Recently, it has come to my attention that the American Association of Oral and Maxillofacial Surgeons (AAOMS) has released a new white paper titled “Office-Based Anesthesia Provided by the Oral and Maxillofacial Surgeon,” in 2013, located over at http://www.aaoms.org/docs/papers/advocacy_office_based_anesthesia.pdf.
This data contains some important data from the OMS National Insurance Company (OMSNIC) which to my knowledge had been previously closed. This data is Anesthesia Morbidity and Mortality Data from 2000 to 2010 for a total of 29,975,459 in-office anesthetics (conscious sedation, deep sedation and general anesthesia) provided by oral and maxillofacial surgeons in their offices. It was found from this data that the ratio of office fatalities/brain damage per anesthetics administered is 1 to 365,534. I had long wondered what this data showed as I have previously looked at numerous studies attempting to determine how many deaths occur when anesthesia is used in dental offices, see http://www.teethremoval.com/mortality_rates_in_dentistry.html. Due to the fact that OMSNIC covers more than 80% of all oral and maxillofacial surgeons in the U.S., their data is very meaningful.
My previous estimate was around 1 death in 450,000 cases when anesthesia is used in dental offices if I deweighted some older studies; however, using equal weight I had gotten around 1 death in 400,000 cases when anesthesia is used in dental offices. Due to the new data from OMSNIC, I have revised the pages on wisdom teeth death and dental deaths to state 1 death in 400,000 cases when anesthesia is used in dental offices. Of course, this is just a rough estimate here.
In previous posts I have discussed anesthesia from a standpoint of oral and maxillofacial surgeons offices. See American Medical Association versus American Association of Oral and Maxillofacial Surgeons, Anesthesia in the Oral and Maxillofacial Surgeons Office, and Adverse Sedation Events and Impact on Provider Specialty in Pediatrics for some examples.
The new white paper by AAOMS states
“The use of all effective drugs carry some risk, however small. Available evidence suggests that the use of sedative anesthetic drugs in the dental office by appropriately trained professionals has a remarkable record of safety.”
I find the statement in the second to last paragraph of the white paper to be very telling
“As insurance costs continue to rise, more people are electing not to pay for health insurance. At the same time states are being faced with enormous deficits and have cut Medicaid benefits for many constituents. As a result, when dental problems arise, the emergency room is the place where many of these patients seek treatment. The cost for this can be significant, especially if the patient must be admitted and treated in the hospital operating room or even intensive care. Often these visits could be avoided by early intervention in the safe and economically reasonable environment of an oral and maxillofacial surgeon’s office utilizing the anesthesia techniques employed on a daily basis.”
The white paper says my suspicion of the real reason of why anesthesia is provided by oral surgeons in their office: to get more patients in to do procedures since the anesthesia is less costly and hence more affordable to a larger number. Hence, I see a trade off here between cost and value (quality). The my advice section on teethremoval.com located at http://www.teethremoval.com/myadvice.html provides more of my comments on this issue
“If the surgery is necessary [wisdom teeth], you may want to consider having it done in a hospital instead of having an oral surgeon administer the anesthesia in his or her office.”