Is It Dangerous?
All professionals in their interactions/interviews with patients/clients, have to prepare for “The Question“. The Question is a question that when answered correctly, removes barriers to your services. In general dentistry, it’s “How much will it cost?”; in endodontics, it’s “How much will it hurt?”; in teaching, it’s “Will this be on the test?”; and so on. In dental anaesthesia, the question from patients and other dentists is “Is it dangerous?” That’s a fair and intuitive question; my answer is “no”. Let me explain why via analogy.
I recently tore through the book Outliers by Malcolm Gladwell. I was fascinated by all of the sections of the book for different reasons. One of the chapters, of relevance here, is entitled, “The Ethnic Theory of Plane Crashes”. This chapter spoke to me because there were some well-worn analogies between flying a jet airliner and anaesthesia. The first was that both are commonly described as dividing into 99% boredom and 1% sheer terror; the second was that the times for trouble are during take-off (or during the induction of sedation/anaesthesia) and during landing (or at the end of a sedation/anaesthesia appointment). The third similarity was that success depends on good team coordination. After my read, I thought about more parallels.
The safety rates of air travel and anaesthesia are not that far off. Air Canada lists its fatal event rate as 0.33 per million flights (an estimated 4.75 million flights since 1970).1 The “loss” rate for United Airlines from 1988 to 1998 was 0.27 per million departures.2 So air travel isn’t perfectly safe, but also it isn’t dangerous enough to have to think really hard about whether or not to fly. In dental anaesthesia, published mortality rates range from 0.58 per million cases to 1.4 per million cases.3,4
Further, when they happen, plane crashes are often the result of human error or, more specifically, a series of minor human errors and conditions that individually would not amount to anything, but when combined, can add up to disaster. The same is true of anaesthetic mishaps.
In Outliers, the crash of Korean Air flight 801 in Guam in 1997 is reviewed. Gladwell notes some common factors to plane crashes including poor weather, pilot fatigue, pilot and co-pilot unfamiliarity with each other, and being behind schedule – then the mistakes start. Sounds familiar.
Dental anaesthesia is a needed and undersupplied treatment modality. The existence of dental anxiety and dental phobia in the population is easily demonstrated in the scientific literature. I recently did an Ovid Medline inquiry on the topic and turned up no less than 133 articles (in English) over the last 14 years. For a variety of reasons, a significant portion of our population is not able to receive dental care while awake. And if they can’t have “sleep dentistry”, then they won’t have dentistry at all. Sedation/anaesthesia for dentistry is safe, but not perfectly safe, even when done correctly. Actually, the same is true about dentistry in general (e.g. antibiotic allergies, local anaesthetic toxicity, etc.).
So I suppose my “no” to the danger question needs a qualifier. And that is, that dentistry (including anaesthesia) isn’t dangerous when performed carefully and to the standard of care. To you, my colleague, I will say that, sadly, morbidity and mortality statistics for dentistry will never be zero, as humans are mortal and human error is not subject to extinction. However, take heart that harmful outcomes should continue to be rare events, just as shark attacks (0.09 deaths per million) and death by lightning strikes (0.11 per million) are, if we continue to carefully do our best.5,6
1. www.airsafe.com. Accessed May 3, 2010.
2. Gladwell, M. Outliers: the story of success. First ed., 177-223, 2008.
3. D’Eramo, EM, WJ Bontempi and JB Howard. Anesthesia Morbidity and Mortality Experience Among Massachusetts Oral and Maxillofacial Surgeons. Journal of Oral and Maxillofacial Surgery, 66:2421-2433, 2008.
4. Nkansah, PJ, DA Haas and MA Saso. Mortality incidence in outpatient anesthesia for dentistry in Ontario. Oral Surgery Oral Medicine Oral Pathology Oral Radiology & Endodontics. 83(6):646-51, 1997 Jun.
5. http://news.nationalgeographic.com/news/2005/06/0613_ 050613_sharkfacts.html. Accessed December 26, 2010.
6. Mills B, D Unrau, C Parkinson, B Jones, J Yessis and K Spring. Striking Back: An Assessment of Lightning-related Fatality and Injury Risk in Canada. From www.sirc.ca/online_resources/documents/Lightning-relatedinjuriesandfatalitiesinCanada_FINAL-TECHNICAL_1-September-06.pdf. Accessed December 26, 2010.