I have been afraid of the dentist for some time. One of my friends suggested that I try a sedation dentist. I was considering it and had even started researching some dentists. Then my sister told me about a woman whose dentist overdosed her with sedation and she died. I think it happened in Idaho. Now I’m starting to wonder if maybe it isn’t safe to do. But, I haven’t been to the dentist in a while and I”m worried my teeth are going to fall apart. Is there a way to make sure it will be safe?
Elle
Dear Elle,
It definitely doesn’t help when you are already anxious about going to the dentist, to hear stories like the one your sister told you. The good news is that dental sedation is very safe. I know you may find that hard to believe after the story you heard. I am familiar with the case your sister told you about. I have a colleague who was called in as an expert witness in this case.
The patient was a 270-pound female with extreme dental anxiety. She was going in to have all her upper teeth removed. She was given 1.0 mg of Triazolam for oral conscious sedation. With oral conscious sedation you take the medicine 30 minutes before your appointment. When she came in she was fine, walked in on her own, and was talking with the dentist and staff normally. Everything changed when she was given a local anesthetic. She went from fine to unresponsive.
The dental board alleged that the dentist gave her too much Triazolam. The justification for that statement was because the typical dose is 0.5 and she was given 1.0. However, that is misleading. Some drugs, like Triazolam, have a wide safety margin. Here is an explanation from the dentist hired as the expert witness, Dr. David Hall.
“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.”
In other words, for that patient, the maximum dose would have been 120,000 mg, not 1.0 mg. The dentist was well within the safety limits. Plus, something I found very suspicious is that the medical examiner did not list a cause of death.
I want to address your other question, though. “Is there a way to make sure it will be safe?” Yes. Dentists who are DOCS certified have more training. DOCS is the Dental Organization for Conscious Sedation. Those would be the dentists who invested extra time in training.
It’s great that you are being proactive about this. The last thing you want is to do is put off treatment and end up with a tooth infection. Then, you’ll need urgent care and wouldn’t get to carefully choose the dentist.
This blog is brought to you by the compassionate Libertyville dentists, Drs. Potts and Mirza.