Is it Safe for Children to Receive Sedation/Anesthesia from an Oral Surgeon or Dentist using a Single Provider/Operator Model?

Recently on this site there has been much discussion on updated guidelines put out by various groups that argue that children having deep sedation and anesthesia are not safely being served by dentists and oral surgeons using a single provider/operator model. Instead these guidelines call for a multi-provider model where the person doing the dental work or oral surgery and the person administering and monitoring the sedation/anesthesia are two separate individuals. See the posts AAOMS Pushes Back on Anesthesia Guidelines for Pediatric Patients and Updated Sedation Guidelines in Dentistry for Children for additional details. Some of the individuals leading the charge against the current anesthesia delivery model for children have published a new opinion piece titled “The Single-Clinician–Operator/Anesthetist Model for Dental Deep Sedation/Anesthesia: A Major Safety Issue for Children” published online in JAMA Pediatrics on Oct. 28, 2019 (written by … Read more

AAOMS Pushes Back on Anesthesia Guidelines for Pediatric Patients

Earlier this year in 2019, the American Society of Anesthesiologists (ASA), the Society for Pediatric Anesthesia (SPA), the American Society of Dentist Anesthesiologists (ASDA), the Society for Pediatric Sedation (SPS), the American Academy of Pediatric Dentistry (AAPD), and the American Academy of Pediatrics (AAP) put out updated guidelines regarding the use of deep sedation and general anesthesia for children at a dental facility. The ASA, SPA, ASDA, and SPS put out a separate distinct set of guidelines from the AAPD/AAP. These guidelines are available from https://www.asahq.org/advocacy-and-asapac/advocacy-topics/office-based-anesthesia-and-dental-anesthesia/joint-statement-pediatric-dental-sedation and the June 2019 edition of Pediatrics in an article titled “Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures” written by Coté and Wilson, which was previously discussed in the blog post Updated Sedation Guidelines in Dentistry for Children. The guidelines are slightly different but the … Read more

Oral and Maxillofacial Surgeons Using Simulation to Improve Preparedness for Adverse Events with Sedation and Anesthesia

According to the July/August 2019 edition of AAOMS today (vol. 17, no 4) the American Association of Oral and Maxillofacial Surgeons (AAOMS) has launched a new National Simulation Program allowing for members and staff to practice techniques on manikins. This can allow for better preparedness by receiving feedback on areas that may require additional training. The same simulated events are given to all participants which allows for objective assessments. The courses can offer instant feedback and point out any deficiencies by the surgeon. The goal of such simulation is to improve patient outcomes. AAOMS currently offers simulation programs in Minnesota and South Carolina. A particular focus on the simulation is on training oral surgeons for preventing events that can be devastating such as a death or brain injury. Thus one focus of the simulation is on Basic Emergency Airway Management … Read more

Is Pediatric Dental Death Avoidable?

An interesting article titled “Pediatric Dental Anesthesia: An Avoidable Tragedy,” written by Lee et al. appears in the December 2017 edition of Pediatrics (vol. 140, no. 6). In the article the authors present a case of a dental death after anesthesia for early childhood caries and have experts provide commentary. Pediatric dental deaths have been reported in the news over the years with all too much frequency. See the dental deaths page for numerous cases and the original source of the information regarding the case. In the article by Lee the authors say how young children with early childhood caries or cavities are often treated using moderate sedation or general anesthesia. It is estimated that up to 250,000 pediatric sedations for dental treatment occur in the U.S. each year. In these sedations the children are often given benzodiazepines, opioids, nitrous … Read more

Does the U.S. Need Universal Healthcare? Thoughts on Universal Healthcare from Democratic Presidential Candidates and Twitter

Many Americans are not satisfied with the current health care system. Before on this site it has been argued how the U.S. is in need of a single-payer health care system, see the post The Cost of Health Care in the U.S. compared to Other Countries. Many democratic presidential candidates in 2020 have come out in favor of universal healthcare. Also looking through tweets on Twitter one can see that many in the U.S. are also in favor of universal healthcare. However, a single-payer health care system does not go far enough and should also include dental care. As has been discussed in the post ADA Breaking Down Barriers to Oral Health for All Americans: Repairing the Tattered Safety Net Americans are increasingly finding it difficult to pay for dental care. Dental care is also intimately tied to health care. … Read more