Review of the intraoperative management and hemodynamic goals for patients with aortic stenosis, mitral stenosis, aortic insufficiency, and mitral valve regurgitation.
Diagnostic considerations for asymptomatic patients who present in the outpatient setting with known or unknown disease (auscultatory exam / preoperative echocardiogram)
The objectives of this course are:
This presentation will introduce new medications, discuss their pharmacologic properties, and dive into clinical applications useful for the Dentist Anesthesiologist.
Attendees will come away with an introduction to the following novel medications:
An introduction to perioperative alternatives to opioids for general anesthesia, and a discussion of how reduced opioid use impacts patient care.
Attendees will come away with:
It’s 1987 and the term virtual reality was coined. Thirty-three years later, this technology is still young. What is this used for other than gaming and how can you apply it to anesthesiology?
Attendees will come away with:
The COVID-19 pandemic has shifted the landscape of anesthesia care to involve telehealth, a tool that includes phone- and video-conferencing. Traditionally, pre-anesthesia consultations involve in person medical history-taking; laboratory testing or investigations; focused physical examination; and referral to other medical services to optimize the patient’s health prior to anesthetic procedures. The transition to incorporate virtual visits for not only patients living in rural and remote areas, but also local patients, prompts anesthesiologists to adapt their traditional practices to a new digital platform.
This lecture highlights best practices for virtual pre-anesthesia consultations.
The objectives of this course are:
Dr. Michelle Wong, Assistant Professor of Dental Anesthesiology at the University of Toronto’s Faculty of Dentistry, is a dental anesthesiologist who obtained her Doctor of Dental Surgery degree in 2010, Master of Science in Dental Anesthesia in 2014, and Doctor of Education in Educational Leadership in 2020. Dr. Wong is a Diplomate of the American Dental Board of Anesthesiology. She performs special care dentistry and anesthesia in an active hospital practice at Sunnybrook Health Sciences Centre’s Department of Dental Maxillofacial Sciences and in private practices in the Greater Toronto Area.
Dr. Andrea Fonner is a Diplomate of the American Dental Board of Anesthesiology and the National Dental Board of Anesthesiology. After graduating from the University of the Pacific School of Dentistry in 2004, she completed a GPR at the University of Washington. After two years in private practice, she entered the UCLA Dental Anesthesiology training program where she trained with Dr. John Yagiela and Dr. Christine Quinn.
She has maintained her mobile anesthesia practice in Bellevue, WA since graduating from her dental anesthesiology program 10 years ago, and she trains residents from various programs on a frequent basis.
Her current positions include: Board of Directors, American Dental Society of Anesthesiology (ADSA), Board of Directors, American Dental Board of Anesthesiology (ADBA), President & Co-founder, Washington State Society of Mobile Dental Anesthesia (WSSMDA), President and Delegate, Washington State American Dental Society of Anesthesiology (ADSA), Faculty & Clinical Instructor, Parenteral Moderate Sedation, Oregon Academy of General Dentistry (OAGD) Co-Director, High Fidelity Human Simulation (SimMan), American Dental Society of Anesthesiology (ADSA), Course Director of the Assistant’s Course, American Dental Society of Anesthesiology (ADSA) and Editorial Advisory Board, Decisions in Dentistry
Dr. Fonner has published several articles in national newsletters and journals and has been a contributing author for two textbooks (Anesthesia Complications in the Dental Office and Complications of Regional Anesthesia: Principles of Safe Practice in Local and Regional Anesthesia). She frequently gives continuing education courses to local dentists interested in sedation dentistry, and she has a passion in medical emergency training for the dental community.
This session will be an amazing opportunity to teach and learn as a community through a live interactive panel discussion with our Dentist Anesthesiologist experts Dr. Andrea Fonner, Dr. Steve Ganzberg and Dr. Joe Giovannitti.
Join us to see how some of our esteemed colleagues approach interesting cases. These may be cases that may not be appropriate to be treated in the office and/or patients with complex medical issues.
Dr. Naftalin is a ADBA board-certified dentist anesthesiologist who provides hospital-quality anesthesia and sedation services in dental offices through his mobile anesthesiology practice. He earned his DDS degree from the Herman Ostrow School of Dentistry at USC and completed a general practice residency at the Veteran’s Administration in West Los Angeles. He then completed the UCLA Dental Anesthesia residency.
