Lenny Naftalin1,2, Jin Ye Yeo3
1Department of Pediatric Dentistry and Dental Anesthesia, School of Dentistry, University of California Los Angeles (UCLA), Los Angeles, California, USA; 2Private Practice - Comfort Dental Anesthesia Group - mobile dental anesthesia practice; 3JOMA Editorial Office, AME Publishing Company
Correspondence to: Jin Ye Yeo. JOMA Editorial Office, AME Publishing Company. Email: joma@amegroups.com.
Expert introduction
Dr. Lenny Naftalin (Figure 1) is a dentist anesthesiologist who provides hospital-quality anesthesia and sedation services in dental offices and ambulatory surgery centers through his mobile anesthesiology practice in Southern California. He earned his DDS degree from the USC School of Dentistry and completed a general practice residency at the Veteran’s Administration in West Los Angeles. He then completed the UCLA Dental Anesthesiology residency.
He is currently President of the American Society of Dentist Anesthesiologists (ASDA). He served on the board and is the past president of the California Society of Dentist Anesthesiologists (CSDA). He is the past president of the American Dental Board of Anesthesiology where he remains as an oral board examiner and an exam developer. He is the past president and former editor of the Southern California Society of Dentistry for Children.
Dr. Naftalin lectures on topics related to office-based anesthesia for dentistry and oral surgery; remimazolam; tranexamic acid use in orthognathic surgery; oral sedation; and medical emergencies in the dental office.
Figure 1 Dr. Lenny Naftalin
Interview
JOMA: What inspired you to pursue a career in dental anesthesiology?
Dr. Naftalin: During dental school, I developed an interest in dental anesthesiology because it sits at the intersection of pharmacology and physiology. The clinical application of these fields fascinated me from the moment I observed a patient undergoing anesthesia. Even today, I remain captivated by the art and science of anesthesia—it is a blend of magic, mystery, and precision. I am continually amazed at how far we have come since the time of Horace Wells and how much more there is to discover about the mechanisms of anesthesia. This constant evolution keeps me motivated to learn and grow alongside the expanding knowledge base of the field.
JOMA: Can you share any recent insights or advancements in the use of remimazolam and tranexamic acid in oral surgery, and their impact on dental anesthesia practices?
Dr. Naftalin: In my practice, I frequently administer anesthesia to patients undergoing orthognathic surgery in an ambulatory surgery center. About five years ago, we implemented a protocol that includes tranexamic acid (TXA), along with deliberate hypotensive anesthesia. This combination has significantly reduced blood loss and improved the surgeon’s ability to visualize the surgical field.
Remimazolam is one of the latest pharmaceutical additions to my practice, which I started using about two years ago for selected patients. The recovery profile has been remarkable, with faster recovery times and enhanced cardiovascular stability. While the current cost of remimazolam compared to midazolam limits its widespread use in my practice, it is invaluable in cases where rapid recovery and hemodynamic stability are critical.
JOMA: Can you introduce dental anesthesia education in the USA, and what factors affect the preference of anesthesia residents regarding subspecialty training?
Dr. Naftalin: Currently, there are ten Commission on Dental Accreditation (CODA)-accredited dental anesthesiology training programs in the United States. To qualify for acceptance, applicants must take the National Board of Medical Examiners (NBME) Comprehensive Basic Science Examination (CBSE). Dental anesthesiology is a rapidly growing field that tends to attract candidates with a strong interest in treating children and patients with special needs. These populations often require specialized care, which makes the field particularly appealing to those who are passionate about providing tailored anesthesia services
JOMA: As a leader in various dental anesthesiology associations, what key changes or advancements have you advocated for in the field?
Dr. Naftalin: As President of the American Society of Dentist Anesthesiologists (ASDA), one of my primary goals has been advocating for uniform legislation governing the use of anesthesia in dental offices. Anesthesia regulations in the U.S. vary by state, as they are typically overseen by state legislatures or dental boards. This creates inconsistencies across the country. The ASDA, in collaboration with the American Association of Oral and Maxillofacial Surgeons and the American Academy of Periodontology, has been actively working on a model legislation document to guide states in implementing more uniform and sensible anesthesia regulations.
JOMA: As President of ASDA, what are your primary goals for the organization, and how do you plan to advance the field of dentist anesthesiology?
Dr. Naftalin: My main goal as ASDA President has been to advocate for the safety of anesthesia in the dental setting while also increasing access to anesthesia care for patients who need it to receive dental treatment. I have also focused on bringing innovative and cutting-edge speakers to ASDA meetings to enhance our professional development. Additionally, I have worked to foster collaboration with other organizations in both dentistry and anesthesiology, helping to strengthen partnerships that will benefit our field.
JOMA: You provide hospital-quality anesthesia and sedation services through your mobile practice. What are the unique challenges and benefits of delivering anesthesia in dental offices and ambulatory surgery centers compared to traditional hospital settings?
Dr. Naftalin: Delivering anesthesia in dental offices offers several benefits. Most dentists in the U.S. do not have hospital privileges, so office-based anesthesia and anesthesia in ambulatory surgery centers (ASCs) provide access to care for many patients—especially those with special needs who require anesthesia or sedation for dental treatment. Dentists also feel more comfortable treating patients in their own offices, where they are familiar with the equipment and environment. However, the responsibility falls on the anesthesia provider to ensure the office environment meets the same safety standards as a hospital or ASC, which includes having the necessary monitoring equipment, crash carts, and trained personnel.
JOMA: What upcoming projects or research initiatives are you currently focused on, and what are your goals for the future of your work in dental anesthesiology?
Dr. Naftalin: As ASDA President, I am currently collaborating with the Society for Ambulatory Anesthesia (SAMBA) to develop a consensus statement on the limitations of surgical and anesthesia time in office-based and ambulatory surgery center settings. This project aims to set clear guidelines for patient safety and care standards in these environments.
JOMA: How has your experience been as an Editorial Board Member of JOMA?
Dr. Naftalin: Serving on the Editorial Board of JOMA has been a tremendous honor. My career has primarily focused on clinical work and education, so this role has offered a new and enriching avenue for my professional development. I have always pushed myself to explore new challenges, and contributing to JOMA’s editorial work has been my latest endeavor.
JOMA: As an Editorial Board Member, what are your expectations for JOMA?
Dr. Naftalin: I aim to contribute by advocating for the inclusion of clinically relevant articles, especially those that focus on office-based anesthesia. These types of articles are critical for advancing best practices in our field and ensuring the highest standard of care.