An ABC News investigation raised questions about the safety of pediatric dentistry sedation.

The report said more than a dozen children had died after sedation by dentists who were not properly trained to respond to emergencies that could arise through the use of sedatives. In some cases, the dentists used substantially more sedative than normal for the age and size of the child being treated.

Oral sedation dentistry – often referred to as pain-free dentistry – has become a booming business for dentists who offer the service to ease patients’ anxiety about going to the dentist, as well as for major procedures.

Some dentists even offer sedation for routine teeth cleanings and filling cavities.

Regulations vary by state, with some calling for minimal sedation, while others give dentists greater latitude in deciding when sedation is called for.

Weekend workshops in oral sedation are being offered around the country and the ABC report said that in the past five years more than 18,000 dentists had taken such courses, which promises to add tens of thousands of dollars to the bottom line of the dentists’ practices.

Dr. Indru Punwani of the University of Illinois, a spokesman for the American Academy of Pediatric Dentistry (AAPD), told ABC that a weekend course would be “inadequate” for preparing dentists to deal with emergencies that can arise through the use of oral sedatives.
“I don’t believe it can be done,” Punwani said.

He also said that dentists who follow AAPD sedation guidelines have never been tied to a death.

AAPD guidelines say that sedation can be used safely and effectively and has issued guidelines for dentists to follow.

The decision to use sedation, according to the AAPD, must consider:
•    Whether there are other treatment options
•    What are the dental needs of the patient
•    What will the effect of sedation be on the quality of dental care
•    What is the state of the patient’s emotional development
•    Whether there are medical and physical considerations that might be affected by sedation

Sedation is usually recommended for fearful, anxious patients for whom traditional treatment has not worked, patients who lack the emotional or psychological maturity to be cooperative and in cases where it might reduce medical risk.

It is discouraged for patients with minimal dental needs or who have medical and/or physical conditions that would make sedation inadvisable.

Janet Southerland, dean of the Meharry Medical College School of Dentistry, has used sedation dentistry on young patients, noting in a previous interview, that issues of pain-free and cosmetic dentistry are areas that will become increasingly important to patients in the future.

Southerland’s research interests include the study of the relationship between diabetes and periodontal disease and early detection and interventions for oral cancer as well as oral manifestation of HIV/AIDS.

Southerland, who previously has served as chair, Department of Hospital Dentistry and Chief of the Oral Medicine Service, both at University of North Carolina Hospitals, as well as the head of hospital dentistry, said she used sedation dentistry for 11 years before joining Meharry last year.

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