He teaches part time at the UCLA School of Dentistry in both the dental anesthesia and pediatric dental departments, where he trains future dentist anesthesiologists. He is treasurer of the American Society of Dentist Anesthesiologists. He serves on the board of the California Society of Dentist Anesthesiologists and the California Dental Society of Anesthesia. He is past president and former editor for the Southern California Society of Dentistry for Children.
Dr. Naftalin is dedicated to a program that provides anesthesia for dental patients with special needs in Nicaragua. Without this program these patients would have no access to dental care. A sought-after expert, he lectures nationally and internationally on oral sedation, anesthesia and dental office emergency management.
A dedicated family man, he is the proud father to two energetic daughters. As a family, they enjoy beach time, biking, hiking, and skiing in the mountains.
In 1990, Ken Kromash made the decision to move to Chicago to attend a training program in anesthesia for dentists at Illinois Masonic Medical Center. He only expected to stay a year or two at the most. Thirty years later, he is the Program Director of the youngest training program for one of the newest specialties in dentistry. He is honored to be invited to speak to his colleagues at the ASDA Fall Virtual Meeting. Stay safe, be well, and keep fighting!
Dr. Giovannitti is a dentist anesthesiologist and Professor and Chair of the Department of Dental Anesthesiology at the University of Pittsburgh School of Dental Medicine, and the Anesthesia Director of the school’s Center for Patients with Special Needs. He is the recipient of the Leonard M. Monheim Distinguished Service Award from the American Society of Dentist Anesthesiologists and the Jay A. Heidbrink Award from the American Dental Society of Anesthesiology. He has been actively involved in teaching at all levels of dental education, has authored numerous scientific articles, book chapters and a textbook pertaining to pain and anxiety control in dentistry, has lectured at professional seminars nationally and internationally, and is active in national dental anesthesiology professional organizations.
Dr. Ganzberg, Clinical Professor of Anesthesiology at the UCLA School of Dentistry, is a dentist anesthesiologist with over 30 years of experience in pain management. Dr. Ganzberg graduated from M.I.T. in 1977 and the University of Pennsylvania School of Dental Medicine in 1981. He completed his pain management training at New York University and his anesthesiology training and Master’s degree at O.S.U. Dr. Ganzberg is a Diplomate of the American Dental Board of Anesthesiology and the American Board of Orofacial Pain.
Dr. Ganzberg taught at The Ohio State University medical and dental schools for 17 years before coming to UCLA. Dr. Ganzberg is a past president of the American Society of Dentist Anesthesiologists and the American Dental Board of Anesthesiology and past editor of Anesthesia Progress. He is active clinically as Director of Anesthesiology for the Century City Outpatient Surgery Center, a Joint Commission accredited surgery center focusing on dentoalveolar, maxillofacial and facial plastic surgery. He has published over 70 original research articles and book chapters in the field. His research focuses on out-patient anesthesia techniques and clinical pharmacology.
Sickle cell disease (SCD) is the most common group of inherited red blood cell disorders, with a prevalence of an estimated 70,000 – 100,000 individuals in North America, and an additional 3.5 million individuals as heterozygous carriers. At low oxygen tensions, hemoglobin in patients with SCD changes conformation to a sickle shape, which can potentially lead to vaso-occulsive crises. Sequelae of these crises include stroke and cranial symptoms, with 11% of SCD children presenting with overt stroke symptoms and another 30% presenting with silent cerebral infarcts. Anesthetic goals for the perioperative management of these patients are to avoid acidosis, hypotension, hypoxia, infection, hypothermia, vaso-constriction and venous stasis, all of which can precipitate a vaso-occlusive crisis.
The following case describes the successful management of a 12-year-old girl with a past medical history (PMHx) of sickle cell anemia who presented for extraction of several supernumerary teeth and biopsy with enucleation of lower left mandibular cyst under general anesthesia. The use of cerebral oximetry in the intraoperative management of sickle cell patients has not yet to date been described in the literature. Cerebral oximeters such as the INVOSTM Cerebral/Somatic Oximeter (Medtronic) which was used in this case are able to estimate regional tissue oxygenation of the frontal cortex, and therefore detect changes in oxygen supply and demand. Utilization of cerebral oximetry in the intraoperative period, can help provide early recognition of signs of ischemia facilitating early interventions to reduce postoperative morbidity and mortality.
