What to Ask the Dentist Before Children Have Sedation

In July of 2017, Today ran a nice piece titled “9 questions to ask your dentist before your kids go under sedation,” written by Linda Caroll, July 10, 2017. The article discusses some recent children dental deaths that occurred in the last few years. If you have been on teethremoval.com before, you know that many cases like these have been covered in the past and you can see more on http://www.teethremoval.com/death.html and http://www.teethremoval.com/dental_deaths.html. The article says that doctors from the American Academy of Pediatrics are speaking out about the dangers of sedating children for oral surgery.

It is said that it is unclear how many children or adults for that matter, have died in the U.S. during dental procedures. However, some work by the Dallas Morning News in 2015, indicates a dental patient dies nearly every other day in the U.S. The state boards that oversee dental practice in the U.S. do not release the numbers of deaths. The article provides commentary from Dr. Jay Friedman who has been featured in many articles on teethremoval.com over the years. For example see http://blog.teethremoval.com/when-abstinence-is-evidence-based/ and http://blog.teethremoval.com/american-journal-of-public-health-author-jay-w-friedman-is-2009-author-of-the-year/. Dr. Friedman says

“There’s really no legitimate oversight. And there are very few sanctions. You have to do something really bad before anything gets done about it… In my opinion, there’s no excuse to give any of these kids general anesthesia.”

The main point to make is that local anesthesia (such as a numbing gel) is not the real danger, but instead general anesthesia is (which makes someone unconscious). Since children have small airways they tend to choke more easily than adults and this can lead to airway obstruction.  The article provides commentary from Dr. Karen Sibert, an associate clinical professor of anesthesiology at the University of California, Los Angeles, who makes a comment that in a hospital or ambulatory surgery center there are medical support systems to help a child in distress but in an office setting by the time anyone gets there it is often too late. The same argument has long been made on teethremoval.com. The article also makes the point that many parents are not aware that death is a possibility in dental offices and even if they sign a consent form with it on there they do may not absorb this information.

The article spells out a list of nine questions that parents should ask about any child who undergoes any serious dental procedure. It is hopeful that a frank discussion about the benefits and risks of using anesthesia for treating the disease or condition can then occur. These questions are:

1. Are you going to sedate my child? If so, what medicines are you going to use? 

2. Will there be a separate person giving general anesthesia in the room? 

3. How much training giving anesthesia does the person have? 

4. Are you going to use a Papoose Board to temporarily restrain the child?

5. How much experience does the person have with similar types of treatments?

6. How will the child be monitored during the treatment to ensure everything is going okay?

7. Who is going to be present in the room if something goes wrong? 

8. What procedure is going to be performed and is it neccessary?

9. Tell me about recovery setup you have?

In conjuction with these questions, Louis K. Rafetto, who is a past president of the American Association of Oral and Maxillofacial Surgeons and previously participated in the Third Molar Conference in 2010, as discussed previously here http://blog.teethremoval.com/third-molar-multidisciplinary-press-conference/, offers some things one should glean from answers to these nine questions. He suggests you want to make sure the doctor doesn’t gloss over the types of medicines that are going to be used and that the office has EKG, blood pressure, pulse oximetry, and end tidal carbon dioxide monitors. An additional red flag is if the doctor said he just took a weekend course and started doing this but everything will be fine. You may also want to insist on having someone other than the dentist or oral surgeon administer the anesthesia. It may be okay to have a dentist administer local anesthesia and nitrous oxide but the concern comes in when general anesthesia is also necessary for treatment.

Additional advice given in the article is that it may be ideal to have two adults accompany a child for any difficult dental procedure performed under general anethesia. This way one person can focus on driving and the roads and the other person can sit in the back of the car with the child and keep an eye on their airway and breathing. It is hoped that by going over these questions prior to dental treatment future children undergoing dental treatment will stay alive and not die. If you are not comfortable with the way the dentist or surgeon is answering the questions it is okay to get a second opinion or seek someone else for treatment.

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