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Anesthesia and Sedation in the Dental Office

National Institutes of Health
Consensus Development Conference Statement
April 22-24, 1985

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This statement is more than five years old and is provided solely for historical purposes. Due to the cumulative nature of medical research, new knowledge has inevitably accumulated in this subject area in the time since the statement was initially prepared. Thus some of the material is likely to be out of date, and at worst simply wrong. For reliable, current information on this and other health topics, we recommend consulting the National Institutes of Health's MedlinePlus http://www.nlm.nih.gov/medlineplus/.

This statement was originally published as: Anesthesia and Sedation in the Dental Office. NIH Consens Statement 1985 Apr 22-24; 5(10):1-18.

For making bibliographic reference to the statement in the electronic form displayed here, it is recommended that the following format be used: Anesthesia and Sedation in the Dental Office. NIH Consens Statement Online 1985 Apr 22-24 [cited year month day]; 5(10):1-18.

Introduction

Pain is a major factor that brings patients to the dental office, while fear and anxiety about pain are common reasons patients fail to seek dental care. The magnitude of this public health problem is indicated by the fact that there are 35 million Americans who avoid dental treatment until forced into the office with a toothache. The control of pain and anxiety is therefore an essential part of dental practice.

To accomplish this objective, various techniques are used, including psychological approaches, local anesthetics, and various types and combinations of sedative and general anesthetic agents. The choice of the most appropriate modality for a particular situation is based on the training, knowledge, and experience of the dentist; the nature, severity, and duration of the procedure; the age and physical and psychological status of the patient; the level of fear and anxiety; and the patient's previous response to pain control procedures.

The use of sedative and anesthetic techniques in the dental office represents a unique situation when compared with their use in the hospital environment. Dental patients are ambulatory and generally in good health, the procedures are usually shorter, the depth of anesthesia or level of sedation is often less, and it is the fear and apprehension of the patient rather than the nature of the procedure that frequently dictates the use of these techniques. These differences often are not clearly understood. As a result, the use of sedation and anesthesia in the dental office has sometimes been unduly criticized.

Despite the record of safety that has been established by the dental profession, problems have occurred and questions have been raised regarding the training necessary for the safe and effective use of sedation and general anesthesia, the indications and contraindications for the use of these techniques in different age groups, the appropriate agents to be used to provide the greatest margin of safety, and the proper management and monitoring of the patient. To resolve some of these questions, the National Institute of Dental Research of the National Institutes of Health (NIH) along with the Food and Drug Administration and the NIH Office of Medical Applications of Research convened a Consensus Development Conference on Anesthesia and Sedation in the Dental Office on April 22-24, 1985.

After listening to a series of presentations by experts in the relevant basic and clinical science areas, a consensus panel composed of individuals knowledgeable in medical and dental anesthesiology, oral and maxillofacial surgery, pediatric dentistry, general dentistry, dental education, pharmacology, behavioral science, biostatistics, epidemiology, and the public interest considered all of the material presented and agreed on answers to the following questions:

  • What are the differences between general anesthesia, deep sedation, and conscious sedation?
  • What are the indications and contraindications for the use of general anesthesia and sedation in children, adults, and the geriatric population?
  • What are the appropriate agents and techniques for general anesthesia and sedation?
  • What are the risks associated with the use of general anesthesia and sedation?
  • What facilities, equipment, personnel, and training are needed for managing and monitoring patients?
  • What are the directions for future research?

What Are the Differences Between General Anesthesia, Deep Sedation, and Conscious Sedation?

Drugs that depress the central nervous system produce a progressive dose-related continuum of effects. Small doses produce light sedation. In this state, the patient remains conscious, with some alteration of mood, relief of anxiety, drowsiness, and sometimes analgesia. As the dose is increased, or as other drugs are added, greater central nervous system depression occurs, resulting in deepening of sedation and sleep from which the patient can be aroused. Finally, when consciousness is lost and the patient cannot be aroused, light general anesthesia begins. General anesthesia can be deepened by additional drug administration. The amount of training, experience, and skill needed to safely produce and manage central nervous system depression increases with the degree of depression involved.

The degree and duration of central nervous system depression required varies with the procedure being performed and with the special requirements of the patient; these may be altered during the procedure as operative requirements change. Only a brief period of central nervous system depression may be necessary to permit the performance of procedures such as administration of a local anesthetic or the uncomplicated extraction of a tooth.