Malignant hyperthermia (MH) is a potentially life threatening event in response to specific triggers during anesthesia. In particular, it is triggered by volatile anesthetic and succinylcholine which a depolarizing paralytic used to facilitate intubation. Clinical signs include increased end-tidal carbon dioxide, muscle rigidity, tachycardia, tachypnea, acidosis and hyperthermia. Furthermore, there are several other syndromes that can mimic MH such as serotonin syndrome, pheochromocytoma, thyrotoxicosis and neuroleptic malignant syndrome.
The COVID-19 Pandemic has changed the world as we know it. COVID-19, shown to be caused by the SARS-CoV-2 virus has led many severely ill patients to undergo acute respiratory distress leading to emergent intubations. Many of the signs and symptoms leading up to intubation in COVID-19 patients often resemble MH, such as hypercarbia, tachypnea, acidosis. These signs may mask a true MH event and thus may not be diagnosed and treated in time.
In this case report, a 37 year old male patient with COVID-19 induced acute respiratory distress received succinylcholine prior to intubation, at which point he became rigid and went into cardiac arrest. Prior to arrest, the patient was hypercarbic, tachypneic, hypoxic and bradycardic. We compare several hypermetabolic conditions including, Neuroleptic malignant syndrome, sepsis, hyperkalemic cardiac arrest and rhabdomyolysis.
Malignant hyperthermia is a potentially fatal pharmacogenetic disorder, triggered by volatile anesthetics or succinylcholine.1 An otherwise healthy 6 year old boy presented to our clinic for a full mouth rehabilitation under anesthesia. The MH episode was detected as the end-tidal carbon dioxide read “+++” and peaked with the patient displaying masseteric and generalized rigidity which was immediately treated with dantrolene administration. The patient was transferred to the pediatric intensive care unit and discharged to home soon thereafter. The successful management of this case was not the singular accomplishment of one clinician or simply attributable to the knowledge of MH but rather a perfect storm of systemic and cultural factors of the team and clinic that enabled the team to implement their knowledge into timely clinical interventions.
It is possible that most dentist anesthesiologists will encounter an adverse event regardless of whether the contributing factors leading to the event is within their control. The key to a successful outcome rests on more than just the didactic knowledge and clinical skills of that individual provider. Just culture explores the role of systems and organizational cultures while balancing the role of individual accountability.2 A root cause analysis (RCA) can identify the contributing factors and improve systems to prevent and promote best practices. In this case, a success cause analysis (SCA) was conducted to identify areas of strength and areas for improvement as they relate to the treatment of an MH episode in a dental clinic setting including appropriate people, methods/processes, materials, equipment, and environment.
Acknowledgements: We would like to acknowledge Dr Nathan Carillo (Class of 2020) for his role in the care of this patient.
Chronic pain and opioid-dependent patients express higher resting pain scores, hyperalgesia and tolerance which may lead to increased analgesic requirements peri- and post-operatively. This case report presents a 37-year-old female with fibromyalgia and chronic back-pain requiring twice-daily Percocet (acetaminophen 325 mg and oxycodone 5 mg) use. Additionally, her medical history includes chronic anxiety, depression, and post-traumatic stress disorder requiring daily lorazepam use. General anesthesia for dental treatment was indicated for dental phobia. Her treatment was performed in the ambulatory setting at the University of Toronto’s Faculty of Dentistry. Previous attempts to provide non-intubated general anesthesia with fentanyl, midazolam, and propofol resulted in high dosages and infusion rates (>230 mcg/kg/min propofol) which led to hemodynamic instability and respiratory depression. An anesthetic strategy that targeted receptors other then those affected by her daily opioid and benzodiazepine medications was designed. This strategy utilized the NMDA antagonist ketamine with an infusion of the α2-agonist dexmedetomidine. Due to the extensive dental treatment required, there was concern that a single bolus of dexmedetomidine during induction would provide inadequate working time. Therefore, dexmedetomidine in addition to propofol was used in two separate infusion pumps to allow control of the anesthetic duration. Induction was performed with ketamine (0.7 mg/kg), midazolam (0.03 mg/kg), and dexmedetomidine (1.0 mcg/kg) over 10 mins, followed by infusion at 0.6 mcg/kg/hr (0.01 mcg/kg/min). Concurrently in the second infusion pump, plain propofol infusion was initiated and maintained at 120 mcg/kg/min. During the procedure, the patient did not experience any adverse events such as hypotension, bradycardia, hypercapnia, or delayed emergence. Likewise, adequate depth of anesthesia was achieved as demonstrated through acceptable blood pressure, heart rate, respiration rate and absence of limb movement. Overall, we demonstrated that dexmedetomidine infusion was feasible and effective in a chronic pain and opioid-dependent patient with history of high-anesthetic requirement.
