The History of the American Dental Board of Anesthesiology

THE EARLY YEARS OF DENTAL ANESTHESIOLOGY

On August 30,1953, when Drs William Kinney, Daniel Lynch, Leonard Monheim, Jay Mervis, and Morgan Allison founded the American Dental Society of Anesthesiology (ADSA), a movement in dentistry began to seek American Dental Association (ADA) recognition of a dental specialty in anesthesiology and its corresponding specialty certifying board. Dr Kinney stated in the ADSA's first Newsletter, “We hold the future of anesthesiology in dentistry in the palms of our hands” and “…we are pledged to build a strong, well respected society of dentist-anesthesiologists which can be the spokesman for anesthesiology in dentistry and which will set the high standards necessary for the specialty of anesthesiology to attain its rightful status.”¹

Little did he know that it would take another 66 years of hard work by a few progressive oral surgeon leaders in the ADSA during the latter half of the 20th century and the heroic sacrifices of a relatively few dedicated dentist anesthesiologist leaders in the first 20 years of the 21st century who were proudly supported by several hundred very generous practicing dentist anesthesiologists before Dr Kinney's vision for the future of anesthesia in dentistry could be secured. He and many other forward-thinking past ADSA presidents, such as Leonard Monheim, Morgan Allison, William Wallace, Wayne Hiatt, Peter Jacobsohn, Norman Trieger, Tom Quinn, Ted Jastak, and Robert Campbell, were all very supportive of the specialty recognition, but after 2 failed attempts, they could only keep the specialty dream alive until another organization, the American Society of Dentist Anesthesiologists (ASDA), finally succeeded.

When the ADSA's original quest for formal recognition of the anesthesia specialty began, they realized that every specialty must have a corresponding specialty board, so they created the American Dental College of Anesthesiology (ADCA) to provide certification of training and competency in general anesthesia. It was presumed that the ADCA would become the specialty's certifying board once ADA specialty recognition was obtained. A certifying examination was developed in 1956, but because of “technical and procedural problems” that were undoubtedly politically based due to opposition from within dentistry to the planned specialty, the ADSA declared the examination null and void, the College was soon rescinded,² and the specialty attempt was abandoned.

ADSA FELLOWSHIP IN GENERAL ANESTHESIA

As an alternative to the anesthesia specialty, the ADSA created a new subcategory of membership in 1964, the ADSA “Fellowship in General Anesthesia.” At their annual meeting in 1965, the ADSA Board of Directors interviewed and passed the first 3 members to be ADSA “Fellows in General Anesthesia” and continued the annual “Fellowship” interview process until 1975 when the ADSA board approved an oral examination. Eligible ADSA “Fellows” had to have completed a 1-year hospital operating room anesthesiology rotation as per the original ADA “Guidelines for Teaching the Comprehensive Control of Pain and Anxiety in Dentistry, Part II” or have completed an oral surgery residency, which at that time required 6 months of a hospital anesthesia rotation plus 150 deep sedations performed in an ambulatory oral surgery clinic. The anesthesia requirements for oral surgery residents were judged to be approximately equivalent to 1 year of anesthesia training.

A few years later, due to a decreased number of 1-year hospital general anesthesia residency positions available for general dentists, the profession was facing the real possibility of losing its ability to have dentists properly trained in all forms of sedation and anesthesia for dental patients. In response, the ADSA Board of Directors created an exploratory committee in 1981 for the recognition of an anesthesia specialty. Their vision was that formal recognition and establishment of a certifying board would solidify the concept that anesthesia is still an integral part of the scope and practice of dentistry and would preserve the long history of a qualified dentist's ability to provide general anesthesia and sedation for their patients.

