After several tragic cases that have been reported widely in media, anesthesiologists are calling for more research into child deaths caused by dental anesthesia. They say that little is known about these deaths in part because of the lack of data surrounding them, since there is no mandated reporting after they happen.
“There are so many questions that we need answers to when it comes to pediatric deaths caused by dental anesthesia,” said Helen Lee, MD, MPH, assistant professor of anesthesiology at the University of Illinois at Chicago College of Medicine and lead author of a recent case study.
“Do the deaths reflect a need for more clinical training? Do we need better regulation of who gets and maintains sedation licenses? How can data best be collected after an adverse event? Are providers following clinical guidelines? If not, why not?” Lee asked.
Early childhood caries is the most common chronic childhood disease. Moderate sedation or general anesthesia is sometimes provided in treatment, depending on the severity of tooth decay and the treatment plan.
Approximately 100,000 to 250,000 pediatric dental sedations are performed each year in the United States using a variety of drugs, including benzodiazepines, opioids, local anesthetics, and nitrous oxide. Adverse effects include hypoxemia, respiratory depression, airway obstruction, and even death.
However, the number of deaths and exactly what caused them are unknown because there is no data, the researchers noted. According to Lee, there may be certain general factors associated with increase adverse effects related to pediatric dental anesthesia.
“For adults, receiving sedation in an office setting has been associated with a tenfold increase in mortality compared to getting sedation in an ambulatory surgical center. Outcomes for children sedated in office settings is unlikely to be better,” said Lee. “But we need more data to determine if this is the case before we can understand how to make office-based procedures safer.”
Age-related differences in physiology put children at greater risk when it comes to anesthesia, the researchers said. Adults have greater physiologic oxygen reserve, so they can withstand brief episodes of low oxygen under anesthesia, which some children can’t.
Also, children have greater metabolic demands for oxygen than adults, so episodes of low oxygen can lead to more serious consequences for them, including brain damage, Lee said, adding that research is needed to examine how providers can be supported in their practices to reduce the risk of negative outcomes for pediatric patients receiving dental anesthesia.
“I believe that there are solutions to this problem and figuring out what that looks like will take collaborative work between anesthesia providers, dentists, and patients,” Lee said. “In the end, everyone wants the same thing—for children to be safer.”
The study, “Ethics Rounds: Death After Pediatric Dental Anesthesia: An Avoidable Tragedy?” was published by Pediatrics.