Recently an 9 year-old girl in the San Diego area died following a dental procedure performed under general anesthesia. Although the child’s death is still under investigation, this was not the first anesthesia mishap for this dentist. Five years ago, an adult patient suffered a code arrest while under anesthesia for a dental procedure with this dentist. The man was able to be resuscitated. That near death experience resulted in a three year suspension from practice for the dentist from 2020 to 2023, but he is back practicing and putting patients under general anesthesia again.
We don’t know enough yet about this death but there is a substantial difference between the story told by the parents and that told by the office of the dentist. The dentist claims that the little girl was recovered after the procedure and that she was awake and stable when her parents took her home. According to the parents, however, when they received their daughter to take her home, she was asleep. They say she remained asleep on the way home and that they put her to bed when they arrived home. She continued to sleep the rest of the day and, when they could not awaken her, they called 911. She was transported to the hospital, where she was pronounced dead.
General anesthesia is far more risky than local anesthesia, such as novocaine or lidocaine. Local anesthetics are delivered by injection and, as the name implies, affect only a local area. By contrast, general anesthesia affects the entire body and most of its functions. It produces unconsciousness and painlessness. It slows the heart and breathing. It affects memory so that the patient has no recollection of events which occurred during the anesthesia. Because it is so profound in its effects, general anesthesia requires close monitoring. If the pulse or breathing slow too much, brain damage can occur. The right amount of the appropriate anesthetic agent must be administered at the proper time. Even under the best of circumstances, a lot can go wrong with terrible consequences.
Despite its risks, general anesthesia has a place in dentistry, especially in young children or children with extreme anxiety about dental procedures. Under these circumstances, general anesthesia may be the only way these children can have the dental procedure.
In hospital settings, a trained anesthesiologist or nurse anesthetist will be present. She or he will screen the patient to make sure they are appropriate candidates for anesthesia. They will administer the anesthesia and monitor the patient during the procedure. Not so much at many dentist’s offices. For a variety of reasons, the dentist or an assistant may be in charge of the anesthesia. These people are not likely to be as well-trained in the risks and uses of anesthesia as anesthesiologists and nurse anesthetists. They may be distracted by their other duties and may not monitor the patient as well as they should. They may lack some of the sophisticated equipment needed to properly monitor patients under general anesthesia. If the patient gets in trouble, they may not be able to quickly resuscitate them and there may be a delay in getting the patient to a facility where high levels of care are available.
Many dentists offer general anesthesia. Their levels of expertise and training vary. The skill and training of their assistants also varies. As a society, we have to rely on the state licensing boards to assure that dentists who offer general anesthesia know what they are doing and will effectively monitor and protect patients. Sadly, these state agencies often fail to do their jobs for a number of reasons.
I wrote a few weeks ago about the risks presented by frequent flyers, doctors who have multiple claims against them. The dentist in the case of this little girl had a similar situation occur before that was egregious enough for the state dental board to suspend him from practice for three years. I am confident that before the board let him resume practicing and administering general anesthesia, it required him to take additional training and to demonstrate competence. Even the best training, however, only goes so far and cannot guarantee that the dentist will follow that training in his practice.
Because general anesthesia has the risks it does, parents must make sure first that their child needs the dental procedure being proposed. Secondly, the parents should carefully examine the office of the dentist, his or her credentials, and the training and experience of the staff who will be assisting the dentist. Who will be monitoring the child patient during the procedure? If it is going to be the dentist, that should be a red flag. The dentist has other things to worry about and may not be able to devote the attention to monitoring that the patient needs. How close is medical help in the event something goes wrong? The closer the better.
A death like this is so tragic but it reminds us of the things we need to do to keep our children safe. It also reminds us that we cannot count on state medical or dental boards to protect us or our families. We have to be vigilant as well.
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