Proposed Changes in Dental Anaesthesia After Tragic Toddler Death

USA: Nearly six years after a heartbreaking incident involving a 2-year-old boy named Zion Gastelum, who tragically lost his life following a visit to a Yuma dentist, state regulators in Arizona are taking steps to implement significant changes in how dentists provide care to their youngest patients.

Zion Gastelum’s visit to a Kool Smiles dental office in December 2017 was meant to address severe cavities. Tragically, he became unresponsive during his recovery from anaesthesia, ultimately passing away four days later. This heartbreaking incident prompted an investigation by the Arizona State Board of Dental Examiners.

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Deviations from Standard Care

The dental board, responsible for licensing and regulating dentists, identified five “deviations from the standard of care” by the dental anaesthesiologist involved in Zion’s care. While both the anaesthesiologist and the treating dentist retained their dental licenses, they were required to undergo continuing education, as documented in dental board records.

Zion’s case was not an isolated incident. One other child under the age of 8 has died after receiving anaesthesia at a dentist’s office in Arizona since 2013, according to information provided by the Arizona dental board. Additionally, four more children have been rushed to the emergency room following anaesthesia during dental procedures, although they survived.

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Rule Changes Under Consideration

In response to these tragic events, the Arizona dental board has undertaken a review of dental rules related to anaesthesia and sedation. Currently, licensed dentists require a permit from the board to administer anaesthesia and sedation.

Proposed rule changes include:

• Dentists with existing permits in anaesthesiology would need to apply for a “paediatric endorsement” to administer anaesthesia or sedation to patients under the age of 8.
• Dentists would undergo evaluation every two years.
• Dentists would be required to administer anaesthesia to at least 20 pediatric patients within a two-year period.

The dental board faces a legislative deadline to implement these changes.

Legislative Action

Earlier in the year, Arizona State Senator Janae Shamp sponsored Senate Bill 1602, setting deadlines for the dental board to enact these changes. Shamp, an operating room nurse, expressed deep concern upon learning of patient deaths following dental visits and emphasised the need for action to prevent such tragedies.

The dental board cited a multi-step process required to amend its rules, acknowledging that the COVID-19 pandemic disrupted these efforts shortly after discussions began. Despite the challenges, the Anesthesia and Sedation Committee has now recommended draft rules to the dental board to meet its September 1 legal deadline.

Calls for Stricter Measures

However, some, including attorney Scott Eldridge, who has represented families in dental malpractice cases, believe the proposed rules may not go far enough. Eldridge highlighted the absence of automatic suspension of a dentist’s anaesthesia permit in cases of patient deaths, potentially allowing continued anaesthesia administration during investigations.

The dental board stated that dentists under investigation must be afforded due process. In some instances, voluntary suspensions of anaesthesia permits are negotiated while investigations are ongoing.

Specialized Concerns

Dr Helen Lee, a paediatric anaesthesiologist at the University of Illinois Chicago, has conducted research into paediatric deaths associated with anaesthesia during dental procedures. She stressed about the unique vulnerabilities of young patients, particularly those aged two to five, and the lack of a national tracking system to monitor emergency medical treatment following dental anaesthesia or sedation.

The tragic loss of young patients underscores the need for careful consideration and reform in dental anaesthesia procedures to ensure the safety and well-being of all dental patients, especially children.