Commentary.

Abstract

It was a great tribute to be awarded the 2022 Jay A. Heidbrink Award from the American Dental Society of Anesthesiology (ADSA). As part of that award, it is also my honor to select a “Landmark Article,” a contribution to the dental anesthesia literature that was of significance to the field.I am pleased to choose an article by Norman Trieger, DMD, MD, (1929-2012) published in Anesthesia Progress in 1969. Those of us with greying hair remember Norm as a consummate gentleman and scholar. Younger readers may recognize the name which headlines the Continuing Education Article in each Anesthesia Progress publication.Dr. Trieger, a Phi Beta Kappa at Emory University, completed his dental degree and oral surgery residency at Harvard School of Dental Medicine. He subsequently joined the faculty at UCLA before returning to his childhood home in New York City to become the long-standing professor and chairman of the Department of Dentistry and Oral and Maxillofacial Surgery at the Montefiore Medical Center and Albert Einstein College of Medicine, where he also earned his medical degree. Dr. Trieger was a Fellow in General Anesthesia of the ADSA as well as a past president and editor of Anesthesia Progress. He helped develop the first American Dental Association (ADA) guidelines for teaching intravenous (IV) moderate sedation for dentists. He was an early supporter of a specialty in anesthesiology for dentistry, having authored the first ADA specialty application which was not submitted due to opposition from oral surgery at the time.Dr. Trieger was also a prolific researcher. One of his enduring contributions to the field became known as the Trieger Test. The test is a semi-objective measure of psychomotor recovery from sedation or general anesthesia. As this presented article points out, it was a modification of the Bender Motor Gestalt Test. I have used the Trieger Test in several of my own and my graduate students' research projects as new sedatives have been released or different techniques studied to help determine the duration of recovery needed to return to baseline psychomotor function. Oral surgeons, as they were known at the time before “maxillofacial” was added to their name, were really the pioneers of office-based anesthesia and the rapid recovery techniques that we all use today. In the early days, IV barbiturates for deep sedation and general anesthesia were commonly used as sole agents. We speak of the “Wild West” of office-based anesthesia today, but that technique could really lead to an anesthesia rodeo where only tooth extraction could be completed and more delicate dentistry impossible.One of the fascinating aspects of this article to me is that the actual data from the initial study are not presented. The data are referenced from an article in Anesthesia and Analgesia which I found and read. The data is, in fact, included in that article, and much of the same language in the Anesthesia Progress article is taken directly from the Anesthesia and Analgesia article, also co-authored by Dr. Trieger. This is a practice that would surely not be allowed today unless the article was part of a review of other published articles.Dr. Trieger made significant contributions to oral surgery, dental anesthesiology, moderate sedation for general dentists, and to the dental and medical professions. This early manuscript is but a small piece of his legacy.Respectfully submitted,This continuing education (CE) program is designed for dentists who desire to advance their understanding of pain and anxiety control in clinical practice. After reading the designated article, the participant should be able to evaluate and utilize the information appropriately in providing patient care.The American Dental Society of Anesthesiology (ADSA) is accredited by the American Dental Association and Academy of General Dentistry to sponsor CE for dentists and will award CE credit for each article completed. You must answer 3 of the 4 questions correctly to receive credit.Submit your answers online at www.adsahome.org. Click on “On Demand CE.”CE questions must be completed within 3 months and prior to the next issue.