We agree that the hypothetical case is not representative of the care provided on a daily basis. Rather, it is meant to represent what happens when many gaps in safety result in an adverse event. Adverse events, although rare, are opportunities to learn and change.
Our intention was to facilitate a discussion about how these adverse events could be framed from the perspectives of dentistry, anesthesiology, and bioethics. However, the perspectives are truly from the individual authors and should not be interpreted to be representative of entire specialties.
Clearly this topic is multifactorial, spans several disciplines, and encompasses many perspectives. We appreciate the perspective from pediatric dentistry provided in your comments and the controversial nature of claims about SDF.
As we noted in our commentary, preventive dentistry to reduce the number of children with severe caries is an important part of the solution. However, preventive dentistry and SDF have their limits. Caries etiology is highly influenced by oral health behaviors, which clinical dentistry may have limited ability to affect, particularly when some parents of patients simply do not seek care until their disease is severe. Just as the disease is multifactorial in nature, we believe that improving safety will entail multiple approaches. Prevention is essential, but it involves not only access to pediatric dentistry but also the social commitment to help families with few resources and little experience with dentistry or oral health requirements. Innovative approaches to outreach and education will be needed, together with more general efforts to improve access to healthy foods.
Such approaches should be considered as part of a larger effort to understand how systems of care allow adverse events to occur. These include access to timely and affordable dental care and, when early childhood caries occurs, safe dental procedures. How many adverse events must transpire before change occurs?
We do not believe that sedation is performed routinely in a cavalier manner. We believe that many people are invested in the safety of children, care about affected families, and sincerely seek meaningful change. We are glad that your comment has expanded and enriched this discussion and hope that this is the beginning of a dialogue that addresses all facets of this important health problem.
Conflict of Interest: The authors have indicated they have no potential conflicts of interest to disclose.
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