First and foremost, at the American Academy of Pediatric Dentistry (AAPD), the health, safety, and welfare of children are our top priorities, and our deepest sympathies are with the families who have tragically lost a child because of an accidental sedation or anesthesia incident.
We recognize that the goal of the "Sunday Night with Megyn Kelly" July 9 TV segment, "Children at Risk? Kids and Sedation at the Dentist’s Office" was to protect our nation's children, and we strongly support that, since it aligns with our mission as well. However, we believe a significant opportunity was missed to emphasize the critical importance of early preventive care to ensure the very best health and well-being of our children.
James Nickman, DDS, is the president of the American Academy of Pediatric Dentistry.Childhood tooth decay is nearly 100% preventable. The AAPD and pediatric dentists work tirelessly to drive awareness about the vital importance of early oral care. The academy has extensive resources for parents and caregivers on our website, covering topics from prevention to sedation. Additionally, AAPD has published the State of Little Teeth Report that explores the key issues related to the oral health of our children. We know that arming parents and caregivers with information is one of the best ways to reduce the chances of being faced with a decision of whether or not to place their child under anesthesia.
However, there are instances when treatment under deep sedation/general anesthesia may be required -- but it is never "routine." It is discussed with parents and caregivers as a treatment option only when necessary. Additionally, parents and caregivers should know that they have rights when it comes to their children's oral health (and medical) care. The AAPD recommends parents get a second opinion from a pediatric dental specialist when discussing any oral procedure or surgery, and ask questions until they have no more.
We would like to emphasize the following:
- The joint sedation guidelines of the AAPD and the American Academy of Pediatrics are focused on the best science for child safety, and, if followed, significantly reduce any possible risk of harm.
- Pediatric dentists focus on prevention and early intervention via an age 1 visit/establishment of a dental home.
- Procedures done under deep sedation/general anesthesia are usually because of severe early childhood caries and an inability to treat a child absent of such setting.
- Providing dental care under deep sedation/general anesthesia is more costly for third-party insurers, including public programs such as Medicaid, not because of the dental services, but because of the costs for the anesthesiologist and the facility, particularly if a hospital or ambulatory surgery center is required because of the child's health status or severity of dental conditions.
- Treatment under deep sedation/general anesthesia is never "routine." It is discussed with parents as a treatment option only when necessary.
- It is far more comfortable, affordable, and convenient for families when a pediatric dentist is able to provide basic care in a dental office than to perform dental surgery in a hospital emergency room or ambulatory surgery center, or to bring in an anesthesiologist to the dental office.
The AAPD is dedicated to improving the oral health of the U.S.'s children and for decades have made advocacy for children our primary mission. For us, it is all about the kids. Our resources have been devoted to supporting early preventive dentistry by all health providers, optimal use of fluoride, advancing the science of dentistry, supporting government programs that increase access to care, and improving access to specialty services by training more pediatric dentists. All of these strategic initiatives are aimed at disease reduction and improved oral health, and, coincidently, reduced need for our services.
James Nickman, DDS, is the president of the American Academy of Pediatric Dentistry. He is in private practice at Metropolitan Pediatric Dental Associates in North Oaks, MN.
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