DENTAL SEDATION AND ANESTHESIA
RESPONSE AT THE STATE LEVEL
Dental board requirements and state laws are
changing in response to these accidents. Although pediatric dental sedation has an excellent safety record, adverse outcomes sometimes occur in apparently healthy patients,
indicating that there may be inherent risk in
sedation and general anesthesia. Nevertheless,
it is important to continue efforts to improve
outcomes for all patients who receive sedation
and general anesthesia for dental
Presently, 25 states have special requirements for pediatric patients, and nine states
have a separate permit for sedation of pediatric
patients. Later this year it is anticipated that
Texas and California will mandate updates to
staff requirements, educational requirements,
and monitoring standards in an effort to improve the safety of pediatric dental anesthesia
and sedation. For example, dentists will be
required to use precordial stethoscopes and
capnography as part of patient monitoring.
For the treatment of children under seven years
of age, it will also be necessary to have a separate staff member trained in patient monitoring dedicated to that task.
TAKING ACTION TO MITIGATE
Each day a large number of patients are put
under some form of sedation. Patient care and
safety must always be the primary objective.
In addition to being properly trained in ap-
proved residency programs, it is requisite that
the doctor and staff have current Basic Life
Support (BLS) certification and even Pediatric
Advanced Life Support (PALS) certification.
Emergency drills should be practiced on a
quarterly basis. Offices must maintain emer-
gency medical kits, portable oxygen carts, and
AED machines. To be compliant with many
state laws, monitoring equipment will need to
include capnography, and the doctor will need to have a precordial
stethoscope. Additionally, appropriate protocol mandates that there
is always a third, dedicated staff member who provides patient
Patient safety must be the first priority in all situations. Added vigilance is required when sedation is prescribed. Regardless of current
mandates, we have the obligation and opportunity as health-care
providers to take all appropriate precautions when treating patients
with sedation and general anesthesia.
1. Houpt M. Project USAP 2000: Use of sedative agents by pediatric dentists—15-
year follow-up survey. Pediatr Dent. 2002;24:289-294.
2. Saxen MA, Wilson S, Paravecchio R. Anesthesia for pediatric dentistry. Dent Clin
North Am. 1999;43:231-245, vi.
3. Cravero JP, Blike GT, Beach M, et al. Incidence and nature of adverse events
during pediatric sedation/anesthesia for procedures outside the operating room:
Report from the Pediatric Sedation Research Consortium. Pediatrics
4. Chicka MC, Dembo JB, Mathu-Muju KR, et al. Adverse events during pediatric
dental anesthesia and sedation: A review of malpractice insurance claims.
Pediatric Dentistry. 2012;34:231-238.
5. Luce EB, McNeill RG, Yu DH, et al. Report to the Texas Sunset Advisory
Commission: Blue Ribbon Panel on Dental Sedation/Anesthesia Safety of the
Texas State Board of Dental Examiners. GetResponse website. https://multimedia.
42463108.1483979633. Published Jan 4, 2017. Accessed August 3, 2017.
6. Pediatric Anesthesia Study, Dental Board of California. Dec. 2016: 56.
JOHN R. AYRE JR.,
DDS, is a board-certified
practicing at Woods
Dental Group and
Orthodontics, a practice
supported by Pacific
Dental Services in
Conroe, Texas. He
graduated from Loma
Linda University School
of Dentistry and
completed his pediatric
residency at Lutheran
Medical Center in
Brooklyn, New York. He
has been practicing
dentistry since 1999.
Later this year it is anticipated
that Texas and California
will mandate updates to staff
requirements, and monitoring
standards in an effort to
improve the safety of pediatric
dental anesthesia and