Contact 2: A Look At Sedation Dentistry

Hate the idea of going to the dentist? Lots of people do and that's why sedation dentistry is on the rise. Used properly, it puts anxious patients at ease. But as Contact 2 uncovered, sedation dentistry gone bad may have cost. It's been three painful years since Sarah Coleman's husband John, a 47-year old father of three, died one day after visiting this North County dental office of Doctor Guilan Norouzi.

"There were times during the procedure that I questioned why they went on with the surgery," says Sarah Coleman.

In March of 2007, John Coleman was scheduled for invasive dental work. He had only eleven teeth and suffered serious health issues, including diabetes and colon cancer.


"The procedure was going to be, she would remove the teeth that were remaining and place four metal posts into the jawbone--2 on the bottom, 2 on the top," says Mrs. Coleman.

The extensive amount of work scared John, so he opted for conscious sedation or, what used to be called sleep dentistry.

"Conscious sedation is what you feel like after a couple of beers; where you're relaxed but you're not asleep," says Dr. Michael Hoffmann, past president of the St. Louis Dental Society and a teacher in conscious sedation dentistry and the only licensed dental anesthesiologist in Missouri explains that it is a procedure that typically involves giving patients sleeping pills, like Halcyon. "They will be able to respond if you ask them questions, they should be able to verbalize--if you ask them to take a deep breath, they should be able to take a deep breath."

That's the key, according to Dr. Hoffmann: patients are relaxed, but not asleep. And therein lays the challenge of sedation dentistry: finding the right amount of oral medication to get the patient to that relaxed state. Too little and they're still anxious, too much they fall asleep, or worse.

"It's almost guess work," says Pat Hagerty, an attorney who represented Sarah Coleman in a lawsuit against Dr. Narouzi.

The suit claimed Coleman wasn't getting to that relaxed state, so Dr. Narouzi kept giving him more halcyon.

"Keep in mind that point-five milligrams is the maximum recommended dose; what she did is give four times the maximum recommended dose to Mr. Coleman," says Hagerty.

According to the lawsuit, Coleman started reacting violently, thrashing his arms and legs while in the chair.

"Rather than stopping, which she clearly should have done, she brought in three other people in the office to down his arms, hold down his legs," says Hagerty.

All the while, Coleman's vital signs were dropping.

"Throughout the day he was showing signs of low blood oxygenation. He was receiving brain damage as the procedure was going on," says Hagerty.

By late afternoon, Coleman is not waking up. His wife is called back to the office.

"Within 10 minutes of me getting to the dentist office that is when the ambulance pulled up," says Mrs. Coleman. Coleman was taken to the hospital in cardiac arrest. His heart was brought back, but it was too late. His brain had been without oxygen for too long.

"By Saturday evening they discontinued life support," says Mrs. Coleman.

John Coleman died that night. But he is not alone. While precise numbers are difficult to come by, a publication by the Missouri Dental Association lists at least 6 deaths within the past 5 years or so caused, at least in part, by sedation dentistry.

So what went wrong?

Dr. Narouzi referred us to her attorney who declined to comment citing privacy laws. Dr. Hoffmann speculates that because of John Coleman's health problems, his stomach did not properly digest each individual pill. Instead of gradually reaching a relaxed state, the halcyon hit him all at once.

"What studies have shown is that the drugs build on one another," says Dr. Hoffmann. "For some patients it may go to work in an hour, for some patients it may go to work in two hours."

Dr. Hoffmann says for many high-risk patients like Coleman, it's safer to use general anesthesia administered through an IV because the levels of sedation are more precise. But that costs more money and requires much more training. Dentists can be certified in oral sedation using relaxants and sleeping pills after only passing an 18-hour course.

"With a pill you give it and you can't take it back," says Dr. Hoffmann

No one knows that more than Sarah Coleman, who has this warning for anyone considering sedation dentistry:

"It's not something like teeth whitening that on a whim you should have done. It's something that you should take very seriously."

Mrs. Coleman settled her lawsuit for a confidential amount of money. Dr. Norouzi is still practicing general dentistry, but not sedation dentistry and disciplinary action could be taken by the Missouri Dental Board.