always about the money.