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What you should know about pediatric dental anesthesia

Any sedation or anesthesia in a dental office comes with risks

I still remember the day, years ago, that a friend from our church referred her cousin to our office. It was sad to hear the shocked, grieving voice of that dad sharing how his two-year-old daughter died in a dental office from anesthesia complications. No one would think that this could happen for a routine visit to the dentist to have some cavities filled.

Early childhood caries (cavities) is the most common chronic childhood disease. According to the peer-reviewed medical journal Pediatrics, American children receive dental sedation 100,000–250,000 times every year.

The peer-reviewed journal Pediatric Dentistry reported a closed claims study on adverse events during pediatric dental anesthesia. Here are some of the important findings:

• The average patient age was 3.6 years.

• Almost one-third of the cases involved a general dentist as the anesthesia provider.

• 2 of the 17 closed claims involved only local anesthesia, and the patients were overdosed 41% of the time.

The risks of pediatric dental anesthesia

Regardless of whether the anesthetic or sedative chosen is a local anesthetic, nitrous oxide (laughing gas), opioid, or a benzodiazepine, there’s a well-known list of serious risks:

• Hypoxemia: Abnormally low levels of oxygen in the arterial blood.

• Respiratory depression: Anesthetic medications impair pulmonary functions. Excessive or lingering medication effect can cause prolonged depression of respiratory function.

• Airway obstruction: Anesthetics can cause the airway to collapse, which obstructs airflow.

• Death

Managing risk

From my experience as a parent of four children, it’s not typical for pediatric dentists to disclose to parents these risks, who will be managing sedation or anesthesia during the procedure, and the dental office’s preparation for handling an emergency. All of this should be part of a robust informed consent discussion with the dentist before anesthesia or the procedure begins.

Think about an operating room setting. The surgeon’s attention is on the procedure, while the anesthetic care is managed by a physician anesthesiologist and/or a certified registered nurse anesthetist (CRNA). It’s the role of the anesthesiologist or CRNA to form an anesthetic plan, continuously monitor the patient’s response to anesthesia and vital signs, and be ready to provide emergency reversal and resuscitation is something goes wrong.

In many dental offices, dentists wear two hats, one as the dentist/surgeon performing the procedure, and another as the anesthesia provider who is responsible for continuous monitoring of the patient’s vital signs and response.

In my view, this creates a double risk. First, dentists have less training and experience in administration and management of anesthetics than physician anesthesiologist or CRNAs. Second, their attention is split between performing the procedure and monitoring the patient’s physiologic response to anesthesia.

If you are loved one has been seriously injured from complications of dental anesthesia in Texas, then contact a top-rated experienced Texas medical and dental malpractice attorney for a free consultation about your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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