The dentist and the anethestist both insist there is 'no risk' in
sedation with Propofol; this cannot be the true. Is there any realistic
information on the actual risk which would allow us to make a more
informed decision?

Hi,

Our paediatric dentist has recommened treatment under sedation for our
22 month old daughter who has chipped her front teeth which now show
some signs of decay. He also wants to fill a molar which he thinks has
some decay. (we follow all the recommended guidelines in caring for her
teeth - he thinks she just has 'weak enamel'? )

The dentist and the anethestist both insist there is 'no risk' in
sedation with Propofol; this cannot be the true. Is there any realistic
information on the actual risk which would allow us to make a more
informed decision?

Thank you.

The dentist and the anethestist both insist there is 'no risk' in
sedation with Propofol; this cannot be the true. Is there any realistic
information on the actual risk which would allow us to make a more
informed decision?



By "risk", I assume you are referring to a significant anaesthetic
complication, such as death or mental/physical impairment as a result of
lack of oxygen to the brain.

There is no such thing as a "no risk" sedation or general anaesthetic. You
are correct in your statement above. However, having said that, this risk
can be very, very, very, very small provided that the individual doing the
sedation/general anaesthetic has the proper training and the facility is
staffed and equipped to the standards as required by state/provincial dental
regulatory bodies.

If I was to say that the chance of such a complication for all children
doing such a procedure was 1 in 10 million, would that address your concern?
Probably not because if you are that 1 person, such odds don't matter.
Quoting odds like this will not make your decision an informed one. You
hear people quoting in textbooks that such a risk is similar to dying in a
plane crash. We all get on planes and simply accept the risk that yes, it
may crash. By the same token, you need to know that sedation or general
anaesthesia does have a very, very, very, very, small riskof a significant
complication. You, as parents, need to determine if:
1. You trust the dentist and anaesthetist and that they have adequate
training.
2. You are comfortable with the facilities and staffing of the location.
3. That the very small risk of a significant complication outweighs the
benefits of having the treatment done for your child, understanding that the
treatment cannot likely be done without the sedation.

The third point is very important. What are the risks to your child's
health if the work is not completed? I have not seen a 22-month old child
who could have such treatment without sedation.

As a medication, propofol is extremely safe, provided it is used by
appropriately trained individuals. By the same token, midazolam,
sevoflurane, or pentathol are all safe. It is not what is used, it is how
it is used and by whom.

J Suljak, DDS, Dip Anaes