The ADSA therefore again began to pursue ADA specialty recognition and the formation of its certifying board. In 1983, the first iteration of the American Dental Board of Anesthesiology (ADBA) was incorporated in the State of Illinois by the ADSA with its slate of officers including oral surgeon Dr Daniel Laskin as president. Other board members included oral surgeons Drs Frank McCarthy, Robert Campbell, and dentist anesthesiologists Drs James Phero, Morton Rosenberg, and Joel Weaver. Dr Norman Trieger was added to the board in 1987, providing oral surgeons with a voting majority.³ Dr William Wallace, former president of both the American Association of Oral and Maxillofacial Surgeons (AAOMS) and ADSA, had successfully lobbied for a plan that the ADBA would grandfather as dental anesthesia specialists all current oral surgeons and general dentists who were ADSA “Fellows” and those who attained “Fellowship” status within a limited grandfathering period following specialty recognition. Thereafter, newly trained anesthesia specialists would have to complete a formal 2-year anesthesiology residency, as outlined in the newly revised 1993 ADA “Guidelines Part II.” The upgrade from a 1-year to a 2-year anesthesia residency was specifically made in anticipation of the ADSA's successful anesthesiology specialty recognition.

However, in 1988 and again in 1989, the AAOMS passed resolutions strongly opposing the ADSA's establishment of the specialty of dental anesthesiology and its corresponding certifying board. In October 1991, with 71% of the ADSA membership also being members of AAOMS, the ADSA Board of Directors was politically forced during this author's ADSA presidency to permanently withhold submission of the specialty application to the ADA. When the ADBA's corporate certification of continuing existence in the State of Illinois was not renewed, the ADBA then ceased to exist.⁴ The ADSA also changed the name of their “Fellowship in General Anesthesia” to the “Fellowship in Anesthesia” and changed their rigorous oral examination to a multiple choice written examination to eliminate the expensive and time-consuming oral board examination.

THE NEW ADBA

After the ADSA's decision to abandon their specialty plans, the ASDA, which was founded in 1980 and comprised of dentists with a minimum of 2 years of anesthesia residency, immediately began to develop their own ADA specialty application. There was much discussion at the ASDA annual meeting on how the specialty's certifying board should be created. Some suggested accepting the established National Board of Anesthesiology (NBA), which according to its website was formed for dentists who had completed a “full-term” Accreditation Council for Graduate Medical Education medical anesthesiology residency but were ineligible to take the physician's American Board of Anesthesiology examination because of their dental degree. The scope of the NBA examination included written and oral questions related to anesthesia for all the medical subspecialties and was designed for a few dentists who needed “board certification” to continue working in accredited hospital anesthesia departments. There was also vigorous discussion on creating a new specialty board and whether the word “dental” should be included in its name, as well as what would be the criteria for grandfathered board certification.

Eventually the ASDA membership voted to create their own certifying board including the word “dental” in its name because they were proud to be dentists and wanted to make it clear that they were focused on being dental specialists within the dental profession. Furthermore, unlike many boards that initially grandfathered not only those with the required formal training but also those with little or perhaps no formal training, the new board would only grandfather dentists who had completed at least 2 years of anesthesia residency, although several world-recognized leaders in academic dental anesthesiology whose residency met the ADA “Guidelines Part II” in affect at the start of their anesthesia training were included in this group.

A search of available board names was made and surprisingly, ADBA was discovered to be available for incorporation. On December 22, 1994, in the State of Illinois, Drs Ralph Epstein, James Snyder, James Chancellor, and Michael Higgins incorporated the ADBA as the ASDA-affiliated specialty board exclusively for dentist anesthesiologists. The ASDA membership elected 9 ASDA members for the initial ADBA Board of Directors, including Drs Joel Weaver (president), Larry Trapp (vice president), James Chancellor (secretary), Richard Finder (treasurer), and directors Drs Joseph Giovannitti, Robert Peskin, Ralph Epstein, John Leyman, and John Yagiela.⁴ They created both written and oral examinations, based on scientifically and educationally sound principles, that utilized valid, reliable, and calibrated testing methods. For the initial calibration, all 9 board members took the written examination, and to no one's surprise, Dr John A. Yagiela, DDS, PhD, had the top score.

Advertisements for qualified dentists to apply for ADBA grandfathering were published in the Journal of the American Dental Association and Anesthesia Progress (Figure), but Dr Laskin, editor of the Journal of Oral and Maxillofacial Surgery, declined publication.⁴ On March 9, 1996, the ADBA certified 98 diplomates, and it has continued on a yearly basis to certify newly trained dentist anesthesiologists who pass the written and oral examinations.

