Vital Times 2019 - 85

CSA contacted and deployed joint AAP-AAPD guideline
authors Charles Cote, MD, and Steven Wilson, DMD, to
assist in our lobbying efforts on why a separate dedicated
and independent anesthesia provider is needed in a dental
office to safely provide deep sedation or general anesthesia.
Dr. Coté gave generously of his time and expertise by flying
to Sacramento several times to testify and meet with key
legislators at the State Capitol.
As a result, Dr. Coté contacted his co-author Steven Wilson,
DMD, and with approval from the AAP set about writing
an addendum that explicitly recommends having a separate
dedicated and adequately trained anesthesia provider (such
as physician anesthesiologists, dentist anesthesiologists,
CRNAs, Certified Anesthesiology Assistants, sedation
trained physician, or dentists etc.) administering and
monitoring the anesthesia or sedation for a child in dental
practices. That resulted in the publication this summer of:
* Guidelines for Monitoring and Management
of Pediatric Patients Before, During, and
After Sedationfor Diagnostic and Therapeutic
Procedures. Coté CJ, Wilson S; American Academy
Of Pediatrics; American Academy Of Pediatric
Dentistry.Pediatrics. 2019 Jun;143(6).
The outrage related to unnecessary dental sedation
deaths has led to many articles in the anesthesiology,
pediatric, and pediatric dentistry literature as well as
mainstream media questioning these practices:
*

The Single-Clinician-Operator/Anesthetist Model
for Dental Deep Sedation/Anesthesia: A Major
Safety Issue for Children. Coté CJ, Brown RE Jr,
Kaplan A.JAMA Pediatr. 2019 Oct 28.
Concerns Regarding the Single Operator Model of
Sedation in Young Children. Agarwal R, Kaplan A,
Brown R, Coté CJ. Pediatrics. 2018 Apr;141(4).
Ethics Rounds: Death After Pediatric Dental
Anesthesia: An Avoidable Tragedy? Lee H et al.
Pediatrics. (2017)
Office-Based Anesthesia: Safety and Outcomes in
Pediatric Dental Patients. Spera AL et al. Anesth
Prog. (Fall)
Should Kids Be Sedated for Dental Work, New York
Times 2017 Aug 24. Should kids be sedated?

*
*

Governor Signs Finley's Law in Hawaii Hawaii
News Now 2017 July 10
Increased interest nationally from physician
anesthesia advocates in other states (Pennsylvania,
Wisconsin, Texas).
Advocacy workshops focusing on Dental
Anesthesia and Caleb's Law around the country.
New information for parents at Healthy Children
https://www.healthychildren.org/English/healthyliving/oral-health/Pages/Anesthesia-or-Sedationfor-Your-Childs-Dental-Work.aspx

Both the AAP and the CSA continue to make safer
dental anesthesia a priority. The ASA and the Society
for Pediatrics Anesthesia are joining the fray to help
with national initiatives. There is a growing coalition of
interested organizations who will continue this fight.
There have been social media campaigns to improve
knowledge about the differences between dental
sedation practices and medical sedation practices.
A coalition representing Pediatric Dentistry, Pediatrics,
Anesthesiology, Dentist Anesthesiologist and Dr. Kaplan,
presented the tool used by the Pediatric Sedation Research
Consortium to the Dental Board of California. This tool is a
simple, easy to use, inexpensive, and objective way to gather
data. Unfortunately, the DBC did not adopt this tool.

What Else Can We Do?
There is still a lot that is unknown and some of the deaths
in children are not easily explained. Gathering high-quality
data regarding all sedation events could really make a
difference in determining best practices. We must continue
to encourage the DBC to adopt the data tool used by the
Pediatric Sedation Research Consortium, or work with
them if they choose to develop their own tool. There is not
a Dental Anesthesia Incident Reporting System in place.,
created by the new OMS Quality Outcomes Registry as part
of the AAOMS . We applaud the AAOMS for taking this
seriously but must continue to make sure all incidents get
reported and analyzed.

Annual Publication 2019 | 85

https://www.healthychildren.org/English/healthy-living/oral-health/Pages/Anesthesia-or-Sedation-for-Your-Childs-Dental-Work.aspx https://www.healthychildren.org/English/healthy-living/oral-health/Pages/Anesthesia-or-Sedation-for-Your-Childs-Dental-Work.aspx https://www.healthychildren.org/English/healthy-living/oral-health/Pages/Anesthesia-or-Sedation-for-Your-Childs-Dental-Work.aspx

Vital Times 2019

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