Ontario Dentists' Practice of Sedation and General Anesthesia: Barriers to Access and Use

Objectives: To investigate, among Ontario dentists, (1) self-reported barriers to access to sedation and general anesthesia (GA) services and (2) their current use of sedation and GA. Methods: Of Ontario dentists practising, 3001 were randomly selected to complete a 16-question survey by mail or online in 2011. Mixed analysis of variance (ANOVA) followed by independent-sample t tests or 1-way ANOVA evaluated the relation between dentists' views and demographic variables including sex, clinical experience and size of primary practice. Results: Of the participants (n = 1076; 37.9% response rate), 69.7% were male, 84.4% were general practitioners, mean time in practice was 20.6 years (0.5-42 years) and 42.2% were in cities of over 500 000 people. Most dentists (60.2%) provided anesthesia services, although 38.2% indicated lack of training and the belief that there is no patient demand (25.3%) as reasons not to use anesthesia in their offices. Nitrous oxide was used 17.5% of the time for all dental procedures except implants. Barriers to referral of patients for anesthesia services included high costs associated with sedation/GA (72.2%) and patient fear of anesthesia (33.5%). Conclusion: This study identified a perceived lack of patient demand, lack of dentist training, high costs of sedation/GA and patient fear of sedation/GA as primary barriers to use of sedation/GA in Ontario dental practices. The use of various anesthesia modalities is diverse, with 60.2% of dentists providing sedation/CA.