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Published Mortality Rates in Dentistry

It is stated on this website that roughly 1 death occurs in every 400,000 cases where anesthesia is used in dental offices. The description below is an explanation of how this number was arrived at.

Numerous studies have been done over the years to determine outpatient anesthesia mortality rates in dentistry. [1-27] The accumulation of these reports shows a death rate of 1 in 348,602 to 1 in 1,733,055 cases depending on which study is looked at [28]. Compilation and analysis of data by various authors in primarily the United Kingdom, Canada, and the United States of America have shown different death rates occurs in dental offices where anesthesia is used. [1-27]

This number is calculated from surveys from 1955 to 2013 which found a total of 295 deaths for an estimated 99,895,402 people given anesthesia in dental offices. [1-27] Various differences in studies occurs depending on if general anesthesia, sedation, and local anesthesia was given and in what setting the procedure occured, such as a hospital or dental office. Further note this data incorporates all possible types of dental procedures.

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Note the study included by Lytle is a comparitive mortality rate which included previous studies over a 20 year period from 1968 to 1987. [9] Therefore, the prior two studies by Lytle [6] and [7] are believed to be included in this.

Of course this does not include all people who were treated with anesthesia in a dental office over this time. Nor does it include all people who died in a dental office during this time or all deaths related to dentistry. Coplans and Curson 1982 determined that a total of 120 total deaths associated with dentistry occured in the study period of 1970-1979 and in 1993 in a 10 year follow up study determined a total of 71 deaths occured associated with dentistry with both studies occuring exclusively in England and Wales. The 1993 study was unable to determine approximately how many total patients were given anesthesia over the 10 year period from 1979-1989 so that figure was not included above. However, they did determine in the 1982 study 56 deaths and in the 1993 study 29 deaths all occured in general dental practices, community dental services, or from hospital outpatients. The other deaths not included out of the total reported were either hospital inpatients or unknown. [8, 25]

The insurance company OMSNIC states on it's website that it insures over 80% of all oral and maxillofacial surgeons in the U.S. [29] OMSNIC examined a total number of 29,975,459 in-office anesthetics (conscious sedation, deep sedation and general anesthesia) which was administered by oral and maxillofacial surgeons and found the ratio of office fatalities/brain damage per anesthetics administered to be 1 out of every 365,534. [24] This data was previously closed [30]. This corresponds to roughly 82 deaths in this study in the roughly 10 year period (2000-2010) explored. A review of the death rate of dental anesthesia using most of the same studies as above, but not including the data from [24] found 218 deaths out of 71,435,282 patients with a mortality rate of 1 in every 327,684 [27].

The two studies by Coplans and Curson showed a decrease in dental deaths after the 1970s so one could argue that the data prior to to the 1990s should be removed. If one were to throw out the studies from Seldin and Recant, Driscoll, Tomlin, Coplans and Curson, and Lytle than roughly 1 death occurs in every 491,143 cases where anesthesia is used in dental offices. However, perhaps a better treatment would be to simply deweight the data prior to the 1990s (as in have that data factor in less to the end result).  If one does not do any deweighting using older data and takes 99,895,402 and divides it by 295, this means roughly 1 death occurs in every 338,628 cases where anesthesia is used in dental offices. For convenience, and taking into account that the earlier studies may have had a higher death rate than present today, this number has been rounded to 1 death in every 400,000 cases where anesthesia is used in dental offices.

Further note the actual numbers classified as a dental death in some of these studies is somewhat debatable and some practitioners massage and tweak the data by altering these numbers slightly. [1-27] Also note that [27] uses a study from Pakistan [31] and may have included a typo in their analysis (see http://blog.teethremoval.com/continuing-to-assess-the-death-rate-of-dental-treatment/ for more details). If one removes this study from their analysis they have a death rate of 1 out of every 330,560.

Refer back to the to the death from wisdom teeth removal page and dental deaths page for individual case reports and descriptions.