An advertisement for qualified dentists to apply for ADBA grandfathering.

In 2013, six years prior to ADA recognition of the dental anesthesiology specialty, the American Board of Dental Specialties (ABDS) was created as an alternative to the specialty recognition process of the ADA House of Delegates (ADA HOD). This was in response to “perceived or actual bias and conflict of interest in specialty recognition process” that was later acknowledged by the ADA HOD in 2017 when it gave its specialty recognition power to the National Commission on Recognition of Dental Specialties and Certifying Boards (NCRDSCB). The ABDS mimics the process of the American Board of Medical Specialties, which is an independent organization of specialty experts in their respective fields. The ABDS was created and predicated on the principle that an organization independent of any professional trade association or self-interest group is required for the objective evaluation and determination of specialty areas in dentistry following careful evaluation of their specialty board. The ADBA was recognized by the ABDS as the only legitimate dental specialty board for anesthesiology in dentistry. The ABDS therefore certifies specialty boards but does not function to certify individual dental specialists since competent boards are presumed to certify only competent applicants.

On March 11, 2019, after 25 years of contentious specialty debate and 4 previous negative votes by the ADA HOD, the ASDA's 5th specialty application was finally approved by the newly created NCRDSCB.⁴ The next step was to submit an application for recognition of the ADBA as the ASDA's associated certifying board for dentist anesthesiologists. The ADA allows only 1 certifying board for each recognized specialty, and the board must have a close relationship with the specialty's sponsoring organization. Although the ADBA was the only board that could possibly qualify for ADA's NCRDSCB recognition, it still had to meet the ADA's rigorous standards as carefully judged by the NCRDSCB. The ADBA soon developed an elaborate and comprehensive application and applied to the NCRDSCB for official recognition as the certifying board for the new specialty. On March 2, 2020, the ADBA was granted recognition by the ADA's NCRDSCB as the official certifying board for the specialty of dental anesthesiology. Thus, only diplomates of the ADBA can now claim to be board-certified dentist anesthesiologist specialists.

NATIONAL DENTAL BOARD OF ANESTHESIOLOGY (NDBA)

After the ASDA's formation of the current ADBA, the ADSA decided to convert their “Fellowship in Anesthesia” to the NDBA. Because some state dental boards had used the ADSA “Fellowship” as a criterion for an anesthesia permit, the “Fellowship” name was retained for NDBA diplomates requiring such a credential. During the initial NDBA credentialing period, ADSA “Fellows” could automatically qualify as grandfathered NDBA diplomates after paying their NDBA dues, but they did not have to take the NDBA written examination. Dentists and particularly oral surgeons were encouraged to immediately join the ADSA and take the ADSA “Fellowship” written examination during the limited NDBA grandfathering window so that they could be grandfathered into the NDBA without being required to take the more rigorous NDBA written examination. The “Fellowship” written examination was given in multiple locations throughout the country, primarily at oral surgery state meetings, in order to qualify as many as possible during the NDBA grandfathering period.

The NDBA requirement for ADSA membership significantly increased membership in the ADSA, whose mission is to provide continuing education in anesthesia for all dentists with an interest in anesthesia without regard to any specific training. After the grandfathering window had ended, according to the NDBA website,⁵ eligible dentists are now required to complete “continuous full-time participation in a Residency in Dental Anesthesiology Program acceptable to the ADSA Board of Directors” (the duration and accreditation status of which is not specified) or have completed “an accredited Oral and Maxillofacial surgery residency.” Although the American Board of Oral and Maxillofacial Surgery (ABOMS) was adamantly against the formation of the NDBA because the ABOMS already examines on the topics of anesthesiology and medicine, many oral surgeons use the NDBA as an additional credential to demonstrate continued education in the area of anesthesiology. The NDBA certification may still be generally regarded as an anesthesia credential, but it does not meet the NCRDSCB requirements for board certification for the specialty of dental anesthesiology. NDBA diplomates are not board-certified dentist anesthesiologist specialists unless they are also diplomates of the ADBA.

