(SLB-032) Adverse Outcomes Associated with High-Risk Medication Administered to Children during the Dental Visit, 2014-2020

Background: Evidence on the epidemiology of pediatric safety is mainly focused on medical clinics and hospitals, with limited research on oral care settings. In pediatric dentistry, high-risk medications are commonly used, including sedatives administered before dental procedures.

Objectives: To assess the frequency of high-risk medications administered to pediatric patients during dental procedures and association with outcomes.

Methods: We conducted a longitudinal analysis of MarketScan Commercial and Medicaid Databases of patients < 18 years with a dental encounter from 2014 to 2019. Among children with dental encounters, we identified claims for high-risk medications (benzodiazepines, barbiturates, opioids) administered during a dental encounter in clinic- and hospital-settings. Our primary outcome was the proportion of dental encounters involving high-risk medications associated with adverse outcomes using all-cause and attributable measures. The all-cause outcome included emergency/urgent care visits and hospitalization within 7 days post-dental encounter. The attributable outcome identified sedation-related adverse events using a validated algorithm. Multivariable generalized estimating equations modeled the association between outcomes and characteristics.

Results: 1,448,608 children received 2,844,651 dental encounters involving high-risk medications. Most high-risk medications were sedatives for mild (90%), moderate (2%), and deep sedation (8%). Among dental encounters with high-risk medications, 3.7% were associated with an all-cause outcome (99% emergency/urgent care visits; 1% hospitalizations). Patients aged 12-17 years of age (OR 2.64 [95% CI 1.77-3.94]), males (OR 1.16 [95% CI 1.15-1.18]), with non-complex chronic conditions (OR 2.29 [95% CI 2.25-2.33]), and with Medicaid coverage (OR 1.90 [95% CI 1.85-1.94]) were more likely to experience the all-cause outcome. Dental encounters in hospital or ambulatory surgery settings (OR 1.21 [95% CI 1.15-1.28]) were associated with the all-cause outcome.

Conclusions: Adverse outcomes were associated with high-risk medications during pediatric dental procedures. For every 27 dental visits with sedation, one is associated with an adverse outcome. Risk mitigation strategies should be targeted to groups at risk to improve patient safety.