Many people fear going to the dentist, and sedation dentistry seems to have become a growth industry.  More and more dentists are offering sedation and advertising as such through multiple mediums including the internet.  It is no wonder since offering something as simple as a pill or other oral sedative allows the dentist to charge anywhere from $300 to over $800 depending upon geographic location and the tolerance of the local market.  Furthermore, this charge is usually collected on the day of the procedure.  When my daughter needed intravenous sedation at the oral surgeon’s office to have a tooth pulled, I was required to write a check for $400 that day.

It is estimated that 85 million Americans avoid the dentist because of fear and anxiety.  While having sedation at the dentist sure sounds like a great idea, I think it is important to fully understand the risks if you are going to use sedative medications to assist you or a loved one through a particular procedure.  A study published in the October 2000 edition of the journal Pediatrics looked at the adverse effects of sedation medications.  Perhaps the most telling statement in the abstract of the article is that “dental specialists had the greatest frequency of negative outcomes associated with the use of 3 or more sedating medications.”

Four-year-old Javier Villa had gone to a dentist in Santa Ana, California to have some drilling done and was given an oral sedative called chloral hydrate. He was then strapped to a papoose board and his head restrained. Neither his blood pressure, pulse, nor breathing was monitored with any of the standard equipment. Javier stopped breathing and died at a hospital a few hours later.

Diamond Brownridge visited a dentist in Chicago to have some teeth filled and others capped. The five-year-old was given three sedatives, an oral agent, an intravenous one, and nitrous oxide which is commonly known as laughing gas. Neither the dentist nor his assistant recognized that Diamond had stopped breathing at some time during the 30 minute procedure. She died after four days on life support.

The family of Georgette Watson settled for $8.5 million after the Chicago area school principal died during a root canal in 2007. She had received a mixture of intravenous medications that ultimately caused her breathing to be shallow and irregular about 40 minutes into the procedure. Attempts to reverse the sedation and revive her were unsuccessful, and she ultimately went into cardiac arrest. She was pronounced dead at a local hospital.

• Be honest about your own level of anxiety.  Yes, the thought of peacefully closing your eyes and waking up after the procedure is done is enticing.  But, if you can handle it without sedation or with a small amount of oral sedation, less is better.
• Ask what kind of training, experience, or license the sedation dentist has.  Was it just a weekend course or was it more extensive training?  Does the state require any sort of license for sedation?
• Ask what kind of medications the sedation dentist plans on using.  Not everyone is aware that the effect of sedation medications will not simply add to one another but the effect can be multiplied.  If the dentist plans on using multiple medications, the dosages should be reduced.
• Ask what kind of monitoring will be used and who will be monitoring the monitors.  Several sedation deaths have occurred in the face of absolutely no patient monitors.  That is ridiculous and dangerous.  Everyone undergoing sedation should have their heart rate, breathing rate, blood pressure, and oxygen level monitored at all times.  Furthermore, it is best if someone trained is able to focus on just the patient and the sedation while the dentist performs the work.  It is too much to ask for the dentist to be focused on his or her work while trying to maintain the safe sedation of a patient.
• Try to find out if the dentist has undergone disciplinary action.  This may be difficult to hunt down but sometimes the state board of dentistry will have some information.  Disciplinary actions will often give clues to the level of organization and attention to detail to which a professional ascribes.  Use this information if you can get it.

Although dental procedures can be anxiety provoking, sedation dentistry is a rapidly expanding option for many which provides a great deal of benefit; however, it is necessary to be aware of the risks as death from a simple visit to the dentist can occur.  By asking the appropriate questions of your sedation dentist and arming yourself with information and knowledge, you can avoid the potential complication of death from sedation dentistry.