CURRENT ADBA DIPLOMATE QUALIFICATIONS AND EDUCATIONAL STANDARDS

The duration of the ASDA's Commission on Dental Accreditation (CODA)-accredited anesthesia residency programs increased in 2015 to 3 years (36 months) including not only a comprehensive didactic program but also a minimum of 12 months of a hospital anesthesiology rotation, 800 cases of deep sedation/general anesthetics, 300 intubations, 50 nasal intubations, 125 children age 7 years or under, 75 patients with special needs, 25 advanced airway insertions other than traditional endotracheal intubation, 100 anesthetics mentored by a dentist anesthesiologist faculty, and 4 months of medical rotations such as cardiology, internal medicine, intensive care medicine, emergency medicine, etc. These new CODA standards require dentist anesthesiologists to have a minimum of 24 months devoted exclusively to clinical training in anesthesiology of which 6 months must be devoted exclusively to dental anesthesiology. Dentist anesthesiologists who completed a CODA-accredited anesthesia residency before the expansion to 3 years are also ADBA board-eligible, as are those who can provide sufficient evidence to document that they completed an anesthesia residency that met the ADA Guidelines Part II at the start of their training and have continued to administer a sufficient number of deep sedation/general anesthetics to demonstrate current active practice to the board. After passing the written examination, the candidate must pass a rigorous comprehensive oral examination. For the ADBA to maintain the ADA's NCRDSCB recognition, the certifying board must regularly complete a complicated examination validation process to ensure that high-quality fair examinations continue to be administered.

THE FUTURE OF THE ADBA

From the original 98 diplomates, the ADBA has grown its current active membership to 262 diplomates, and to this date, a total number of 320 diplomate certificates have been issued since 1996. The anesthesia specialty is growing, with a current average of 25 new diplomates each year despite only recent specialty recognition. The quality of the oral and written examinations and the sophisticated psychometric analyses used to ensure examination validity demonstrate that the ADBA has matured exponentially since its beginning, as evident by the recent NCRDSCB recognition of the ADBA as the exclusive board of the specialty of dental anesthesiology.

Dental historians in the future will ultimately recognize the importance of several dates that were critical to the discovery and preservation of anesthesiology for the benefit of the entire dental profession and for the benefit of the public it serves:

• December 11, 1844: Dentist Horace Wells discovers nitrous oxide general anesthesia to eliminate surgical pain when he had Gardner Quincy Colton administer nitrous oxide to him while Dr John Riggs painlessly removed one of Dr Well's teeth. On the previous day, the astute Dr Wells had recognized the pain-relieving effects of nitrous oxide on an injured pharmacy assistant named Samuel Cooley who had no recollection of injuring his leg during a nitrous oxide public exhibition.

• October 16, 1846: (Ether Day) Dentist William T.G. Morton, a student of Dr Wells, gave the first successful public demonstration of ether general anesthesia at the Massachusetts General Hospital for Gilbert Abbott, who had a tumor from under his jaw painlessly removed. Morton's successful public demonstration of ether general anesthesia is viewed as one of the greatest medical contributions by the United States to the world.

• August 30, 1953: The American Dental Society of Anesthesiology (ADSA) was founded and attempted to create a recognized specialty of dental anesthesiology.

• February 16, 1980: The American Society of Dentist Anesthesiologists (ASDA) was founded to create the recognized specialty of dental anesthesiology.

• December 22, 1994: The American Dental Board of Anesthesiology (ADBA) was founded to certify dentist anesthesiologists.

• September 30, 2008: Jarom Heaton, DDS, MS, at The Ohio State University is the first dentist to complete a CODA-accredited dental anesthesiology residency following CODA's restructuring to accredit anesthesia residencies.

• March 11, 2019: ADA's NCRDSCB recognizes the specialty of dental anesthesiology with ASDA as the sponsoring organization.

• March 2, 2020: ADA's NCRDSCB recognizes the ADBA as the official certifying board of the specialty of dental anesthesiology.