Recently in Chicago, a pediatric dentist routinely performing dentistry on his child patients suffered the death of a young girl in a sedated state. The situation made national news and is being investigated by all governmental and professional organizations to determine if there were any means that this could have been prevented. In the meantime, our profession has stepped to the forefront in recommending and publishing sedation guidelines. While many of these guidelines seem to be "common sense" and have been published before, the immediate need was to quantify them to everyone in an established form, particularly to the skeptical general public aroused by this particular case. Now, all of dentistry comes under the microscope again to be re-examined. Providing answers to the public before they have asked the questions and to oversight governing bodies demonstrates that our profession continues to act in the best interests of our patients.

The American Academy of Pediatric Dentistry (AAPD), founded in 1947 and headquartered in Chicago, consists of some 6800 members who are primary care providers for comprehensive specialty treatments for infants, children, adolescents, and patients with special health care needs. As advocates of children's oral health care, the AAPD works closely with legislators, professional associations, and health care professionals to develop policies and guidelines, to implement research opportunities in pediatric oral health, and to educate pedodontists, pediatric dentists, all health care providers, and the public regarding pediatric oral health AAPD.org.

A separate organization, the American Academy of Pediatrics (AAP), has some 60,000 members in primary care roles as pediatricians, pediatric medical sub-specialists, and pediatric surgical specialists who are dedicated to the health, safety, and well-being of infants, children, and young adults www.AAP.org.

In a landmark event, these two groups released joint recommendations for all medical and dental practitioners regarding the management and monitoring of pediatric patients during and after sedation procedures. This reinforces a standardized approach to pediatric sedation procedures across the health professions. The guidelines follow definitions of sedation categories and expected physiological responses currently used by the Joint Commission of Accreditation of Healthcare Organizations and by the American Society of Anesthesiologists.

AAPD President Dr. Phil Hunke stated that the AAPD partnership with AAP has provided extensive, updated sedation guidelines in a monumental step toward ensuring that all children who undergo a medical or dental procedure will receive the safest, most effective treatment in practicing in a manner consistent to benefit all patients and the entire pediatric medical community.

The recent trend in outpatient procedures that involve sedation is becoming more common outside of the safety net of the hospital environment. While proper sedation procedures have long been established, a review that included codification and publication of the procedures was felt to be required to assure the profession's compliance on a routine basis.

Almost all professionals are familiar with the horror stories of lost patients even in following all these procedures. But any sedative involves some risk, as does the procedure itself. Sedation should not ever be considered routine for simple procedures that could be handled differently without incurring additional risk to the safety of the patient.

Many forms of sedation are becoming more commonplace in the professions as newer medicaments are being developed. But no matter how many times a sedative form is used prior to a procedure, the specter of death looms in the shadows for even the finest practitioner. And the psychological effect on the staff and doctor in losing a patient is irreparable.