Have you ever brought your child in to the dentist for the treatment of painful cavities. It can be incredibly difficult, if not impossible! According to the Surgeon General, childhood caries are “the single most common chronic childhood disease.”
Moderate sedation or general anesthesia is often used due to their behavior, age, and disease severity. Using anesthesia for treating pediatric cavities is on the rise. In fact, it is estimated there are 250,000 sedation performed annually on children.
Unfortunately, there has been a problem of anesthesia being performed by dentist who are busy doing procedures. One case is documented in American Academy of Pediatrics News & Journals.
The mother reports that the child complains of pain while eating and occasionally wakes up in the night because of tooth pain. Previous visits to the family’s regular dentist are difficult because the child has behavioral issues and is uncooperative with oral examinations. The family’s dentist is able to determine that the child has decay affecting his front teeth but is unable to provide treatment because of the child’s behavior. The family’s dentist does not feel comfortable sedating children and therefore refers the child to a pediatric dentist.
Because of the child’s clinical symptoms, there is concern for extensive disease affecting the child’s molars. The family dentist explains that a pediatric dentist is trained to treat a child’s cavities with the aid of anesthesia.
The pediatric dentist recommends moderate sedation in the office to perform a thorough examination and treat decay. A separate provider, the dental assistant, provides sedation and monitors the child during the procedure. The child is given oral midazolam and inhaled nitrous oxide. He requires an extra dose of midazolam because of his inability to tolerate the procedure.
After the procedure, the dentist leaves the child in the recovery area to speak with the mother about the procedure. The recovery area is staffed by a dental assistant, who clinically monitors children recovering from sedation. When the mother and dentist arrive in recovery, the child is noted to be cyanotic. There is no pulse oximeter, and respiratory efforts are absent. The staff initiates cardiopulmonary resuscitation and calls 911. Paramedics initiate cardiopulmonary resuscitation, but the child is pronounced dead on arrival at the hospital.