Pharmacologic approaches used for relief of pain and anxiety in dentistry, in addition to local anesthesia, include sedation and general anesthesia. These are defined as follows:

  • Sedation describes a depressed level of consciousness, which may vary from light to deep. At light levels, termed conscious sedation, the patient retains the ability present before sedation to independently maintain an airway and respond appropriately to verbal command. The patient may have amnesia, and protective reflexes are normal or minimally altered. In deep sedation, some depression of protective reflexes occurs, and although more difficult, it is still possible to arouse the patient.
  • General anesthesia describes a controlled state of unconsciousness, accompanied by partial or complete loss of protective reflexes, including the inability to independently maintain an airway or respond purposefully to verbal command.

When sedative or anesthetic drugs are used, the exact technique can be further described by specifying route of administration, agents used, and their dosage.
 

What Are the Indications and Contraindications for the Use of General Anesthesia and Sedation in Children, Adults, and the Geriatric Population?

The selection of a particular drug or drugs to allay apprehension, anxiety, fear, and pain ultimately rests on the clinical judgment of the dentist. A comprehensive medical history is essential in making this decision. Laboratory tests should be selected on the basis of necessity, specificity, sensitivity, and cost. Consideration of the patient's preference and risk/benefit ratios should influence the method of treatment. Sedation and general anesthesia should only be used when there are adequate facilities and appropriately trained personnel.

The decision to use a particular technique in a certain age group is based on the following:

Adults

For the anxious adult patient, sedation provides a calming effect, and the addition of local anesthesia provides relief of pain or discomfort. Sedation may also be indicated to minimize stress in the presence of certain medical conditions (e.g., hypertension) and for complex procedures requiring an extended period of operating time. The chief contraindication to the use of sedative techniques is the presence of a medical condition that significantly increases the risk to the patient.

General anesthesia for healthy (ASA class I or II) patients may be indicated when there is greater complexity of the procedure, higher levels of preoperative anxiety, or a greater need for a pain-free operative period. A contraindication to local anesthesia might also require that a general anesthetic be administered.

General anesthesia in an office setting may be contraindicated in patients who are not healthy (ASA class III or IV). These individuals demand special consideration, which may require treatment in the hospital or a similar setting.

Geriatric Patients

The indications for use of sedation or general anesthesia for the geriatric patient are basically the same as for other adults. However, advancing age brings marked changes in pharmacodynamics and pharmacokinetics as well as an increase in medical problems. Chronic use of multiple prescription and over-the-counter drugs is frequently encountered, thus increasing the risk of adverse drug interactions. Contraindications to the use of sedation or general anesthesia for older patients are based almost entirely on the nature and severity of such risk factors.

Pediatric Patients

The dentist's need for a cooperative and quiescent patient for the rendering of high-quality care is a prime indication for the use of sedation or general anesthesia in some children. These modalities tend to reduce fear and anxiety and assist the uncooperative child to accept and continue to receive regular dental care.

Pediatric patients with extensive and complicated treatment needs, with acute pain and/or trauma, as well as those who are physically disabled or mentally retarded, may require sedation or general anesthesia. At times, the very young child (up to 3 years of age) and those with limited or compromised ability to comprehend and communicate also are candidates for such procedures.

Additionally, there may be an indication for sedation or general anesthesia when the child would be better served by increasing the length of the appointment time and thus reducing the number of visits to accomplish the required treatment.

Although the presence of a severe, compromising medical condition is generally a contraindication to sedation, some patients in this category may benefit from its use. These children should be managed in close cooperation with the physician involved in their medical care.

While not necessarily contraindicated in the dental office, general anesthesia in the very young child often is best managed in the hospital or a similar setting, especially for lengthy restorative procedures. In all children, severe, compromising medical conditions contraindicate general anesthesia in the dental office.
 

What Are the Appropriate Agents and Techniques for General Anesthesia and Sedation?

The drug groups used for sedation or general anesthesia in the dental office are essentially the same as those used in the hospital setting. These groups include benzodiazepines (e.g., diazepam), barbiturates (e.g., pentobarbital), alcohols (e.g., chloral hydrate), the opioid analgesics (e.g., meperidine, fentanyl), antihistamines (e.g., diphenhydramine, hydroxyzine), phenothiazines (e.g., promethazine), and nitrous oxide/oxygen.

