How Safe is General Anesthesia During Dental Procedures on Young Children?

How safe is general anesthesia in dental procedures for children?

When three-year-old Finley Boyle’s parents took her to the dentist last December, they expected to be returning home with her later that day – a bit tired and in some discomfort perhaps, but alive and well.

According to court documents, Finley was undergoing four root canals in early December at Island Dentistry for Children in Hawaii when something went terribly wrong.  The parents have filed suit against Island Dentistry and dentist Dr. Lilly Geyer for negligence and dangerous conduct.

It appears that a combination of 5 sedatives and anesthetic drugs were administered by the clinic.  The suit alleges that the staff acted negligently by leaving the child unattended for 26 minutes after being sedated.  When she was discovered not breathing, according to KITV News, the dentist had to locate a Pediatrician to try to revive the child.  Finley was taken to a hospital and later, a hospice center, where she was put on a feeding tube.

Sadly, Finley’s story didn’t end well.  Her parents made the agonizing decision to have the tubes removed, after an MRI showed she was ‘brain dead’.

According to CNN, Finley was first seen at Island Dentistry in November.  Finley’s mother was told that her daughter had 10 cavities and needed 4 root canals.

Right now, there are many more questions than answers:

• Why did a three-year old have so many cavities?  According to news reports, she had not been to a dentist prior to the November visit.
• Why did the mother, a Registered Nurse who worked at Castle Medical Center in Kailua, not seek a second opinion before agreeing to the procedure?
• Why did the dental office plan to do all four root canals at the same time?
• Is it true, as reported, that the procedures were actually unnecessary?
• Why, if the reports are true, was the child left alone for 26 minutes?

Most of these questions will be answered during the investigation.  For now, let’s look at some questions surrounding your child’s oral health which can be answered:

When should my child first visit the dentist?

When your child’s first tooth arrives, it’s time to visit the pediatric dentist. Infants should regularly have gums gently wiped with a soft cloth.  Your Pediatric Dentist can evaluate your baby’s gums and jaw during that all-important first visit.  Any potential problems can be addressed very early – almost always before a cavity forms.  Studies have shown that parents who take babies to see a Pediatric Dentist at the eruption of the first tooth save an average of 40% on dental visits by being proactive.

Can young children get cavities?

Certainly.  The bacteria which cause cavities, Streptococcus Mutans, can be transmitted from mother to baby (see our blog https://www.caringtreechildrensdentistry.com/spit-out-that-pacifier/ ).  Even very small children can develop cavities.  Good oral health begins in utero – and the overall health of the mother is paramount.  Other causes of cavities in young children include dipping pacifiers in sweet substances and giving bottles for extended periods which contain milk or juice.

Is it appropriate to use sedation on young children?

When a child needs treatment, and cannot sit in a dental chair or cooperate for treatment, sedation can be an appropriate option.  There are different categories of sedation for these patients, from mild sedatives, (the least invasive of these being nitrous oxide, or ‘laughing gas’) to a more powerful oral sedation.  If your child has unusual anxiety, a physical limitation that makes sitting for long periods uncomfortable, or developmental issues, your Pediatric Dentist can discuss the options with you and make recommendations.  Of course, the goal is always to provide the safest, most pain-free treatment for your child.

Are root canals performed on toddlers?

A procedure called a ‘pulpotomy’ may be performed on a small child when decay has penetrated into the nerve of the child’s tooth. It is done to prevent premature tooth loss when a child is several years away from naturally losing her teeth and to prevent infection, which could become life-threatening.  The reason we hope to prevent premature tooth loss is that it can alter the bone growth and create a situation where the permanent teeth cannot erupt properly.  These are done as a ‘last resort’, because they are a more invasive procedure, although they most often require only a local anesthetic. 

What if my child needs anesthesia?

Local anesthesia is simply ‘numbing’ the area so your child feels no discomfort, but is awake. General anesthesia is the procedure by which your child will be given a medicine to put her into a deep sleep – an unconscious state.  There are instances where general anesthesia is the best option.  In these cases, the anesthesia is the same as that used in tonsillectomies or other surgeries and must be performed in a hospital.  There are always inherent risks where general anesthesia is used, and although they represent a small percentage of patients, cases are carefully screened to ensure the best outcome for your child.  A thorough medical examination and often additional blood work is used to screen for potential issues. The risks and benefits should be discussed completely with the parents, so they can make an informed decision.  You may feel more at ease to know that the risk of a serious reaction to general anesthesia in toddlers is less than the risk to the child from riding in your car.

Does the American Academy of Pediatric Dentists approve of sedation or anesthesia in young children?

According to the AAPD ‘Policy on the Use of Deep Sedation and General Anesthesia in the Pediatric Dental Office’, updated in 2012, ‘as an advocate for oral health in infants, children, adolescents and persons with special health care needs, recognizes that there exists a patient population for whom routine dental care using non-pharmacologic behavior guidance techniques is not a viable approach.  It also recognizes that a population of patients, because of their need for extensive treatment, acute situational anxiety, uncooperative age-appropriate behavior, immature cognitive functioning, disabilities or medical conditions, would benefit from deep sedation or general anesthesia.’

What about getting a second opinion for my child?

Any time a major procedure is recommended for your child which involves powerful sedation or general anesthesia, it is a good idea to get a second, independent opinion from a specialist.  Not having necessary work done can present even greater danger than that of general anesthesia, but you want to be assured that the procedure is, in fact, the best option for your child. How safe is general anesthesia in dental procedures for children? It’s important to weigh the risks vs benefits to your child with your child’s Pediatric Dentist.

At Caring Tree Children’s Dentistry, all procedures needing general anesthesia are done at Sierra Nevada Memorial Hospital, where Dr. Kucera is on staff.  If your child needs general anesthesia, you can rest assured that she is in the best possible hands. Dr. Kucera and her staff are trained in emergency procedures in the unlikely event an adverse reaction should occur.