State board looks at anesthesia rules in dentist offices after 6 deaths since 2014

CHARLOTTE — Members of the North Carolina State Board of Dental Examiners are weighing proposed changes to rules surrounding anesthesia during dental procedures.

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In a public hearing Thursday, the North Carolina State Board of Dental Examiners heard arguments on both sides of the amendment that would require dentists to have a person licensed in anesthesia alongside them during procedures. The board stated that there have been six deaths following complications related to anesthesia in dental offices since 2014.

One of those deaths was Dr. Henry Patel, a well-known cardiologist in Wilmington. He died unexpectedly following complications from anesthesia he received during a dental procedure in 2020. He was 53 years old.

Dr. Patel’s widow, Shita Patel, spoke during the meeting to advocate on behalf of the change.

“Even though my husband was a physician, he never once considered, ‘I better ask about anesthesia when I go to my dentist,’” Patel explained. “I never expected to walk out of there being a widow at age 47. Medical doctors cannot do a procedure and give sedation at the same time, even in a hospital setting where they have every single thing available to them. However, it’s all right to do it in a dental setting?”

Dr. Rob Harper worked alongside Dr. Patel and also spoke at the meeting in favor of the amendment.

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“Henry’s death has cast new light on what I believe to be a dangerous practice, but let me be clear,” Dr. Harper said. “This is not just about the case of Henry Patel. This is about the use of potent anesthetic agents inside the office setting and the ability of dentists to be able to recognize and rescue patients from emergency situations.”

Dr. Harper outlined main points supporting his position. First, he says sedative drugs like Propofol have a high potential for airway compromise with a narrow margin of safety and no ability to reverse their effects. Secondly, the anesthesia for dental procedures is performed in an office setting where there is a lack of experienced support personnel who can respond to a cardiac or respiratory emergency. Thirdly, that dental staff are not sufficiently experienced in clinical management of such emergencies.

“The general public is largely unaware of the risks that can carry potential deadly consequences,” Dr. Harper said. “The practice of deep sedation and anesthesia should not be allowed in the office setting and should be restricted to an ambulatory surgery center or hospital where experienced support personnel are readily available.”

More than 10 dentists and oral surgeons spoke out against the changes during the public hearing, citing increased costs to patients, which is an added barrier for access to affordable dental care; and low death numbers when compared to the overall number of patients who are put under sedation.

Dr. Robert Rogers has been a practicing dentist in Concord for more than 20 years. While he chooses not to use sedation in his practice, he said he does see how the change could cause more harm than good, especially in the short-term.

“As bad of an outcome and as tragic as it may be, I don’t know if you make this big of a leap,” Dr. Rogers said. “If you’ve got one person who is totally dedicated to just monitoring the patient, that’s an extra person during the procedure and those costs will have to be passed along to the patient.”

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Dr. Rogers said he once brought in an anesthesiologist for a particularly tricky case, driving up the cost of the procedure for the patient more than $3,500. He also noted that finding staff is already an issue, so finding someone licensed in anesthesia, especially in rural areas, could be close to impossible. He believes every negative case should continue to be evaluated individually so professionals can understand what went wrong and learn from the mistakes made.

“We’ve got to ask, ‘What went wrong, what happened here, what changes need to be made, what needs to be done, what could have been done differently?” Rogers explained.

The North Carolina Dental Society sent Channel 9 this statement opposing the changes:

“The NC Dental Society (NCDS) respects and agrees with the NC State Board of Dental Examiners (NCSBDE) commitment to ensuring patient safety.  At this time the NCDS does not support the NCSBDE’s proposed rule change requiring a separate dental anesthesia provider.  There is no scientific evidence to support that the proposed rule change would enhance patient safety or decrease adverse events occurring in the administering of sedation for dental care.  If the rule is passed, there would be increased costs of a separate dental anesthesia provider and the supply of medical and dental anesthesiologists and CRNA’s is not sufficient to meet the need in North Carolina, particularly in rural areas.  In addition, North Carolina would be the only state in the country to require a separate anesthesia provider, if the rule is approved.”

Anyone can submit public comment to the NCSBDE until March 4. According to the board, the earliest the changes would take place is May.

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