Drugs that in low dosage produce sedation, but are generally recognized as general anesthetics, are the halogenated inhalation agents (e.g., enflurane), ultrashort-acting barbiturates (e.g., thiopental, methohexital), and the dissociative agent ketamine. Accessory agents are the antimuscarinics (e.g., atropine, glycopyrrolate), which are useful in sedation and general anesthesia, and the neuromuscular blocking agents (e.g., curare, succinylcholine), which are useful only in general anesthesia.

The routes of drug administration used in the dental office include oral, inhalation, submucosal, intramuscular, intravenous, and rectal. The selection of the route of administration and agents to be used depends on the dentist's expertise and experience and the ability to optimally accomplish the treatment plan. The dentist should utilize psychological approaches as much as possible to minimize drug dosage and thus ensure the safest levels of pharmacologic central nervous system depression. Careful attention must be given to the very young, the elderly, and the special patient. These considerations will ensure that management of each patient will be highly individualized.
 

What Are the Risks Associated With the Use of General Anesthesia and Sedation?

Reliable national estimates of mortality or morbidity associated with the use of general anesthesia and sedation in the dental office are not available for the United States. The most valid data, derived from a population-based study in Great Britain, indicate a mortality rate of 1:250,000 general anesthetic administrations for the period 1970-1979. Two large surveys of oral and maxillofacial surgeons in the United States suggest lower estimates of risk, ranging from 1:350,000 to 1:860,000; however, the validity of these latter estimates cannot be evaluated because of questions about the survey methods, completeness of data collection, and the degree to which the findings can be generalized.

The British study indicates that treatment with local anesthesia with or without conscious sedation carries less risk than treatment with deep sedation or general anesthesia. Risks may increase in the medically compromised, the elderly, and the very young.

Data concerning morbidity are extremely limited and do not permit the calculation of rates. A general impression suggests that an increased morbidity and mortality are associated with greater duration of anesthesia and complexity of the dental procedure.

Confounding effects of medications being taken by the patient may increase the risks associated with sedation and general anesthesia. A consultation with the patient's physician may be advisable prior to the administration of sedative or general anesthetic agents.

Another important consideration in risk assessment relates to the choice and dosage of specific sedative and anesthetic agents. The use of any effective drug is almost always associated with some undesirable effects. For example, opioid drugs in therapeutic dosage cause respiratory depression and may cause airway obstruction. The use of central nervous system depressants for conscious sedation, especially when used in combinations, requires careful titration and close monitoring to avoid unanticipated deep sedation or general anesthesia.

Special caution is advised when considering anesthetic care for the patient who may develop malignant hyperthermia. A high index of suspicion based on the patient's family history indicates the need for further evaluation and management in the hospital.

For the medically compromised patient, the benefits of using sedation to relieve stress sometimes clearly outweigh the risk of aggravating the medical condition.
 

What Facilities, Equipment, Personnel, and Training Are Needed for Managing and Monitoring Patients?

Facilities and Equipment

The effectiveness of all techniques used for control of pain and anxiety is significantly enhanced by a quiet environment. The facility should be properly equipped with suction and monitoring equipment, emergency drugs, and equipment capable of delivering oxygen under positive pressure. A protocol for management of emergencies should be developed, and emergency drills should be carried out and documented.

Gas delivery machines should have an oxygen fail-safe system, and should be checked and calibrated periodically. All emergency equipment and drugs should be maintained on a scheduled basis. An adequate, supervised recovery space should be available.

Monitoring

For conscious sedation, the chart should contain documentation that heart rate, blood pressure, respiratory rate, and responsiveness of the patient were checked at specific intervals, including the recovery period. In addition, for deep sedation or general anesthesia, use of the precordial stethoscope for continuous monitoring of cardiac function and respiratory rate is a minimal requirement; an intravenous line, electrocardiographic monitoring or pulse oximetry, and temperature monitoring in children are desirable. Postoperative instructions and precautions should be discussed at the time that the preoperative consent is obtained and should be reinforced in printed form at the time of discharge.

Personnel

For conscious sedation, the practitioner responsible for treatment of the patient and/or administration of the drugs must be appropriately trained in the use of this modality. The minimum number of people involved should be two, i.e., the dentist or other licensed professional and an assistant trained to monitor appropriate physiologic parameters.

For deep sedation or general anesthesia, at least three individuals, each appropriately trained, are required. One is the operating dentist, who directs the deep sedation or general anesthesia. The second is a person whose responsibilities are observation and monitoring of the patient; if this person is an appropriately trained professional, he or she may direct the deep sedation or general anesthesia. The third person assists the operating dentist.

