Our state legislators have an important opportunity this week to vote on a bill that could save lives and improve patient safety for young children in communities throughout our state. The current laws related to pediatric dental anesthesia are insufficient and must be updated to better protect the safety of children undergoing these procedures. AB 224 (Thurmond) provides that pathway.

The deaths of two Bay Area children in recent years – Caleb Sears and Marvelena Rady – highlighted how delicate pediatric dental anesthesia cases are, and that tragic complications can occur quickly. We owe it to these children to make sure there are appropriately trained anesthesia providers, and adequate monitoring equipment, in the room with them.  Not every complication can be prevented, but there should be basic systems and protections in place to make it as safe as possible.

As devastating as their headlines are, it is even more troubling to know that the regulations guiding anesthesia in dental offices are not on par with those for anesthesia in a medical setting. Why is that? Anesthesia is complex and risky, whether you are lying in a dental chair or lying on an operating table. And yet dental regulations do not yet require a separate second trained anesthesia provider in the room for an oral procedure – the same person is allowed to give anesthesia and conduct surgery at the same time. But both activities require vigilance and meticulous attention to detail and should be done by two separate experts; nowhere else in the medical field would it be allowed for a single person to do both.

Most children require moderate to deep sedation for many procedures that adults would tolerate with minimal or no sedation.  Young children may not understand what is going on or why it needs to be done, they may be scared and not easily reassured, and as a result need more medication than an adult would to cooperate. Even healthy  children can have breathing problems related to the medications and because they don’t have as much reserve as older patients, their oxygen saturation can drop quickly and they will go into cardiorespiratory distress more rapidly than a healthy adult.

Sedation is a continuum and levels can change quickly – monitoring a child requires not only knowledge about the various medications used but also how to recognize a problem early on and be able to respond appropriately and rapidly. That takes knowledge, experience and skill.  Not even the most brilliant dentist or physician can do all of that while also engaged in a surgical procedure.

AB 224 (Thurmond) would now require a second properly trained, dedicated anesthesia provider to be in the room when children are receiving anything more than a minor procedure under minimal sedation.

Physician anesthesiologists are strongly in support of this bill. We know these drugs, we know the challenges of treating pediatric patients and managing unpredictable responses, and we want to help ensure the safest possible outcomes in any scenario involving anesthesia.

We hope to offer some of the lessons and best practices learned in the medical field to help improve safety for procedures in dental offices. Requiring a second qualified anesthesia provider will not impede access to care. But it will certainly help ensure a better system and approach to safety – one with the appropriate level of staffing and monitoring needed to quickly identify and treat life-threatening problems. This will avoid adverse outcomes and save lives. Our children deserve no less.

There have been studies, attempts to gather more data, debate, and discussion. It’s time for our legislators to vote yes on AB 224.