After the recent tragic death of a child in Southern California after having dental surgery done under general anesthesia, I thought it would be beneficial to discuss the risks and safety measures that should be considered in pediatric dentistry. Dental treatment for children often brings a unique set of challenges. Whether it’s a fear of the dentist, difficulty staying still, or extensive decay requiring complex work, dentists may recommend sedation or general anesthesia to safely and effectively treat young patients. While this can be a highly successful approach, it also comes with inherent risks that every provider and parent must understand. In light of the recent tragic events involving pediatric dental anesthesia, it’s more important than ever to re-examine the protocols, assessments, and safety measures involved in treating children under sedation.
Why Dental Anesthesia is Used for Children
Anesthesia in pediatric dentistry is most commonly used when a child:
- Requires extensive dental work
- Has special healthcare needs
- Experiences extreme dental anxiety
- Is too young or uncooperative to tolerate treatment while awake
Depending on the child’s health and the complexity of the procedure, different types of anesthesia may be used. Anesthesia from nitrous oxide (“laughing gas”) for minimal sedation to general anesthesia in a hospital or surgery center setting are potential methods for handling complex cases in children.
Understanding the Risks
While most pediatric dental procedures under anesthesia are completed safely, the use of anesthesia in children is not without risk. Adverse outcomes are rare, but when they occur, they can be devastating.
The most serious risks include:
- Respiratory complications – Children are more prone to airway obstruction, laryngeal spasm, and hypoventilation due to their smaller airways and higher oxygen demand.
- Cardiovascular events – Changes in heart rate or blood pressure can occur under anesthesia, especially if a child has an underlying condition.
- Medication reactions – Children may have undiagnosed allergies or sensitivities to anesthetic agents.
- Post-operative complications – Nausea, vomiting, prolonged drowsiness, or in rare cases, life-threatening conditions like methemoglobinemia, a disorder affecting the blood’s ability to carry oxygen.
May 2025, a widely publicized case involved a 9-year-old girl who passed away from methemoglobinemia after a routine dental procedure under general anesthesia. The case has sparked renewed attention on how pediatric dental anesthesia is administered and monitored.
The Importance of a Thorough Pre-Procedure Assessment
A safe anesthesia experience begins long before the child ever enters the treatment room.
A comprehensive pre-procedure evaluation is essential and should include:
- Medical history review – All health conditions, previous surgeries, medications, and allergies must be disclosed. Even minor respiratory issues like asthma can affect anesthesia decisions.
- Physical examination – The child’s airway, heart, and lungs should be assessed by a qualified provider, ideally an anesthesiologist or trained dental anesthetist.
- ASA classification – Children should be classified according to the American Society of Anesthesiologists (ASA) physical status scale. Only ASA I and II patients (generally healthy children or those with mild conditions) are appropriate candidates for office-based sedation.
- Parental consultation – Parents should be fully informed about the procedure, type of anesthesia being used, and potential risks and benefits. They must know what to expect before, during, and after the appointment.
Protocols That Protect
Once the child has been cleared for anesthesia, strict adherence to safety protocols is non-negotiable.
These include:
- Use of credentialed professionals – Only licensed and trained providers should administer anesthesia. For general anesthesia, a board-certified anesthesiologist or dental anesthesiologist should be present throughout the procedure.
- Monitoring equipment – During treatment, the child’s oxygen saturation, heart rate, blood pressure, and respiratory rate should be continuously monitored using up-to-date equipment.
- Emergency preparedness – Staff should be trained in pediatric Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS). Emergency equipment, including oxygen, reversal agents, and a defibrillator, must be readily accessible.
- Post-operative observation – Children should be monitored until they are fully alert and stable. Discharge should only occur when vital signs are normal and the child can maintain airway control and hydration.
What Parents Should Know and Ask
Parents have a crucial role in ensuring their child’s safety.
Before consenting to anesthesia, they should ask the following:
- Who will be administering the anesthesia and what are their qualifications?
- What type of monitoring will be used?
- What emergency equipment is on site?
- How will my child be observed after the procedure?
- What symptoms should I watch for once we’re home?
If a provider cannot clearly answer these questions or lacks emergency resources, it’s a red flag. Choosing the right team and facility makes all the difference in a safe outcome.
A Culture of Caution and Communication
The goal of using anesthesia in pediatric dentistry is always to create a safe, pain-free environment for care. But that goal must be balanced with vigilance. Dentists, team members, parents, and regulatory bodies all share a responsibility to uphold the highest standards of safety.
By emphasizing thorough assessments, qualified providers, constant monitoring, and open communication, the dental community can help ensure that every child returns home safely, with a healthier smile and without harm.
Sherri Merritt
Dental Consultant & Trainer
