Sedation in Dental Work

A trip to the dentist twice a year is a common occurrence for many people. Many of us can name at least one instance where we have been sedated for a procedure, whether for a root canal or having wisdom teeth removed. But how did you feel when your parents took you to the dentist as a child? Many children experience anxiety at the dentist, and in order to keep them cooperative and calm, they are sedated for simple procedures like filling a cavity. However, should we really be using nitrous oxide or an intravenous sedative for our children?

According to this recent article in the New York Times, sometimes children can face major complications during sedation and even die. Over three decades up to 2013, it has been found that at least 44 children between the ages of 2 and 5 have died of complications arising from various forms of anesthesia. The situation is not getting any better. In 2016, a 14-month old died in the dentist’s chair when she was put under general anesthesia to fix two cavities. Even worse, it became clear after the family sued that the x-rays showed no evidence of cavities in the first place. The American Academy of Pediatric Dentistry has published strict guidelines for sedating children, but it is still an incredibly commonplace practice. The necessity of sedation for small procedures like filling a cavity is under scrutiny, however, and some dentists claim it would be easier to place a temporary filling until a child is able to sit still and receive a proper one. In addition, a general dentist may have only had a single weekend seminar to cover anesthesia. Considering that children with developmental disabilities may react differently to anesthesia, it is important that dentists have more varied experience. Additionally, if the decision is made to put a child under sedation, it ought to be monitored by a full fledged pediatric anesthesiologist, and not just the dentist.

Many children experience fear and anxiety when they head to a dentist’s office, so the first step in preventing accidental sedation deaths is to address their fear so they will sit still. Of course, even if this fear and anxiety are addressed, there will still be those children that will refuse to sit still for even the simplest of procedures. In that case, when it comes to the health and well-being of our children, no one can be over-qualified. If a child needs to be sedated for a serious dental issue, there should be an anesthesiologist in the room. For incredibly minor dental issues like cavities, all alternate methods should be exhausted before sedation is considered.  

Overall, the parent should be consulted and be informed of all of the risks associated with sedation and given plenty of alternative options, and they should seek a second opinion if they think a dentist is too quick to jump to sedation.

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