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Should Kids Be Sedated For Dental Work?

Should Kids Be Sedated For Dental Work?
by Catherine Saint Louis

In dental offices nationwide, children who need cavities filled or teeth pulled are sometimes sedated. Ideally, it makes them less anxious and more cooperative.

They may swallow a liquid sedative or inhale laughing gas and once it kicks in, they will be conscious but calmer, so the dentist can do extensive work.

But in rare cases, children fall into a much deeper level of sedation than intended. If they aren’t rescued quickly, they may stop breathing or even die. It is critical for the dental staff to keep track of the patient’s vital signs and quickly recognize an obstructed airway or a problem with the heart or breathing.

In recent years, a few reports of sedated children dying at dental offices have come to light, alarming lawmakers, parents and the dental profession. In 2013, University of Washington researchers found 44 cases over three decades in which dental patients died after sedation or general anesthesia. Most were 2 to 5 years old.

More recently, in 2016, Daisy Lynn Torres, 14 months old, underwent general anesthesia at an Austin dental office to fix two cavities, and died after her heart and breathing stopped. Her parents sued after dental experts found no evidence of cavities on her X-rays. In June, Daleyza Hernandez-Avila, 3, went to a surgical center in Stockton, Calif., to have her teeth fixed and never woke up.

For sedation to be safe, certain protocols are critical and many factors must be carefully weighed, according to the 2016 guidelines jointly written by the American Academy of Pediatric Dentistry and the American Academy of Pediatrics.

1. Understanding Sedation

Sedation is a continuum from minimal to moderate to deep to general anesthesia, and “it is common for children to pass from the intended level of sedation to a deeper, unintended level of sedation,” the guidelines note. So parents should ask the dentist what level they’re aiming for and what emergency measures will be taken should, for example, moderate sedation become deep and a child can no longer breathe on his or her own.

“The risk is small but there’s always a risk when you sedate a child, primarily of airway obstruction, where the child — for whatever reason — becomes oversedated,” said Dr. Joseph P. Cravero, a senior associate in perioperative anesthesia at Boston Children’s Hospital.

A dentist’s office generally has fewer hands on deck than a hospital if trouble strikes. “If you are working in a hospital, you press a button, an alarm goes off and everyone comes to help with that kid,” Dr. Cravero said. But in an office, “you end up having to call 911 for help” and the dentist must begin resuscitation during the wait.

The Pediatric Sedation Research Consortium — which collects data mostly from hospitals, not dental offices — has found a low but persistent rate of life-threatening events associated with sedation, such as airway blockage, a drop in blood oxygen levels or a spasm of the vocal cords that makes breathing hard.

Unfortunately, it’s not known how many children are sedated in dental offices nor the actual frequency of problems. “What you have in dentistry are reports of disasters, and that’s all we have to go by,” said Dr. Cravero, a co-founder of the consortium.

Read full article on TheNewYorkTimes.