Risk Factors for Dental Outpatient Sedation Procedures Derived from Deaths Reported in the Public Domain

ABSTRACT:

The incidence of serious morbidity and mortality associated with administration of sedative drugs, deep sedation and general anesthesia are not known due to lack of prospective data collection and the failure of state boards and liability insurance companies to make closed claims data available in redacted form.

risk_factorsInformation in the public domain of deaths in dental offices, however, provides evidence of the incidence of cases and the characteristics of factors associated with serious adverse outcomes. A search of the internet using the term ‘deaths in dental offices’ yielded 40 cases of serious morbidity or deaths that were associated with anesthetic and sedative procedures. The majority of deaths were associated with general anesthesia and parenteral sedation; only 4 deaths were associated with oral/enteral sedation (N=2 chloral hydrate alone and in combination with other drugs, N = 2 triazolam).

These data do not support attempts to further regulate the use of benzodiazepines for oral/enteral sedation but do suggest the need to re-evaluate the risks of deep sedation/general anesthesia provided to dental outpatients.

The drug classes most frequently reported in cases of serious morbidity and mortality include opioids, propofol and combinations of 2 or more drugs with a benzodiazepine.

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Table of Cases:
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Experts FACT CHECK American Dental Association’s ‘Frequently Asked Questions’ on ‘Resolution 37’

A group of scientists, academics, and dentists issued a 7,000-word FACT CHECK of the American Dental Association’s official ‘Frequently Asked Questions’ pertaining to Resolution 37, a proposed revision to the ADA’s Sedation and Anesthesia Guidelines.

Delegates to the ADA’s House of Delegates are scheduled to vote the resolution up or down at the group’s annual meeting which will be held October 20-24 in Denver.

The official FAQ was released by the ADA’s Council on Dental Education and Licensure (CDEL), which drafted ADA Resolution 37 and is advocating for its adoption. If approved by ADA delegates, Resolution 37 will dramatically revise the ADA’s recommended guidelines that govern the use of sedation and anesthesia, as well as related training requirements.

The entire 7,000-word FACT CHECK is available to download here as a PDF.  There is also an abbreviated SUMMARY available for download.

The FACT CHECK, a collaboration reflecting the input of more than a dozen ADA members who are independent of CDEL, responds to each of CDEL’s 15 assertions.

Click on link below to download the complete 7,000-word FACT CHECK

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Click on link below to download the SUMMARY

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