Should Children Be Put Under for Dental Procedures?

In the past several decades, dentists have made great strides in researching and understanding how to best perform routine check-ups, care for teeth and perform dental operations. It’s recommended that mothers take their babies in for their first dental check-up before they turn one-year-old even when the child’s teeth have not yet erupted from the gums. It’s not uncommon for a younger child under the age of five to need cavities filled, teeth extracted or another type of dental procedure. Recently, dentists have been sedating children to make dental procedures easier, but many are questioning if the risks associated with anesthesia are too high to utilize the method unless it is deemed medically necessary for the child. It’s crucial for parents to understand this swirling controversy, the risks associated with such dental procedures and their rights.

Recent Controversy

In 2016, one young girl’s tragic story made national headlines when she passed away during a routine dental procedure. The 14-month-old was scheduled to have two cavities filled, but the dentist noticed six cavities needing care during the appointment. Instead, the youngster would need four crowns and two fillings. Ignoring her nagging doubts, the mother trusted the dentist and allowed her child to be sedated by the dentist’s anesthesiologist. Unfortunately, the child stopped breathing and went into cardiac arrest. Despite calls to 911 and being transported to the hospital, the 14-month-old died. Shocking reports referencing the child’s autopsy reports and dental records revealed that there was no evidence the child was in pain or required such extensive dental treatment. Her cause of death was a result of anesthesia complications.

This horrible story is unfortunately one of many. Just one year prior, a six-year-old from San Francisco Bay was put under anesthesia to remove a tooth. Complications from the anesthesia is thought to have caused the young boy’s death. The family’s outrage sparked lawmakers to pass a new bill, Caleb’s Law, which requires dentists to notify parents about the increased risk of death associated with the same oral surgeon giving the anesthesia and performing the surgery. The bill was ultimately watered down when the California Dental Association fought to replace it with a more generalized warning about anesthesia risks.

Risk Factors Associated with Sedation

Deaths from anesthesia are rare, but they are still possible in a dentist’s office. Children across the nation who need procedures such as tooth extraction or cavity fillings will often be sedated to make them more cooperative. Younger children are more likely to fall into a deeper level of sedation, suffer from an obstructed airway or have an unanticipated problem with the heart or breathing. Recent reports of kids perishing due to sedation are horrific but thankfully rare. The University of Washington studied this issue in 2013 and found around 44 similar cases spanning over thirty years.

When a dentist decides to sedate a child younger than twelve, many states require the dentist to qualify for a special anesthesia permit. Most state’s dental boards defer to the American Academy of Pediatrics for creating guidelines on younger children’s dental care, and each state’s rules may vary significantly in regards to safety and sedation levels. The risks of complications are small, but a dentist’s office is less prepared to handle emergency situations than hospitals. A dentist needs to be prepared to rescue an over sedated child. In deep sedation, children can’t maintain their own airway, so the American Society of Anesthesiologists recommends an additional qualified individual to monitor the patient during the procedure.

Know Your Rights

If your child’s dentist has recommended sedation, then the first thing you need to ask is whether the sedation is necessary. Sedation certainly makes dental procedures easier for the dentists, but it’s crucial for parents to understand their rights, the risks associated with the procedure and viable alternative treatments. It’s completely natural and understandable for your young child to be uncomfortable at the dentist’s office. Most pediatric dentist’s offices have cartoons, toys or other methods of distracting an uncomfortable child. It’s common for parents to be able to remain close and provide emotional support for their children. When the child is very young, has behavioral problems or suffers developmental delays, dentists may struggle to provide efficient and effective care. At times, your trusted care provider may suggest anesthesia or sedation for your child.

There are alternatives to sedation for some procedures. If your child’s cavity is less advanced, then the decayed portions can be treated with a liquid. The silver diamine fluoride will stop the infection, and sedation is not required to apply the liquid. Another less risky option is to have a temporary filling placed for your child until they are old enough to sit though the longer procedure. Sedation should never be a younger child’s first-line treatment for minor problems. Dentists who recommend sedation for more complicated problems like root canals or abscess, however, are unlikely to have a suitable alternative. There are situations where the risks of sedation are necessary for the health or comfort of your child.

Mitigating The Risks Of Sedation

Common injuries stemming from anesthesia errors include nerve damage, pain and suffering, asphyxia or brain damage, long-term nausea, paralysis, severe emotional distress or heart problems.

The most comprehensive research studies conducted about dental anesthesia reveal that most deaths occur among children aged two to five, in an office setting and with the pediatric dentist acting as the anesthesia provider. Risk is inherent when performing extensive dental work requiring sedation, but the potential for negative outcomes can be greatly reduced by increasing the number of qualified individuals monitoring children undergoing such procedures. While providing effective, quality dental care to infants and young children is difficult, sedation should never be considered an efficient tool for managing a child’s behavior. As a parent, always ask your care provider if sedation is necessary and inquire about potential alternatives.