Training

Training for the use of conscious sedation techniques should conform to the American Dental Association's Guidelines for Teaching the Comprehensive Control of Pain and Anxiety in Dentistry, Parts I and III. The didactic background and clinical experiences can be provided at the predoctoral, postdoctoral, and continuing education levels. The curriculum should be sequenced to build on the basic science education, knowledge of physical evaluation, an understanding of psychological approaches, and the didactic material specific to each modality. The techniques should be taught to the level of clinical competence.

Training for deep sedation and general anesthesia requires a minimum of 1 year of advanced study or its equivalent as described in Part II of the American Dental Association's Guidelines for Teaching the Comprehensive Control of Pain and Anxiety in Dentistry. This training should have a dental orientation to assure the ability to apply the entire spectrum of pain and anxiety control to the needs of the dental patient.
 

What Are the Directions for Future Research?

There is a critical need for a comprehensive approach to research in dental anesthesiology. Major areas that should be explored include epidemiology, clinical trials of drug safety and efficacy, behavioral approaches to pain and anxiety control, pharmacokinetics, pharmacodynamics, and drug interactions.

Comprehensive data on the indications for dental anesthesia, the most efficacious drug regimens, and the morbidity and mortality rates will permit a more effective use of available sedative and anesthetic modalities. In addition, definitive clinical research in pediatric, adult, and geriatric populations is essential.

The panel specifically recommends research in the following areas:

  • Epidemiology
    • Data on the number and type of sedative and anesthetic procedures by geographic region and type of practice.
    • Information on specific drugs and dosages currently being used in each type of practice for conscious sedation, deep sedation, and general anesthesia.
    • Morbidity and mortality rates by demographic characteristics, preoperative status, type of sedation or anesthesia, and specific drugs. There is a need for development of statistically sound models for such studies. State, regional, and national data would be useful.
  • Drug Efficacy Studies
    • There is a need for well-controlled, randomized, double-blind safety and efficacy studies. There should be continued development of methods to quantitate onset, peak effects, duration of effects, and recovery from sedation and anesthesia. Oral, parenteral, and inhalation regimens should be evaluated.
    • Studies should address the risk/benefit ratio of single and combination drug regimens. Emphasis should be on the dose-response effects of each regimen and on the contribution of each drug in combination therapy.
    • Studies should include the pediatric, adult, and geriatric populations, with special emphasis on the risks unique to each group.
  • Monitoring of Patients
    • Studies are needed to determine the type and amount of monitoring best suited for the various sedation and anesthesia regimens. These studies should consider the cost-effectiveness of monitoring equipment and the necessary criteria for early intervention for drug toxicity.
    • Better methods are needed for early detection of malignant hyperthermia to permit more rapid therapeutic intervention for this sudden and potentially fatal complication.
  • Behavioral and Other Nonpharmacologic Approaches
    • Behavioral approaches and other techniques used alone or in conjunction with pharmacologic pain control need to be systematically studied.
    • Barriers to the use of psychologic approaches need to be identified and remedial programs developed.
  • Environmental Risk Assessment
    • Special studies should address the hazards of anesthetic agents to the professional personnel and office staff. This is particularly important with gaseous or volatile anesthetics.
  • New Drugs
    • There should be continuing efforts to develop new and better drugs for sedation and general anesthesia.
    • Specific reversal agents for each class of drugs should also be sought. Drugs such as the opioid antagonists and soon-to-be available benzodiazepine antagonists should be evaluated for use in dentistry as they are being developed.
  • Resources
    • It is particularly important that there be a critical mass of trained clinical and basic science researchers. It is necessary to assess whether there are adequate personnel to implement comprehensive teaching and research programs.

 Conclusions

The use of all effective drugs carries some degree of risk, however small. Available evidence suggests that use of sedative and anesthetic drugs in the dental office by appropriately trained professionals has a remarkable record of safety. However, even this record can be improved as scientific knowledge of dental anxiety and pain control is expanded, as strong training programs at all levels of professional education are developed, and as appropriate guidelines governing requirements for dental office personnel, facilities, and equipment are promulgated and adopted.
 

