Adverse outcomes associated with pediatric dental sedation: Claims data analysis, 2014-2019

High-risk medications are used commonly in pediatric dentistry. Yet evidence on medication safety is focused on medical clinics and hospitals, with limited research on dental settings. The authors aimed to assess adverse outcomes associated with pediatric dental sedation.

The authors analyzed MarketScan data for patients younger than 18 years who underwent dental sedation from 2014 through 2019. Composite outcomes included emergency department or urgent care visits and hospitalization within 7 days of sedation. Attributable outcomes included sedation-related adverse outcomes. Multivariable generalized estimating equations modeled the association between characteristics and outcomes.

Four percent of all sedations were associated with a composite outcome. Children aged 12 through 17 years (odds ratio [OR], 2.42) and from 6 through 11 years (OR, 1.75) and children with noncomplex chronic conditions (OR, 2.28), complex chronic conditions (OR, 1.87), Medicaid coverage (OR, 1.88), and prior medical visits (OR, 7.60) were more likely to experience a composite outcome; 0.18% of all sedations were associated with a sedation-related adverse outcome. Children with Medicaid coverage (OR, 1.49) and those with complex chronic conditions (OR, 2.54) were more likely to experience a sedation-related outcome. Sedations in hospital or ambulatory surgery settings were nearly 3 times more likely than those in outpatient clinics settings to be associated with a sedation-related outcome (OR, 2.55).

For every 27 dental sedation visits, 1 is associated with an adverse outcome. Targeted risk-mitigation strategies are necessary to enhance patient safety among high-risk populations.

Improving the safety of pediatric dental sedation requires thorough presedation assessment, vigilant patient monitoring, ongoing provider training, and adherence to clinical guidelines.