Airway management is one of the most important responsibilities of an anesthesiologist. Some may even argue that anticipating and preparing for a difficult airway is the crux of our role. As advancements are made in surgical procedures and equipment, the anesthesiologist must develop ways to adapt. Fortunately, many tools and techniques already exist in our armamentarium.
According to the American Society of Anesthesiologists’ difficult airway algorithm, the first step is to identify patients who may be difficult to ventilate . More specifically, an aspect of this is determining whether a patient will have a poor mask seal, whether it be due to edentulism, facial hair, or a dentofacial deformity . In this presentation, we evaluate the difficulty of achieving a good mask seal on patients undergoing robotic implant placement with a Yomi robot, in an outpatient ambulatory setting. We demonstrate the process of establishing and securing the airway via nasal-tracheal intubation prior to ventilating patients. A large component of our decision-making is influenced by the requirement of the Yomi technique to insert either an Edentulous Patient Splint (EPS) or a Chairside Patient Splint (CPS) prior to taking a cone beam CT scan and inducing the patient. Our ability to provide this service allows our surgical colleagues to use a new technique to advance implant placement in a more precise manner. Ultimately, we align with certain recommendations that can be broadly applied to intubated general anesthesia cases in an outpatient setting .
1. Updated by the Committee on Standards and Practice Parameters, et al. “Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway.” Anesthesiology 118.2 (2013): 251-270.
2. Williams, W. Bradford, and Yandong Jiang. “Management of a difficult airway with direct ventilation through nasal airway without facemask.” Journal of oral and maxillofacial surgery 67.11 (2009): 2541-2543.
3. Law, J. Adam, et al. “The difficult airway with recommendations for management–part 2–the anticipated difficult airway.” Canadian Journal of Anesthesia/Journal canadien d’anesthésie 60.11 (2013): 1119-1138.
Hemodynamic resuscitation in critically ill trauma patients receiving massive blood transfusions
have a 35% increased chance of developing trauma-induced coagulopathy, a secondary event that drastically increases mortality rates. As a multifactorial system, trauma-induced coagulopathy or acute traumatic coagulopathy (ATC) encompasses an array of complex
mechanisms including: consumption coagulopathy and blood loss; dilution; hormonal disruption; coagulation disruption; hypoxia; metabolic acidosis; hypothermia; and immune activation. As a potentially life-threatening event, ATC must be identified as early as possible to prevent death by massive hemorrhage.
This is a case report of acute traumatic coagulopathy following post-operative secondary
hemorrhage and resuscitation.
This patient is a 70 year-old male with a past medical history of hypertension, hepatitis C, peripheral artery disease with bilateral femoral-popliteal occlusion, and polysubstance abuse presenting for right groin exploratory, endovascular balloon occlusion of aorta, control of hemorrhage, patch angio right CFA/EIA following lower left extremity angioplasty with stunting and graft bypass under general anesthesia. Symptoms of intraoperative hemodynamic instability were observed after several units of blood, plasma, and platelet transfusions.
Intravenous sites including the triple lumen port, arterial line, and peripheral lines had excessive bleeding. Areas around the mouth and membranous tissues were also bleeding. Arterial blood gas samples were obtained confirming metabolic acidosis, hyperkalemia, hypovolemia, severe blood loss, and dilution. Once the patient arrived at the surgical intensive care unit, cryoprecipitate was transfused and all bleeding sites were controlled with pressure until clotting was observed. He recovered in the SICU until he was hemodynamically stable.
Identifying the presentation of ATC and making a collective effort in managing this secondary event is critical in prognostic outcome. In this particular case, the resulting presentation of ATC followed collective factors of iatrogenic origin and post-operative vascular complications.
