DENTAL SEDATION is commonly administered for the treatment of anxious children. It is one of the hallmarks of training for pediatric dentists. It is estimated that between 10% and 20% of children and special needs adults will require pharmacosedation to safely and efficiently complete dental treatment. 1, 2 Children and the elderly present the highest risk and lowest error tolerance in patient safety during sedation procedures. Although rare, the most serious adverse outcomes of sedation are brain damage and death. 3, 4 No one should die from visiting the dentist.
A number of severe adverse events have occurred in the United States during the past five years. In response, state legislatures have told their dental boards to investigate dental anesthesia–related deaths and mishaps. These panels are composed of dental anesthesiologists, oral surgeons, pediatric dentists, and general dentists. All are actively licensed and practicing dentists who frequently perform in-office sedation. Many teach sedation/anesthesia in dental schools.
The panels reviewed deidentified data compiled during board investigations that were involved in patient mortali-ties and patient harm during or following dental treatment in which sedation/anesthesia was administered. They evaluated substance and application of emergency protocols related to the administration of the sedation/anesthesia. They also reviewed other state laws and rules and scientific literature.
In 2016, a Texas panel performed an intensive review of 78 cases. 5 Nineteen were determined to have been mishandled, six were identified as major events (death or permanent injury), and four of the six were children under eight years of age. An additional 13 were categorized as mishaps (adverse events without permanent injury).
Between 2011 and 2016, five deaths and one brain injury occurred that were directly related to sedation/anesthesia. It was revealed that oral and maxillofacial surgeons, pediatric dentists, and dental anesthesiologists perform approximately 411,000 sedation/anesthetics annually in Texas. Adding all licensed Texas dentists, the total number of sedation procedures is estimated to be between 500,000 and 1,000,000 annually.
Texas is not alone. A July 2016 pediatric anesthesia study undertaken by the Dental Board of California found that between 2010 and 2015, nine pediatric deaths were noted from various combinations of local anesthetic, sedation, and general anesthesia. 6 Fifty-six additional pediatric hospitalizations were also described, many of which are still being investigated.
outpatient surgical centers, and hospitals.
nurse anesthetists, and medical anesthesiologists.
• No one type of provider or sedation delivery model had better outcomes, i.e., oral sedation was no safer than IV or general anesthesia.
• There were cases of premature discharge.
• There was poor drug selection.
• There was poor management in the early stages of a developing urgency that allowed the condition to deteriorate to an emergency.
• There were delayed calls to 911.