Vital Times 2017 - 33

Here's the Bottom Line
You can't fix stupid.
If state dental boards persist in allowing their practitioners
- whether dentists or oral surgeons - to give medications
as potentially lethal as fentanyl while they concentrate on
performing procedures, and the practitioners don't know or
won't acknowledge the risks, it's hard to see a way forward to
a legislative solution.
You can't fix greedy.
As long as dentists and oral surgeons - as distinct from every
other surgeon - can legally bill for giving moderate sedation,
deep sedation, or general anesthesia while doing procedures,
then they'll move heaven and earth to maintain that revenue
stream.
Our best bet, in addition to supporting AB 224 with all the
ammunition we can muster, is to keep up a relentless public
campaign for safe dental anesthesia.
Thanks to the efforts and connections of our outstanding
KP public relations team, I've appeared on NBC television,
in an excellent segment called "Children at Risk? Kids and
Sedation at the Dentist's Office." I've been quoted in an awardwinning article in Today.com, "9 questions to ask your dentist
before your kids go under sedation." NBC also taped an online
segment, "What Happens When a Child Stops Breathing?",
about exactly what can go wrong during a pediatric dental
procedure when a child becomes apneic and no one notices
it in time.

Recently, another excellent publication in the November
2017 issue of Pediatrics reviewed a death after moderate
sedation in a dental office. The pediatric dentists, who
wrote commentary on behalf of the American Academy of
Pediatric Dentistry, said unequivocally that the association
between tooth decay in primary teeth and subsequent
decay in permanent teeth has been "vastly overstated".
They recommended "less invasive, less risky procedures"
on baby teeth, including silver diamine fluoride, which can
be painted on any tooth to arrest active caries. Then the
baby tooth eventually falls out, as they pointed out dryly,
"a normal developmental process that requires no professional
intervention."
Above all, we must continue the push to educate parents.
Over and over, we've heard the refrain:
*
*
*

I didn't know there wouldn't be an
anesthesiologist.
I had no idea it could happen.
I thought they knew what they were doing.

When parents know, they can demand that a procedure
be done under safe circumstances, in the right location,
with appropriate personnel and monitoring. It's our job to
continue the work of making sure EVERY parent knows.
Safe anesthesiology care is the right of every child, every
patient, every time.

Rita Agarwal, MD, FAAP, who chairs CSA's Committee
on Professional and Public Communication, and Sam
Wald, MD, MBA, our president-elect, have done more than
their share as well. They collaborated on a comprehensive
article in the November 2017 issue of the ASA Monitor,
called "Improving Anesthesia Safety for Dental Restorations
and Surgery." Dr. Agarwal has also co-authored an excellent
piece for parents on the American Academic of Pediatrics'
website, healthychildren.org, about the risks and benefits of
anesthesia and sedation for dental work in children.

Annual Publication 2017 | 33

http://www.Today.com http://www.healthychildren.org

Table of Contents for the Digital Edition of Vital Times 2017