Anesthesia providers must be vigilant in monitoring the patient for clinical symptoms such as excess bleeding from IV access sites, central venous lines, arterial lines, and delicate membranous tissues; follow ATC resuscitation with cryopercipitate, fresh frozen plasma, and platelet; maintain core temperatures; and evaluate arterial blood gas findings for volume overload, hyperkalemia, and metabolic acidosis. Maintenance of hemodynamic stability following massive blood loss and management traumatic coagulopathy is key in preventing fatal outcomes.
Cap, A., Hunt, B. J., (2015), The pathogenesis of traumatic coagulopathy. Anaesthesia. 2015
Jan; 70 Suppl 1:96-101, e32-4.
Clinical Case Report
The following case report will address the local anesthetic toxicity considerations of a 63-year-old healthy female, undergoing a lengthy full mouth surgical case under general anesthesia.
In the case report, local anesthesia was administered during the procedure and a long lasting anesthetic (EXPAREL) intended to be given at the end of a lengthy (6 hour) surgical case. This report will review the following:
Local anesthetic overview:
When intravenous medications are indicated for patient care, the appropriate administration of those medications is necessary for safe and efficient outcomes. The anesthetic management of a patient continuously evolves as resources and data become more available.
Scientific evidence has rarely (if at all) been reported in the literature demonstrating analytical confirmation of the physical compatibility and stability of glycopyrrolate and rocuronium combined. The evaluation of the compatibility of glycopyrrolate with rocuronium is the subject of this research.
Glycopyrrolate and rocuronium were combined in various containers, observed over a 60-minute period, statistically analyzed, and compared against positive and negative controls to determine their physical compatibility. In the research environment through which the test protocol was performed, it was determined that glycopyrrolate and rocuronium are physically compatible.
Although no current information indicates inappropriateness of the coadministration of glycopyrrolate with rocuronium, additional testing (e.g., chemical and therapeutic compatibility testing) may be considered for improving completeness of data.
Dr. Cornelius is an assistant professor and the program director of dental/maxillofacial anesthesiology at The Ohio State University School of Dentistry. He received his DDS degree from Northwestern University, his MBA degree from the University of Utah, and his MPH degree from The University of Pittsburgh. Dr. Cornelius completed a three year residency in anesthesiology at the University of Pittsburgh. He is a Fellow of the American Dental Society of Anesthesiology and a Diplomat of both the National Dental Board of Anesthesiology and the American Dental Board of Anesthesiology.
Currently, Dr. Cornelius is an attending anesthesiologist at The Ohio State University Wexner Medical Center and serves as the Vice President of the American Society of Dentist Anesthesiologists. Dr. Cornelius enjoys hiking, snowboarding, taekwondo, and spending time with his family. He can be reached at firstname.lastname@example.org.
Ross Renew MD, FASA, FASE, graduated from Clemson University (Chemistry, BS) and completed medical school at the University of South Carolina School of Medicine. Dr. Renew completed anesthesia residency at Mayo Clinic Florida and his fellowship in Adult Cardiothoracic Anesthesiology at Mayo Clinic in Rochester, MN. Dr. Renew then returned to Jacksonville and has worked on staff at Mayo Clinic Florida where he is currently an Assistant Professor of Anesthesiology. Dr. Renew serves as the Vice Chair of Research and Associate Program Director for the department’s residency program. His research interests involve neuromuscular blockade and monitoring, transesophageal echocardiography, and caring for the cardiac patient undergoing non-cardiac surgery.
Dr. Jamie Kitzman is a pediatric anesthesiologist at Children’s Healthcare of Atlanta at Egleston and Assistant Professor of Anesthesiology for Emory University School of Medicine. She is also a board certified in Medical Acupuncture and Co-director of the Acupuncture Clinic at the Center for Advanced Pediatrics. She is the Medical Director of the Preoperative Clinic at CHOA at Egleston. She is an active member of the American Society of Anesthesiologist and Society for Pediatric Pain Medicine. Her research interest is in pediatric perioperative care. When she is not busy running around in the operating room or acupuncture clinic, she a proud mother, chasing around her twin toddlers.
Dr. Guthrie received his undergraduate education at the University of Notre Dame, earning a B.S. in Biochemistry, magna cum laude. He then graduated cum laude from the Harvard School of Dental Medicine in 2012. After completing a General Practice Residency, Dr. Guthrie practiced general dentistry for five years before beginning his anesthesia training on Long Island. While a resident at Stony Brook, he was selected as chief resident in the class of 2021. Dr. Guthrie now resides in Louisville, KY, with his wife Katie and their four children. He joined SmileMD and provides office-based dental anesthesia services throughout the state Kentucky.
