Anesthesia and sedation for dental patients have recently faced scrutiny following notable tragedies, such as the death of six-year-old Caleb in 2015, cardiologist Dr. Henry Patel in 2020, and five media-reported fatalities in 2025. These events underscore the inconsistencies and lack of regulation in dental sedation practices, highlighting an immediate need for reform.
The chief concern is the inconsistency in state regulations. Presently, there is no uniform state or federal oversight, leading to significant variations in regulations. For example, only 36 states mandate pulse oximetry during deep sedation or general anesthesia, 44 states require ongoing education for sedation providers, and 42 states lack preoperative fasting guidelines. Only California and Florida mandate airway evaluations before sedation, and emergency preparedness is inconsistent, with only 23 states detailing the emergency and airway equipment needed in dental practices. These inconsistencies can result in insufficient monitoring and emergency responses, endangering patients.
To tackle these issues, it is imperative for organizations like the American Dental Association (ADA), the American Association of Oral and Maxillofacial Surgeons (AAOMS), and CODA to work together with entities such as the American Society of Anesthesiologists (ASA), the American Academy of Pediatrics (AAP), and the American Society for Patient Safety (APSF) to enhance education and training for dental professionals. This involves increasing knowledge of sedation depth, employing standardized language and definitions like the ASA does, and advocating for uniform patient care standards, irrespective of who administers the anesthesia.
A prevailing model in dentistry is the single-provider/operator-anesthetist model, wherein the dentist or oral surgeon provides anesthesia while performing the procedure. Usually, dental assistants, who may possess only a high school education and on-the-job training, aid them, signaling the necessity for comprehensive training. AAOMS suggests employing two dental assistants for deep sedation or general anesthesia, proposing—but not mandating—that one holds Dental Anesthesia Assistant National Certification Examination (DAANCE) training. This program offers online education and a certification exam but does not include advanced life support training.
Educational prerequisites for healthcare workers in this arena vary. Dental assistants typically require a high school diploma and on-the-job training, while advanced training may encompass online education and certification. Dental hygienists need college-level education and certification, while registered nurses must possess at least an associate degree and pass certifying exams.
Many recent fatalities did not involve the oral surgery anesthesia care team model, and much of the information relies on media reports, creating a gap in understanding the epidemiology of these incidents. Most states do not monitor morbidity and mortality data or gather near-miss data. Robust data collection on adverse events and near misses is crucial. The Dental Anesthesia Incident Reporting System (DAIRS) provides a self-reporting mechanism, but a comprehensive database for dental anesthesia and sedation is imperative for enhancing patient safety.
Incorporating qualified anesthesia providers, such as anesthesiologists or oral maxillofacial surgeons, is essential for improving safety. These professionals offer specialized knowledge that can reduce associated risks. However, the dental lobby resists this approach, citing concerns over costs and accessibility. It is vital to counter such narratives, emphasizing patient safety.
Insurance companies can impact safety by enhancing reimbursement for anesthesia services, encouraging practices to employ qualified providers. Furthermore, federal or state oversight of dental office environments is necessary for enforcing safety standards.
In conclusion, the tragic fatalities associated with dental sedation underscore the urgent need for reform. By fostering collaboration among dental and medical organizations, standardizing practices, and prioritizing patient safety, it is feasible to bridge the gap in dental sedation practices, ensuring the highest care standards for patients. As healthcare providers, a commitment to enhancing patient safety and averting future tragedies is essential.