California does not guarantee the safe use of sedation in children at the dentist. As an anesthesiologist, I am worried


In 2015, 6-year-old Caleb Sears from Albany died after being placed under general anesthesia for tooth extraction. Caleb’s death prompted Caleb’s Law, which, starting in 2017, requires the California State Dental Board to collect and investigate data related to such tragedies.

In the five years since the Caleb Act came into force, data collection on the use of general anesthesia in dental procedures in the state has improved, a milestone in protecting California Children’s Health. But as an anesthesiologist who has studied the use of sedation on children, I know the law doesn’t go far enough. California and the country must ensure the safety of all use of anesthesia on children by all dental health practitioners, including general and pediatric dentists.

To minimize the pain, anxiety, and trauma children may experience during treatment for severe tooth decay, including routine cavity fillings, dentists are increasingly offering in-office sedation. Unlike local anesthesia, where a person remains fully conscious during the procedure, sedation, another type of anesthesia, offers more variance and can be classified as mild, moderate, or deep. Dentists are only allowed to administer deep sedation or general anesthesia if they have specialized training or if they need an anesthesiologist to help them. With the right equipment, the right protocol, and the training in place, sedating even a young patient is a very safe procedure. The problem, however, is that there is little federal oversight or regulation of dental practices, making it difficult to ensure quality and safety, especially with light and moderate sedation.

There is no way to know how often deaths like Caleb’s occur because there is no systematic collection of data on pediatric dental complications in the United States. To study the phenomenon, I reviewed several decades of media reporting. My colleagues and I have found that deaths were more common among 2- to 5-year-olds who were sedated in the office. The few published studies on poor pediatric dental outcomes also suggest that death and other serious complications occur most in general dentists as sedation providers, in the office, in young children and with insufficient supervision.

In order to participate in Medicare and Medicaid reimbursement, hospitals and day surgery centers must obtain accreditation from the Joint Commission, a non-profit organization that accredits more than 22,000 healthcare organizations and programs in the United States. . But offices, dental or any other provider, are not subject to the same standards as a hospital. In medicine at least, when children are sedated in an office, it is always under the supervision of an anesthesiologist or doctor, whose licenses require them to have extensive training. In dentistry, however, whether the sedation is mild or moderate, the person who sedates a child may have greatly varying training and experience from state to state.

In the absence of a mandatory, standardized national accreditation body for dental practices that provide sedation, each state regulates licensing for pediatric dental sedation differently. For example, only 16 states require specific training for children, whose anatomy and reactions to drugs differ from those of adults. Only 20 states require providers to be certified in pediatric resuscitation, a child-specific resuscitation certification. California requires basic life support training, but not pediatric life support.

We already know what safe dental sedation should look like. In 2019, the American Academy of Pediatrics and the American Academy of Pediatric Dentistry collaborated on guidelines for the monitoring and management of young patients. But the guidelines are recommendations and providers are not required to follow them. What we need is a national standard for pediatric dental sedation. This could be achieved through state licensing requirements. In 2020, the Academy of Pediatric Dentistry developed an accreditation process for in-office pediatric dental sedation with the American Association for Accreditation of Ambulatory Surgery Facilities, but it is neither mandatory nor generalized.

So what should be done? Nationally, the healthcare system can improve the quality and safety of sedation by tracking and learning about poor results, just as Caleb’s law made it mandatory for general anesthesia in California. State dental boards already collect this data, but there is no mechanism to share it between states. Providers, payers, patients, malpractice insurers, dental organizations and policy makers must agree on a national standard for data collection and create working groups to study it so that the system can improve.

Until parents are sure their state’s laws guarantee safe sedation practices in dental offices, they will need to ask their child’s dentist whether or not they have pediatric accreditation.

Of course, dental offices should not be prohibited from offering sedation – children need more, not less, access to qualified dental providers. Anesthesia is an important clinical service that enables children to obtain treatment without trauma. Many families have spent critical months trying to find a provider willing to sedate their child. By the time many of these families find care, cavities have worsened and multiplied and more invasive procedures are needed. But all children deserve the same standard of safe, quality care.

Teeth are part of the body and dentistry should be fully integrated into our health system. Dental anesthesia, including sedation, should make it safe for children to visit their dentist. With standardized regulation, accreditation and oversight, parents and their children can be sure this will be the case.

Helen Lee is Associate Professor in the Department of Anesthesiology at the University of Illinois at Chicago and a Voices audience member of the OpEd Project.


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