Pilots are not judged by routine flights. Firefighters are not measured by the buildings that never catch fire. Formula One teams are not evaluated by ordinary pit stops. The true measure of any professional is how they perform when something unexpected happens and the margin for error disappears. 

Every profession has defining moments—rarely the moments people plan for—and dentistry is no different. 

As oral health-care providers, we spend countless hours mastering techniques, refining workflows, and improving efficiency. We invest in technology, continuing education, and better ways to care for our patients. Those are worthwhile pursuits, but they can also distract us from a more important question. 

What happens when something goes wrong? 

I’ve heard clinicians say, “I’ve sedated thousands of patients and never had a problem.” While I understand the sentiment, I have always found that statement unsettling. A complication -free career does not necessarily prove competence. It may simply mean you have not yet encountered the complication that tests it. 

Health care is unique because success cannot simply be measured by outcomes. Luck occasionally produces good outcomes. Preparation consistently does. 

Anesthesia has transformed dentistry. Millions of patients who once avoided treatment because of fear, complex medical conditions, or extensive treatment needs can now receive care comfortably and safely. It has expanded access to treatment, improved the patient experience, and elevated what dentistry can accomplish. 

The question, however, has never been whether anesthesia belongs in dentistry. 

The question is whether the clinician providing it is fully prepared for the rare moment when physiology refuses to cooperate. 

Being prepared for worst-case scenarios 

Every procedure carries a risk. Every medication carries a risk. Every patient brings variables that cannot always be predicted. Most anesthetics proceed uneventfully, and thankfully serious complications remain uncommon. But uncommon is not the same as impossible. The patient who develops airway obstruction, laryngospasm, aspiration, an unexpected arrhythmia, or another medical emergency does not care how many routine sedations came before theirs. They need a doctor who immediately recognizes the problem, understands what is happening physiologically, and has both the technical skill and the judgment to intervene without hesitation. 

That level of preparedness deserves far more attention than discussions about which medications to administer or which monitoring equipment to purchase. 

As someone who completed residency in a hospital-based oral and maxillofacial surgery program with extensive anesthesia training, I can tell you that the greatest lessons were never learned during routine sedations. They were learned during the moments no one wanted to happen. The unexpected airway. The patient who did not respond the way the textbook suggested they would. The physiology that forced rapid decision -making under pressure. Those experiences fundamentally shape clinical judgment because they cannot be simulated by reading about them. They are learned through repetition, mentorship, progressive responsibility, and thousands of hours caring for patients under the supervision of experienced anesthesiologists and surgeons. 

That is not a criticism of continuing education. Continuing education is one of the obligations of every health-care professional. I have spent my entire career pursuing it, and I hope I never stop learning. But there is an important distinction between learning how to perform a technique and developing the experience necessary to manage every complication that technique can produce. Those are different educational objectives, and they should never be confused. 

Perhaps the most important quality a clinician can possess is not confidence. It is humility. 

The importance of humility 

Humility allows us to honestly assess our own abilities. It allows us to recognize when a patient would benefit from another specialist, another setting, or another level of expertise. It reminds us that referring a patient is not a sign of weakness. It is often one of the strongest demonstrations of professional judgment. 

One of the most encouraging developments in dentistry over the past decade has been the increasing collaboration between general dentists, specialists, and dental anesthesiologists. These partnerships allow practices to safely expand access to care for anxious patients, medically complex individuals, children, older adults, and those requiring lengthy or particularly involved procedures. They demonstrate something I have long believed. The best health care is rarely delivered by individuals working in isolation. It is delivered by teams that understand one another’s strengths and place the patient’s interests above everything else. 

As my responsibilities as a full-time practicing surgeon have evolved to include leading a multipractice surgical organization, my perspective on safety has also evolved. The conversation is no longer limited to how one doctor practices. It is about how organizations build cultures where safety is protected every single day. 

Cultures of safety do not appear by accident. They are intentionally built through rigorous credentialing, standardized emergency protocols, ongoing simulation training, equipment verification, honest case selection, peer accountability, and a commitment to continuous improvement. The organizations with the strongest safety records are rarely the ones that believe emergencies will never happen. They are the ones that assume emergencies eventually will happen and prepare relentlessly for that day. 

Patients often evaluate us based on whether we are gentle, efficient, and compassionate. Those qualities matter tremendously, and they should never be underestimated. But what patients cannot evaluate is often what matters most. They cannot judge the depth of our training. They cannot assess our emergency preparedness. They cannot know how many hours our team has spent rehearsing a crisis that we hope never occurs. They simply trust that if something unexpected happens, the people caring for them will know exactly what to do. 

That trust is sacred and every decision we make as clinicians should honor it. 

Whether sedation is delivered by an oral and maxillofacial surgeon, a dental anesthesiologist, or another appropriately trained provider is ultimately less important than whether that provider possesses the education, judgment, systems, and experience necessary to keep the patient safe from beginning to end. Our profession should continue encouraging thoughtful discussion around education, preparedness, and collaboration because those conversations elevate all of dentistry. 

In the end, technical skill may earn a patient’s confidence, but preparedness preserves it. Every dentist has the right to determine which procedures they offer. Every patient has the right to assume their doctor is fully prepared if something goes wrong. 

Never perform a procedure unless you are prepared to manage its worst complication.

Editor's note: This article appeared in the October 2026 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.