Updated Dec. 22, 2017

References
1. Seldin HM and Recant BS. The safety of anesthesia in the dental office. J Oral Surg. vol. 13. pages 199-208. 1955.
2. Seldin HM. Survey of anaesthetic fatalities in oral surgery and a review of the etiological factors in anaesthetic deaths. J Am Dent Soc Anaesthesiol. vol. 5, pp. 5- 12, 1958.
3. Driscoll EJ. Anesthesia morbidity and mortality in oral surgery. In: Trieger N., ed. Anesthesia for the ambulatory patient. American Society of Oral Surgery 48th annual meeting premeeting conference. pages 48-54. 1966.
4. Driscoll EJ. A.S.O.S. Anesthesia morbidity and mortality survey. J Oral Surg. vol. 32. pages 733-738. 1974.
5. Tomlin PJ. Death in outpatient dental anaesthesic practice. Anaesthesia. vol. 29. pages 551-70. 1974.
6. Lytle JJ. Anaesthesia morbidity and mortality survey of the Southern California Society of Oral Surgeons. J Oral Surg. vol. 32, pp. 739-44, 1974.
7. Lytle JJ, Yoon C. 1978 anaesthesia morbidity and mortality survey: Southern California Society of Oral and Maxillofacial Surgeons. J Oral Surg. vol. 38, pp. 814-819, 1980.
8. Coplans MP, Curson I. Deaths associated with dentistry. Br Dent J. vol. 153. pages 357-361. 1982
9. Lytle JJ, Stamper EP. 1988 Anesthesia survey of the Southern California Society of Oral and MaxillofaciaI Surgeons. J Oral MaxiIIofac Surg. vol. 47 pages 834-842. 1989.
10. Edward M. D'Eramo. Morbidity and Mortality With Outpatient Anesthesia: The Massachusetts Experience. J Oral Maxillofac Surg. 1992. 50. page 700-704.
11. William G. Flick and et. al. Illinois Dental Anesthesia and Sedation Survey for 1996. Anesth Prog. 1998. 45. pages 51-56.
12. Peter J. Nkansha. and et. al. Mortality Incidence in Outpatient Anesthesia For Dentistry in Ontario. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997. 83. pages 646-651.
13. Hunter MJ, Molinaro AM. Morbidity and mortality with outpatient anaesthesia: the experience of a residency training program. J Oral Maxillofac Surg. vol. 55, pp. 684-687, 1997.
14. Edward M. D'Eramo. Mortality and Morbidity With Outpatient Anesthesia: The Massachusetts Experience. J Oral Maxillofac Surg. 1999. 57. page 531-536.
15. Alan E. Deegan. Anesthesia Morbidity and Mortality, 1988-1999: Claims Statistics From AAOMS National Insurance Company. Anesth Prog. 2001. 48. pages 89-92.
16. David H. Perrott and et. al. Office-Based Ambulatory Anesthesia: Outcomes of Clinical Practice of Oral and Maxillofacial Surgeons. J Oral Maxillofac Surg. 2003. 61. pages 983-995.
17. Edward M. D'Eramo and et. al. J Oral Maxillofac Surg. Adverse Events with Outpatient Anesthesia In Massachusetts. 2003. vol 61. pages 793-800.
18. Lee JY, Roberts MW. Mortality risks associated with paediatric dental care using general anaesthesia in a hospital setting. J Clin Paediatr Dent. vol. 27, pp. 381-383, 2003.
19. Steven F. Rodgers. Safety of Intravenous Sedation Administered by the Operating Oral Surgeon: The First 7 Years of Office Practice. J Oral Maxillofac Surg. vol. 63. pages 1478-1483. 2005.
20. William G. Flick and et. al. Illinois Dental Anesthesia and Sedation Survey for 2006. Anesth Prog. 2007. 54. pages 52-58.
21. Edward M. D'Eramo and et. al. Anesthesia Morbidity and Mortality Experience Among Massachusetts Oral and Maxillofacial Surgeons. J Oral Maxillofac Surg. 2008. 66. pages 2421-2433.
22. Braidy HF, Singh P, Ziccardi VB. Safety of deep sedation in an urban oral and maxillofacial surgery training program. J Oral Maxillofac Surg. vol. 69, pp. 2112-2119, 2011.
23. Steven F. Rodgers and Matthew S. Rodgers. Safety of Intravenous Sedation Administered by the Operating Oral Surgeon: The Second 7 Years of Office Practice. J Oral Maxillofac Surg. vol. 69. pages 2525-2529. 2011 23. 24. AAOMS. Office-Based Anesthesia Provided by the Oral and Maxillofacial Surgeon. White Paper. 2013.
25. Coplans MP, Curson I. Deaths associated with dentistry and dental disease 19801989. Anaesthesia. vol. 48. issue 5. pages 435-438. 1993.
26. Harry M. Seldin. Survey of Anesthetic Fatalities in Oral Surgery and a Review of the Etiological Factors in Anesthetic Deaths. J Am Dent Soc Anesthesiol. vol. 5. issue 2. pages 512. 1958.
27. H. Mortazavi, M. Baharvand, and Y. Safi. Death Rate of Dental Anaesthesia. Journal of Clinical and Diagnostic Research, Jun, Vol-11(6): ZE07-ZE09 2017.
28. N. G. Reuter, P. M. Westage, M. Ingram, and C. S. Miller, Death related to dental treatment: a systematic review, Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, vol. 123, iss. 2, pp. 194-204. e10, Feb. 2017.
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4019200.pdf
29. OMSNIC. https://www.dds4dds.com
30. Larry J. Moore. In My View: AAOMS anesthesia study benefits entire specialty. AAOMS Today. March/April 2011. vol. 9. issue 2.
31. Qiam F, Khan M, Mehbood B, Un Din Q. Assessing the mortality rate of patients in a maxillofacial surgical unit. JKCD. vol. 3, pp. 2-6 2012.

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