Consensus Development Panel

Daniel M. Laskin, D.D.S., M.S. (Chairman)
Professor and Chairman
Department of Oral and Maxillofacial Surgery
Medical College of Virginia
Richmond, Virginia
DeWitt C. Baldwin, Jr., M.D.
Emeritus Professor of Psychiatry and Behavioral Sciences
University of Nevada School of Medicine
Reno, Nevada
Stephen A. Cooper, D.M.D., Ph.D.
Professor of Oral and Maxillofacial Surgery
University of Medicine and Dentistry of New Jersey
Newark, New Jersey
Robert L. Creedon, D.D.S.
Director
Division of Pediatric Dentistry
Children's Hospital Medical Center
Cincinnati, Ohio
Linda Golodner
Deputy Director
National Consumers League
Washington, D.C.
Robert H. Griffiths, D.D.S.
Past President
American Dental Association
Charleston, Illinois
Jess Hayden, Jr., D.M.D, Ph.D., M.S.
Chairman
Executive and Advisory Committees
Niels Bjorn Jorgensen Memorial Library
Loma Linda University
Loma Linda, California; and
Clinical Assistant Professor of Anesthesiology
University of Colorado Health Sciences Center
Denver, Colorado
Lawrence H. Meskin, D.D.S., Ph.D.
Dean
University of Colorado School of Dentistry
Denver, Colorado
James C. Phero, D.M.D.
Associate Professor of Anesthesia
Assistant Professor of Surgery
Department of Anesthesia
University of Cincinnati Medical Center
Cincinnati, Ohio
Carol K. Redmond, Sc.D.
Professor and Acting Chairman
Department of Biostatistics
Graduate School of Public Health
University of Pittsburgh
Pittsburgh, Pennsylvania
Alvin L. Solomon, D.D.S.
President
American Dental Society of Anesthesiology
Assistant Clinical Professor
State University of New York at Stony Brook
School of Dentistry
Bayside, New York
Norman Trieger, D.M.D., M.D.
Professor and Chairman
Department of Dentistry, Oral and Maxillofacial Surgery
Albert Einstein College of Medicine
Montefiore Medical Center
Bronx, New York
William R. Wallace, D.D.S., M.S.
Dean
The Ohio State University College of Dentistry
Columbus, Ohio
Harry Wollman, M.D.
Robert Dunning Dripps Professor
Chairman
Department of Anesthesia
Professor of Pharmacology
University of Pennsylvania
Philadelphia, Pennsylvania

Speakers

C. Richard Bennett, D.D.S., Ph.D.
"Therapeutic Goals of Conscious"
Chairman and Professor of Anesthesiology
University of Pittsburgh School of Dental Medicine
Pittsburgh, Pennsylvania
Frederic A. Berry, M.D.
"Intraoperative Considerations: Monitoring and Management"
Professor of Anesthesia and Pediatrics
Children's Medical Center of the University of
Virginia
Charlottesville, Virginia
Michael P. Coplans, M.B., F.F.A.R.C.S., D.A.
"Mortality and Morbidity Studies"
Honorary (Retired) Consultant Anaesthetist
St. George's and the Royal Dental Hospitals
Association of Anaesthetists
London
ENGLAND
Paul J. Desjardins, D.M.D., Ph.D.
"Postoperative Considerations: Clinical Criteria of Recovery"
Assistant Professor
Department of Biodental Sciences
University of Medicine and Dentistry of New Jersey
Newark, New Jersey
Raymond A. Dionne, D.D.S., Ph.D.
"Drug Interactions and Adverse Effects"
Research Pharmacologist
Neurobiology and Anesthesiology Branch
National Institute of Dental Research
National Institutes of Health
Bethesda, Maryland
Edward J. Driscoll, D.D.S.
"A Historical Perspective of Dental Anesthesia and Sedation"
Former Chief of Anesthesiology Section
Neurobiology and Anesthesiology Branch
Former Clinical Director
National Institute of Dental Research
National Institutes of Health
Bloomington, Indiana
Samuel F. Dworkin, D.D.S., Ph.D.
"Nonpharmacological Considerations for Facilitating Dental Anesthesia, Analgesia, and Sedation"
Professor of Oral Medicine
School of Dentistry
Adjunct Professor and Director
Psychophysiology Disorders Clinic
Department of Psychology and Behavioral Sciences
University of Washington School of Medicine
Seattle, Washington
J. Max Goodson, D.D.S., Ph.D.
"Evaluation of Dose-Response Data to Derive Maximum Recommended"
Senior Member of the Staff
Head of Pharmacology Department
Forsyth Dental Center
Boston, Massachusetts
Milton Jaffe, D.D.S., M.A.
"Continuing Education"
Professor (CFT) of Hospital Dentistry
New York University College of Dentistry
New York, New York
J. Theodore Jastak, D.D.S., Ph.D.
"Dental Considerations Related to Anesthesia and Sedation in the Dental Office"
Professor and Chairman
Department of Hospital Dentistry
Oregon Health Sciences University
Portland, Oregon
Kari Korttila, M.D.
"Psychomotor Recovery After Anesthesia and Sedation in the Dental Office"
Associate Professor of Anesthesiology
Department of Anesthesia at Departments I and II of Obstetrics and Gynecology
Helsinki University Central Hospital
Helsinki
FINLAND
Frank M. McCarthy, M.D., D.D.S.
"Management and Prevention of Adverse Drug Reactions in Outpatient Dental Anesthesia and Sedation"
Professor and Chairman
Anesthesia and Medicine Section
University of Southern California School of Dentistry
Los Angeles, California
Paul A. Moore, D.M.D., Ph.D.
"Monitoring and Management-- Adult Versus Pediatric Patients"
Staff Associate
Forsyth Dental Center
Boston, Massachusetts
Michael F. Roizen, M.D.
"Preoperative Patient Evaluation for Dental Surgery"
Associate Professor
Departments of Anesthesia, Medicine, and Pharmacology
University of California, San Francisco
San Francisco, California
James W. Smudski, D.M.D., Ph.D.
"Predoctoral Education for Anesthesia and Sedation for Dental Medicine"
Dean and Professor of Pharmacology
University of Pittsburgh School of Dental Medicine
Pittsburgh, Pennsylvania
Joel M. Weaver, D.D.S., Ph.D.
"Postdoctoral Residency Training in Anesthesia and Sedation"
Associate Professor and Director of Anesthesiology and Pharmacology
Ohio State University College of Dentistry
Columbus, Ohio
John A. Yagiela, D.D.S., Ph.D.
"Preoperative Preparation and Anesthetic Selection"
Professor and Coordinator of Anesthesia and Pain Control
Center for the Health Sciences
University of California at Los Angeles School of Dentistry
Los Angeles, California

