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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From the September 2016 Issue of “Compendium of Continuing Education in Dentistry.”
In the September 2016 Compendium article, Dr. Raymond A. Dionne describes changes proposed by ADA Resolution 37 as “substantial,” warning that the new guidelines “may have far-reaching and unintended consequences.”
According to Dr. Dionne, since 2000, more than 22,000 dentists have been trained to provide conscious sedation to their patients for use in anxiety control in outpatient settings.
“If implemented, the proposed revisions of the [ADA] guidelines will not appreciably improve the safety of enteral sedation but may eventually limit the ability of general dentists to provide sedation services to patients who would otherwise avoid restorative and preventive dental procedures,” Dr. Dionne writes in Compendium.
Discussion of all potential risk factors that affect the safety of dentists providing anesthesia and sedation in outpatient settings is beyond the scope of this article, but it should be recognized that dictating clinical practice based on the concept of MRD and arbitrary assignment of training hours and clinical experiences are only a few of the many factors that determine the overall risk. Recognition of the need to adequately inform patients of the incidence of death associated with various types of anesthesia and sedation, for example, is now being recognized through legislative efforts in California and Florida and in the insurance liability profession.37 The dental profession and the public would be better served by development of an evidence-based comprehensive strategy to optimize the safety of outpatient anesthesia and sedation rather than attempting to restrict the use of enteral sedation through the proposed revisions to the ADA guidelines.
– See the full article at: http://tinyurl.com/Dionne2016