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