Dr. Katie Bradford is a dentist anesthesiologist currently in private practice near Nashville, TN. Born and raised in Cape Girardeau, MO, Dr. Bradford received her undergraduate degree in Interdisciplinary Studies with emphasis in Biology, Chemistry, and Mathematics/Physics from Southeast Missouri State University and her Doctor of Dental Surgery from Indiana University School of Dentistry. After graduation from IU, she completed a General Practice Residency at The Ohio State University prior to completing her anesthesia training, which included a Dental Anesthesia fellowship at Indiana University followed by a Dental Anesthesiology residency program at NYU Lutheran Medical Center in Brooklyn, NY. During her final year of training, Dr. Bradford also served as Chief Resident for her program.
After completing her training, Dr. Bradford moved with her husband, Ryan, to Tennessee to join Nashville Office-Based Anesthesia where she provides anesthesia services in the middle-Tennessee area. The Bradfords are proud parents to two rambunctious boys: three-year-old EJ and five-month-old Ollie. In her free time, Dr. Bradford enjoys spending time with her family, volunteering with her church, exploring the wineries of middle Tennessee, and attending concerts.
Dr. Reed attended dental school at OHSU where he remained, receiving advanced training in anesthesia and completing a residency in periodontology. Later he completed a CODA-approved dental anesthesia residency at Lutheran Medical Center where he remains as the Associate Program Director.
Dr. Reed is an Affiliate Assistant Professor in the Department of Periodontology at The Oregon Health & Science University School of Dentistry and he serves as a Clinical Instructor in the Department of Dentistry on the Faculty of Medicine and Dentistry of the University of Alberta in Edmonton, Alberta, Canada.
Dr. Reed is a Past President of the American Dental Society of Anesthesiology and is a Diplomate of the American Dental Board of Anesthesiology (ADBA) and serves on the Board of Directors of the ADBA as Secretary.
As an author, Dr. Reed has published five textbook chapters in Sedation: A Guide to Patient Management. Dr. Reed partnered with Dr. Okundaye to author two additional textbook chapters, “Working with a Dentist Anesthesiologist” and “Management of Emergencies Associated with Sedation”, both in Behavior Management in Dentistry for Children. The second edition of this textbook has now been published with both chapters having been updated. Dr. Reed has further contributed to the professional literature by publishing over two dozen articles in peer-reviewed journals.
Dr. Reed is a Professional Registered Parliamentarian through the National Association of Parliamentarians and he has a multi-engine ATP certificate and is a flight instructor, with AGI, CFI, CFII & MEI certificates.
The Hands-on Difficult Airway Course will take 24 participants through a series of difficult airway management cases. Small group stations will allow for attendees to participate as the primary and/or secondary anesthesia provider during case simulation guided by course instructors.
Bryant Cornelius, DDS
Steven Ganzberg, DMD, MS
Jesse Manton, DDS
Ryan Wu, DDS
Carilynne Yarascavitch, DDS, MSc, PhD
Dr. Jonathan Wong is a graduate of Southern Illinois University School of Dental Medicine. He completed his general practice residency at Saint John’s Mercy Medical Center in St. Louis and an oral surgery externship at Banner Good Samaritan Hospital. He then went on to complete his anesthesia residency at Stony Brook Medical center. Dr. Wong is now in private practice and is the founder of Coastal Pediatric Dental and Anesthesia in Norfolk, VA.
He is a patient safety advocate whose national lectures include topics such as surgical airway techniques, simulation training, sedation and anesthesia regulations, including NFPA 99 and the ADA’s Management of Sedation Complications.
Dr. Wong is a Diplomate of the American Dental Board of Anesthesiology and serves on the Board of Directors for the American Society of Dentist Anesthesiologists.
Dr. Messieha received his DDS degree from Ohio State University. He then completed a General Practice Residency at the College of Virginia Medical Center and McGuire VA Medical Center in Richmond, VA. From There he went to Long Island Jewish Medical Center where he completed a residency in Anesthesiology. After working in an office-based practice for a year, Dr. Messieha went to the University of Illinois at Chicago where he worked full-time between the College of Dentistry and the Anesthesiology Department at the University Hospital.
