The state Medicaid agency is investigating the death Tuesday of a 6-year-old boy who was sedated for a dental procedure at the Virginia Commonwealth University Dental Faculty Practice.
An autopsy was performed yesterday on Jacobi Hill, but a spokesman at the state medical examiner's office said it could take weeks to determine the cause and manner of death.
Dentists typically use sedation and anesthesia to control pain and keep patients, particularly children, from moving during procedures. But sedation carries risks, and there have been deaths in Virginia and elsewhere.
"It's used thousands of times every day," said dentist Indru Punwani, a spokesman for the American Academy of Pediatric Dentistry and head of the pediatric dentistry department at the University of Illinois at Chicago.
The academy did not have any statistics on how frequently adverse events occur. But there have been recent news reports of two Florida children who died during separate dental procedures where sedation was used.
Punwani said sedation is more common in pediatric dental procedures today because so many children are coming into dentist offices at younger ages with tooth decay and sometimes need extensive work.
Dr. Robert Campbell, a pediatric oral surgeon at Virginia Dental and Anesthesia Associates, said the level of sedation depends on how many procedures are being done and the patient's ability to remain still.
Levels of dental sedation vary -- from minimal to moderate to deep, the latter comparable to general anesthesia. Sedation also is a safety issue because dental instruments move at high speeds.
"If the patient starts moving around inordinately and we cannot control them, then that drill bit can rip down inside of the mouth and produce huge problems," said Campbell, who practices in Henrico County and Fredericksburg.
Campbell said the most common cause of death in dental offices under anesthesia is related to an airway condition.
In the upper airway, "the most common problem is that the vocal cords go into a spasm and shut down," said Campbell, who taught in the oral surgery and anesthesiology departments at VCU.
It can be, but is not necessary related to, an allergic reaction, he said.
"The next most common airway issue is lower airway," Campbell said. "The lower airway passages can close down, for example, [and a patient] have an asthmatic attack after general anesthesia."
Virginia Board of Dentistry guidance documents spell out who can give pain, anti-anxiety and sedating medications during procedures.
Jacobi was at the dental practice to have caps, also called crowns, put on several of his teeth, said his mother, Crystal Lewis. He was administered anesthesia.
Lewis said that after a breathing tube was removed, her son's heart stopped.
Richmond Ambulance Authority officials responded Tuesday to an 11:54 a.m. call of a cardiac arrest at the dental facility in the 500 block of North 11th Street. About 24 minutes later, the ambulance transported the patient to VCU Medical Center's emergency department.
Jacobi's mother said he was pronounced dead at the hospital.
VCU officials declined to talk about the case, pending the outcome of the autopsy.
Because Jacobi's care is paid by Medicaid, that agency is looking into the circumstances. Virginia Medicaid officials, citing federal patient privacy laws, declined to comment.
Manning Funeral Home is handling arrangements. Staff there said services are scheduled for Monday at 1 p.m. at the chapel, 700 N. 25th St.
Contact Tammie Smith at (804) 649-6572 or TLsmith@timesdispatch.com.
Staff writer Reed Williams contributed to this report.