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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 calculated.

Numerous studies have been done over the years to determine outpatient anesthesia mortality rates in dentistry. Statistics range from 1 death in every 162,000 cases [1] to 1 in every 1.733 million cases [16], where anesthesia is used in dental offices, depending on which study is looked at. In some studies no deaths occur and for obvious reasons is not included as an upper bound. Compilation and analysis of data by various authors in the United Kingdom, Canada, and the United States seems to indicate that death occurs in dental offices where anesthesia is used somewhere in the range of 1 death in every 229,730 cases to 1 death in every 835,000 cases. [1-16, 21-23]

Note this does not fully include all dental surgeries such as the ones that occur in a hospital setting. In some cases this figure includes general anesthesia, sedation, and local anesthesia that was given. In other cases local anesthesia and/or sedation may be omited from the number. Emphasis was made to filter out dentistry procedures that occured in a hospital. Further note this data incorporates all possible types of dental procedures. This number is calculated from surveys from 1955 to 2013 which found a total of 239 deaths for an estimated 91,904,867 people given anesthesia in dental offices. [1-16, 21-23]

death rates dentistry.

Note the study included by Lytle is a comparitive mortality rate which included previous studies over a 20 year period from 1968 to 1987. [6]

Of course this does not include all people who were treated with anesthesia in a dental office over this time. [1-18] 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. [5, 16]

The insurance company OMSNIC states on it's website that it insures over 80% of all oral and maxillofacial surgeons in the U.S. [19] 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. [23] This data was previously closed [20]. This corresponds to roughly 82 deaths in this study in the roughly 10 year period (2000-2010) explored.

If one takes 61,929,408 and divides it by 157 (not including the OMSNIC data in [23]), this means roughly 1 death occurs in every 400,000 cases where anesthesia is used in dental offices. In addition, 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 1980s should be removed. If one were to throw out the studies from Seldin and Recant, Driscoll, Tomlin, and Coplans and Curson, than roughly 1 death occurs in every 737,000 cases where anesthesia is used in dental offices. However, perhaps a better treatment would be to simply deweight the data prior to the 1980s (as in have that data factor in less to the end result) perhaps by multiplying the deaths that occured in that period by a factor of 0.55. If this is done than roughly 1 death occurs in every 450,000 cases where anesthesia is used in dental offices. [1-16, 21-23] If one does not do any deweighting using older data and takes 91,904,867 and divides it by 239, this means roughly 1 death occurs in every 385,000 cases where anesthesia is used in dental offices. For convenience 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. [1-16, 21-23]

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

Updated October 26, 2013

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. 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.
3. Driscoll EJ. A.S.O.S. Anesthesia morbidity and mortality survey. J Oral Surg. vol. 32. pages 733-738. 1974.
4. Tomlin PJ. Death in outpatient dental anaesthesic practice. Anaesthesia. vol. 29. pages 551-70. 1974.
5. Coplans MP, Curson I. Deaths associated with dentistry. Br Dent J. vol. 153. pages 357-361. 1982
6. 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.
7. Edward M. D'Eramo. Morbidity and Mortality With Outpatient Anesthesia: The Massachusetts Experience. J Oral Maxillofac Surg. 1992. 50. page 700-704.
8. William G. Flick and et. al. Illinois Dental Anesthesia and Sedation Survey for 1996. Anesth Prog. 1998. 45. pages 51-56.
9. 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.
10. Edward M. D'Eramo. Mortality and Morbidity With Outpatient Anesthesia: The Massachusetts Experience. J Oral Maxillofac Surg. 1999. 57. page 531-536.
11. Alan E. Deegan. Anesthesia Morbidity and Mortality, 1988-1999: Claims Statistics From AAOMS National Insurance Company. Anesth Prog. 2001. 48. pages 89-92.
12. 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.
13. Edward M. D'Eramo and et. al. J Oral Maxillofac Surg. Adverse Events with Outpatient Anesthesia In Massachusetts. 2003. vol 61. pages 793-800.
14. William G. Flick and et. al. Illinois Dental Anesthesia and Sedation Survey for 2006. Anesth Prog. 2007. 54. pages 52-58.
15. 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.
16. Coplans MP, Curson I. Deaths associated with dentistry and dental disease 1980–1989. Anaesthesia. vol. 48. issue 5. pages 435-438. 1993.
17. 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 5–12. 1958.
18. A Conscious Decision: A review of the use of general anaesthesia and conscious sedation in primary dental care. London. Department of Health. July 2000. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4019200.pdf
19. OMSNIC. https://www.dds4dds.com
20. Larry J. Moore. In My View: AAOMS anesthesia study benefits entire specialty. AAOMS Today. March/April 2011. vol. 9. issue 2.
21. 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.
22. 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. AAOMS. Office-Based Anesthesia Provided by the Oral and Maxillofacial Surgeon. White Paper. 2013. http://www.aaoms.org/docs/papers/advocacy_office_based_anesthesia.pdf

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