The answer depends on what you’re doing in the office.
By Duane Tinker – The Toothcop
Dental Compliance Consultant | Former Investigator
I’ve been talking a lot lately about medical emergency preparedness in dentistry.
BLS.
ACLS.
Airway management.
Emergency equipment.
Rescue.
But sooner or later, all of those conversations lead to the same question:
Does your team actually practice this stuff?
And that leads to another question I hear from dentists:
“Are medical emergency drills actually required?”
The answer is one of my favorite compliance answers:
It depends.
Because we need to separate at least three things:
- What the ADA recommends for dental offices generally.
- What the ADA’s new sedation and anesthesia guidelines say.
- What your state actually requires.
Those are not necessarily the same thing.
What Does the ADA Say for the Typical Dental Office?
Let’s start with a general dental practice that isn’t providing sedation beyond routine local anesthesia or perhaps nitrous oxide.
The ADA says dentists should be familiar with preventing, diagnosing, and managing common medical emergencies and should provide appropriate training to staff so everyone knows what to do and can act promptly.
Because these skills aren’t used every day, the ADA says they should be reviewed at least annually and preferably more often.
The ADA also says conducting mock emergencies may help staff become more confident with their roles during a real emergency.
Notice the language.
That’s important.
The ADA’s general medical-emergency guidance does not appear to say:
Every dental office must conduct a medical emergency drill every six months.
That’s not what the general guidance says.
It recommends regular review and recognizes mock emergencies as a useful way to prepare the team.
But then we get into sedation.
And things change.
Sedation Raises the Bar
The ADA adopted its updated Guidelines for the Use of Sedation and General Anesthesia by Dentists in October 2025.
And the language concerning emergency drills is much stronger.
Under emergency management, the guidelines state that providers and offices must have written emergency protocols.
They also require documented training sessions that include rehearsed emergency drills at least every six months.
That’s substantially different from saying mock emergencies “may help.”
We’re now talking about:
Documented.
Rehearsed.
Emergency drills.
At least every six months.
And that’s one reason I think emergency drills need to become their own conversation in dentistry.
Training and Drilling Aren’t the Same Thing
This distinction gets missed all the time.
You can send everyone to BLS.
That’s training.
You can require the dentist to maintain ACLS or PALS.
That’s training.
You can have everyone watch a medical-emergency CE course.
Also training.
But none of those necessarily tells you what happens when someone walks into the operatory and says:
“The patient isn’t breathing.”
A drill does.
Now we find out:
Who takes charge?
Who calls 911?
Who gets the emergency kit?
Who brings oxygen?
Who gets the AED?
Who positions the patient?
Who manages the airway?
Who starts ventilation?
Who documents?
Who meets EMS at the door?
And, perhaps most importantly:
Does everybody know they’re supposed to do those things without standing around waiting for the dentist to tell them?
That’s why I don’t consider emergency training and emergency drilling interchangeable.
Training teaches people what to do.
Drilling shows whether they can actually do it together.
Here’s Where State Law Enters the Picture
This is where I don’t want anyone reading a blog article and assuming they’ve figured out their legal requirements.
The ADA itself tells dentists to consult their state dental association or dental board for applicable safety requirements because state requirements vary.
Your state may require something different.
It may regulate drills based on:
- sedation level;
- permit type;
- pediatric versus adult patients;
- anesthesia services;
- facility requirements; or
- other circumstances.
And remember something else we’ve been discussing:
ADA guidelines are professional guidance. Your state’s dental practice act and rules are law.
The two can overlap.
They aren’t interchangeable.
So the question isn’t simply:
“Does the ADA require drills?”
The better question is:
“What emergency preparedness requirements apply to what we’re doing in this particular dental office?”
But What If My State Doesn’t Require Drills?
Now we get to the more interesting question.
Suppose you’re a general dental office.
Your state doesn’t specifically require medical emergency drills.
