I have been avoiding the dentist. A friend told me that she used to be afraid of the dentist until she used dental sedation. I was all excited about it. Then, I read this article about a woman who died from dental sedation in Iowa and they said it was the dentist’s fault. Now I’m worried that it wouldn’t be safe. How big are the risks with this? I really need to do something because I’m afraid my teeth are in bad shape and don’t want to lose them.
Lanie
Dear Lanie,
I’m glad you wrote. The first thing I want to tell you is that dental sedation is very safe. If you’re worried, you can take the extra precaution of going through a dentist who is not just DOCS certified, but also a fellow with the organization. DOCS in the Dental Organization for Conscious Sedation. These dentists have extensive training.
I’m familiar with an Iowa case where the dentist was accused of giving the patient double the recommended dose of Triazolam, which they claimed led to her death. A colleague actually gave expert testimony in this case. Here is the problem with their theory. I’m going to quote part of a blog post he wrote about it that sums it up, but you can read the post in it’s entirety here.
“The Iowa Dental Board conducted an investigation and issued a report, which I carefully studied. In the report they alleged that Dr. Byrne had overdosed Beverly on triazolam, saying that he had given her twice the recommended dose. They submitted references stating that a typical dose of triazolam was 0.5 mg, and Dr. Byrne had given her 1.0 mg.
But, to anyone truly knowledgeable in sedation medication, such an assertion is ridiculous. To establish the safety of a medication, using the usual recommended dose is not very helpful because it gives no clue about the safety margin of the drug. Some drugs have a wide safety margin. Triazolam is such a drug. To determine the maximum safe dose, we need to turn to clinical data establishing what is called the LD-50. The LD-50 of a drug is the dose at which 50% of the animals in a clinical trial die. This dose is extremely high for triazolam. Tested on mice, its LD-50 is greater than 1,000 mg/kg (see Halcion data from the FDA). For a 270-pound woman (a little over 120 kg), that would work out to a dose of 120,000 mg. While mice data can’t be extrapolated accurately to humans, it does give us a rough idea of the safety…
While a dose of 0.5 mg would be appropriate for a typical patient, Ms. Mazurenko weighed about double what a typical female patient might weigh, and, besides, she was extremely anxious and had a history of drug abuse. In those circumstances, given the extremely high safety margins with triazolam, it would seem reasonable to me to have given her even much more. Her behavior at the appointment seems to indicate that she was inadequately sedated. She walked into the operatory and for some time conversed with the staff and, by the clinical record, showed no sign of even being sedated.”
I think you will find that dental sedation will change your life for the better. Not only will you be able to catch up with all your old dental work while sleeping, but it will save you from losing your teeth. Believe me, fixing your teeth is much cheaper than replacing your teeth.
This blog is brought to you by Libertyville Dentist Dr. David Potts.