Planning Committee

Aaron Ganz, Ph.D. (Chairman)
Special Assistant for Centers and Special Programs
Extramural Programs
National Institute of Dental Research
National Institutes of Health
Bethesda, Maryland
Michael J. Bernstein
Director of Communications
Office of Medical Applications of Research
National Institutes of Health
Bethesda, Maryland
Raymond A. Dionne, D.D.S., Ph.D.
Research Pharmacologist
Neurobiology and Anesthesiology Branch
National Institute of Dental Research
National Institutes of Health
Bethesda, Maryland
Edward J. Driscoll, D.D.S.
Former Chief of Anesthesiology Section
Neurobiology and Anesthesiology Branch
Former Clinical Director
National Institute of Dental Research
National Institutes of Health
Bloomington, Indiana
Ronald Dubner, D.D.S., Ph.D.
Chief
Neurobiology and Anesthesiology Branch
National Institute of Dental Research
National Institutes of Health
Bethesda, Maryland
Jerry Elliott
Program Analyst
Office of Medical Applications of Research
National Institutes of Health
Bethesda, Maryland
Itzhak Jacoby, Ph.D.
Acting Director
Office of Medical Applications of Research
National Institutes of Health
Bethesda, Maryland
Susan Johnson
Writer/Editor
Public Inquiries and Reports Section
Office of Planning, Evaluation, and Communications
National Institute of Dental Research
National Institutes of Health
Bethesda, Maryland
Daniel M. Laskin, D.D.S., M.S.
Professor and Chairman
Department of Oral and Maxillofacial Surgery
Medical College of Virginia
Richmond, Virginia
Allan Levey, D.D.S., M.S.
Oxon Hill, Maryland
Edgar W. Mitchell, Ph.D.
Secretary
Council on Dental Therapeutics
American Dental Association
Chicago, Illinois
Patricia H. Russell, M.D.
Acting Director
Division of Surgical-Dental Drug Products
Food and Drug Administration
Rockville, Maryland
John L. Waller, M.D.
Department of Anesthesia
Emory University Hospital
Atlanta, Georgia
Clifford W. Whall, Jr., Ph.D.
Assistant Secretary
Council on Dental Therapeutics
American Dental Association
Chicago, Illinois

Conference Sponsors

National Institute of Dental Research
Harald Lo�, D.D.S., Dr. Odont.
Director
Office of Medical Applications of Research, NIH
Itzhak Jacoby, Ph.D.
Acting Director
Center for Drugs and Biologics, FDA
Harry M. Meyer, M.D.
Director

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