Every year, dentists and oral surgeons perform thousands of procedures on patients under anesthesia. Many patients are children who require sedation due to unique physical conditions, or psychological issues such as fear and anxiety. (Razavi & Malekianzadeh, 2022)
The types of anesthesia used for pediatric dental sedation include minimal, moderate, and deep sedation. The degree of sedation will depend on the procedure in question. Sedation in a dentist’s or oral surgeon’s office is performed safely in the vast majority of cases. However, complications can arise unexpectedly. Rarely, these complications can lead to the tragic loss of life or severe brain damage.
Unfortunately, medical errors can occur during pediatric dental sedation. Medical mistakes associated with pediatric dental sedation include medication errors such as improper dosing, inappropriate monitoring of vital signs, and the failure by untrained staff to recognize signs of respiratory failure. (Lee, et al. 2013)
Complications of Pediatric Dental Sedation
Some children have pre-existing physical conditions which increase the risk of an adverse reaction to anesthesia. Also, compared to adults, children placed under moderate or deep sedation are more prone to unexpectedly fall into a deeper state of sedation. (Razavi & Malekianzadeh, 2022). Under deep sedation or general anesthesia, children may become unable to protect their airways through normal reflexes. Suddenly, a child under anesthesia may develop airway problems, making it difficult to breathe.
Safeguards to Protect Children Who Need Dental Sedation
Dentists and oral surgeons who perform office-based dental procedures should have the staff and equipment necessary to protect a child who develops a complication of moderate or deep sedation. The American Association of Pediatrics issued guidelines supported by the American Academy of Pediatric Dentistry which recommend pediatric anesthesia is provided under the supervision of more than one health care provider with the skill and experience to protect pediatric patients in the event of a life-threatening emergency. According to the “multi-provider team based safe practice model” at least two people should be present and medically trained to monitor the patient, manage the airway, and obtain vascular access in necessary to rescue a patient with advance life support. (Brown, et al. 2019).
However, some dentists or oral surgeons will place children under moderate or deep anesthesia with the assistance of only a dental assistant. These dental assistants are not medically trained and lack the skills necessary to properly monitor children for dangerous complications involving the airway, breathing difficulties, and respiratory failure or provide medical care necessary to prevent harm to the child. (Brown, et al.).
Dental assistants lack the medical training necessary to monitor vital signs and provide meaningful assistance in the event of a life-threatening emergency for a child under sedation. (Brown, et al.). The use of dental assistants instead of skilled anesthesiology providers during pediatric dental sedation is a gap in safety which increases the risk of harm to vulnerable children, including events like cardiorespiratory collapse, brain injury from lack of oxygen or death.
Efforts to Enhance the Safety of Pediatric Dental Sedation
The American Society of Anesthesiologists, The Society for Pediatric Anesthesia, the American Society of Dentist Anesthesiologists, and The Society for Pediatric Sedation recently issued a Joint Statement criticizing the practice of using support personnel who lack sufficient hands-on training to deal with complications of pediatric dental sedation. Regrettably, this dangerous practice is endorsed by the American Association of Oral and Maxillofacial Surgeons, which endorses a single provider/operator practice model that allows oral surgeons to provide direct sedation and anesthesia, while simultaneously performing the procedure in question.
Many states closely regulate the performance of office-based anesthesia for adult and pediatric patients. Fortunately, Pennsylvania state law requires dentists and oral surgeons to have proper anesthesia equipment and anesthesia trained staff who can help assure patients are carefully monitored for complications. Dentists and oral surgeons who use office-based deep or general anesthesia for pediatric patients must use a separate health care provider such as a CRNA or anesthesiologist dedicated solely to the administration and monitoring of anesthesia. 49 Pa. Code Section 33.340(8); 28 Pa. Code Section 551.22(3).
Do you have questions about a potential lawsuit related to pediatric dental sedation?
State laws may provide an added layer of security to protect children from the risks of dental sedation. Still, in many office settings where children receive dental sedation the margin of error remains too high. If you or a loved one suffered an unexpected injury in the setting of dental sedation you may wonder whether it could have been avoided. If you have questions about what went wrong, and whether somebody should be held responsible, please feel free to reach out to our law firm.
Razavi, S. & Malekianzadeh, B., The Efficacy and Complications of Deep Sedation in Pediatric Dental Patients: A Retrospective Cohort Study, Hindawi: Anesthesiology Research and Practice, Vol. 2022, Art. ID 5259283, 1-4.
Lee, H., Milgrom, P., Starks, H., Burke, W., Trends in Death Associated with Pediatric Dental Sedation and Anesthesia, Pediatric Anesthesia, 2013, Vol. 23(8), 741-746.
Brown, R., Coté, C., Mason, L., Lalwani, K., Fukami, C. & Kost, S., Joint Statement from the American Society of Anesthesiologists, the Society for Pediatric Anesthesia, the American Society of Dentist Anesthesiologists, and the Society for Pediatric Sedation Regarding the Use of Deep Sedation/General Anesthesia for Pediatric Dental Procedures Using the Single-Provider/Operator Model, American Society of Anesthesiologists, 2019.