Dr. Messieha has lectured nationally and internationally on Anesthesiology and Pain Anxiety Control. He has several published papers and abstracts. After spending over 21 years as an educator, Dr. Zak Messieha retired as Professor of Clinical Anesthesiology both at the College of Medicine and the College of Dentistry in December of 2017.
Dr. Messieha has filled leadership positions at the national and state and is the current President American Society of Dentist Anesthesiologists. He is also a Fellow in the American College of Dentists, and the International College of Dentists. Dr. Zak Messieha publishes in peer-reviewed scientific journals and lectures nationally and internationally on topics related to anesthesia care as well as medical risk assessment. He has received several recognitions from various organizations for his contributions.
Dr. Saxen received his undergraduate education at the University of Notre Dame and his predoctoral dental training at the Case Western Reserve University School of Dental Medicine. After practicing general dentistry for a decade, he entered the Medical College of Virginia/Virginia Commonwealth University Dentist Scientist Program, receiving his certificate in Anesthesiology and his PhD in Pharmacology in 1993. Since that time, he has provided office-based anesthesia to dental practices in the greater Indianapolis area while serving on the faculty at Indiana University School of Dentistry, where he directed courses in pharmacology, pain and anxiety control, and anesthesia training for the oral surgery and pediatric dentistry residency programs. Dr. Saxen is a past president of the American Society of Dentist Anesthesiologists, the American Dental Board of Anesthesiology, and the American Board of Dental Specialties. He currently serves on the Anesthesia Quality Institute Data Definitions Committee and is an Associate Editor for Anesthesia Progress. Throughout his career he has contributed many publications on anesthesia-related issues in dentistry and presented over 50 invited presentations both nationally and abroad.
Dr. Steven Kupferman is a board-certified oral and maxillofacial surgeon. He is the founding partner at the Los Angeles Center for Oral and Maxillofacial Surgery (LACOMS).
After graduating from Yeshiva University in Manhattan in 1997 with a degree in biology, Dr. Kupferman went straight to dental school. In 2001, he graduated from the Harvard School of Dental Medicine with his Doctor of Dental Medicine (DMD) degree. To increase his knowledge and level of care, Dr. Kupferman continued his education by
attending medical school at the David Geffen School of Medicine at UCLA where he obtained his MD degree in 2004. He completed his internship in General Surgery at UCLA in 2005. Following the completion of his medical degree and general surgery internship, Dr. Kupferman remained at UCLA to finish his oral and maxillofacial surgery training.
Dr. Kupferman was an associate at Kaiser Permanente’s Los Angeles Medical Center from 2007-2009. In 2009, Dr. Kupferman recognized the need for full scope oral and maxillofacial surgery in the Los Angeles region and opened the Los Angeles Center for Oral and Maxillofacial Surgery.
Dr. Kupferman is a Diplomate of the American Board of Oral and Maxillofacial Surgeons (AAOMS), a fellow of the American College of Surgeons (FACS), a fellow of the American Academy of Craniomaxillofacial Surgeons, and a fellow of the American Society of Temporomandibular Joint Surgeons (ASTMJS).
In addition, Dr. Kupferman is a lecturer at the UCLA School of Dentistry and a clinical faculty member of the Division of Otolaryngology at Cedars Sinai Medical Center.
Outside of work, Dr. Kupferman spends most of his time with his wife and four children.
Dr. Gregory Ness is the DP Snyder Professor of Oral Surgery at The Ohio State University College of Dentistry. He received his dental degree from Case Western Reserve University and his residency training in oral and maxillofacial surgery at University Hospitals of Cleveland, Ohio. He joined the faculty of dentistry at The Ohio State University following residency, and pursues a full-scope surgical practice while training residents and dental students. In 2005, he moved to Virginia Commonwealth University in Richmond where he was also a full-time faculty member, and then returned to Ohio State in 2011. He has taught oral and maxillofacial surgery to students and residents for over two decades with has taught oral and maxillofacial surgery to students and residents for over two decades with emphasis on nonsurgical and surgical therapy for temporomandibular joint disease.
He has served the American Board of Oral and Maxillofacial Surgery as examiner, Section Co-Chair, and as content expert for temporomandibular joint disease and orofacial pain.
He also serves on numerous other national, regional and local committees and organizations and is a past President of the American Society of Temporomandibular Joint Surgeons.