And you’re not operating under a sedation provision requiring them.
Should you drill anyway?
I think you should.
That’s my opinion—not a universal legal requirement.
And I’d go further.
I don’t think once a year is enough to develop meaningful team performance.
Why?
Because we’re talking about skills dental teams don’t routinely use.
The ADA makes essentially the same observation when explaining why emergency skills should be reviewed regularly: these aren’t skills we use every day.
That’s exactly the problem.
You don’t want the first time your dental assistant tries to assemble the BVM to be when your patient isn’t breathing.
You don’t want to discover during a cardiac arrest that nobody knows where the AED is.
You don’t want three people calling 911 while nobody manages the airway.
And you definitely don’t want to hear:
“I thought she was supposed to do that.”
What Should a Dental Emergency Drill Actually Look Like?
It doesn’t need to become a theatrical production.
And it doesn’t need to take half the day.
Pick a scenario.
For example:
Your patient becomes unresponsive and isn’t breathing normally.
Then go.
Let the team respond.
Don’t coach every step.
Watch.
How long until someone recognizes the problem?
How long until 911 is activated?
How long until the BVM arrives?
How long until effective ventilation begins?
How long until the AED reaches the patient?
Does everyone know their role?
Afterward, talk about it.
What worked?
What didn’t?
What equipment couldn’t you find?
Where did communication break down?
What needs to change before the next drill?
Now you’re not just checking a compliance box.
You’re testing the system.
And Yes, This Is Where CodeReady™ Came From
This problem is one of the reasons I developed CodeReady.
Not because the ADA suddenly invented emergency preparedness.
It didn’t.
But I believe the traditional model of occasional certification and infrequent emergency review leaves a gap.
CodeReady uses a monthly emergency-readiness model with education, realistic drills, team discussion, and documentation.
Is monthly drilling universally required by the ADA?
No.
I want to be very clear about that.
The ADA’s general guidance recommends emergency skills be reviewed at least annually and preferably more often, while its current sedation guidelines establish a six-month minimum for the documented rehearsed drills to which those provisions apply.
Monthly practice is a best-practice model I’m proposing.
Why monthly?
Because I don’t want a dental team merely to remember that they once learned how to manage an emergency.
I want the response to be from a place of familiarity.
Who does what.
Where things are.
How equipment works.
How we communicate.
How we recognize deterioration.
How we rescue the patient.
That’s a different objective.
The Toothcop’s Take
So, does the ADA require your dental office to conduct medical emergency drills?
Maybe.
If you’re asking about dentistry generally, ADA guidance encourages mock emergencies and says emergency skills should be reviewed at least annually and preferably more often.
If you’re providing sedation or anesthesia covered by the applicable provisions of the current ADA guidelines, the expectations can be substantially higher, including documented training sessions with rehearsed emergency drills at least every six months.
And then you still have to determine what your state requires.
But I think there’s an even more important question:
Why would we wait until somebody requires us to practice?
If your patient stops breathing tomorrow, nobody is going to care how impressive your emergency policy looked in the binder.
They’re going to care whether your team knew what to do.
And that’s what the drill is supposed to find out.
Before the real emergency does.
If you are interested, I put together a system of emergency training and emergency drills for dental teams. Check out CodeReady.
Duane Tinker – The Toothcop
Clinical & Legal Disclaimer
This content is provided for general educational and informational purposes only and does not constitute legal, medical, or clinical advice or establish a standard of care. Laws, regulations, professional standards, and clinical guidance vary by jurisdiction and change over time. Readers should verify current requirements and exercise independent professional judgment based on their specific circumstances.
Examples and case discussions may be simplified, modified, or de-identified for educational purposes and should not be interpreted as legal conclusions regarding any person or organization.
Dental Compliance Specialists, LLC and The Toothcop provide compliance education and consulting services, not legal or medical advice. Consult qualified legal counsel or an appropriate healthcare professional regarding specific circumstances.