The tales are heart-rending, with photos of vibrant, smiling children whose lives were cut short after their parents tried to take care of them by visiting a dentist.

"It’s very hard to read these stories," said Dr. Helen H. Lee, an anesthesiologist and the lead author of a 2013 article in Pediatric Anesthesia that reviewed news reports of children who died after dental sedation.

Given the huge pool of children visiting dentists across the country, such cases appear relatively rare. But because there is no national tracking of dental deaths, there is no clear way to determine the relative risk and incidence of these tragedies.

The journal article, "Trends in Death Associated with Pediatric Dental Sedation and General Anesthesia," combed through news reports of youths through age 20 who died after receiving anesthesia for a dental procedure.

"We sought to understand pediatric anesthesia-related mortality risks in light of the evidence that increasing numbers of children were receiving anesthesia for dental procedures," the researchers wrote. "Because systematic data collection on outcomes of pediatric dentistry was lacking, we examined media reports of pediatric deaths."

They identified 44 cases in the United States between January 1980 and May 2011. The biggest cluster was among children ages 2 to 5, who accounted for nearly half, or 21 cases. And the majority of the deaths overall, 70 percent, took place in dental office settings, as compared with nearly 14 percent in surgery centers or hospitals. The rest did not report the setting.

"These data may indicate an association between mortality and pediatric dental procedures under sedation, particularly in office settings," the authors wrote. "However, these relationships are difficult to test in the absence of a database that could provide an estimate of incidence and prevalence of morbidity and mortality."

The researchers concluded, "With growing numbers of children receiving anesthesia for dental procedures with variable training, it is imperative to be able to track anesthesia-related adverse outcomes."

As far as anesthetic depth, 20 of the children had received "moderate" sedation, either orally or intravenously. Ten had undergone general anesthesia, four had local anesthesia, and the 10 other cases did not indicate the type of anesthesia. Three of the 44 children who died had pre-existing conditions.

The journal article did not include the locations, but Lee believes none took place in Hawaii.

The researchers said the media reports likely represent just a fraction of the injuries or deaths resulting from dental sedation of children. Lee noted that children have specific needs that require proper training on the part of dentists.

"Kids aren’t small adults," Lee said. "Physiologically, they are built differently than an adult. Sedating an adult versus sedating a child, those are two different things. I would think you need experience in providing sedation for each population."

Lee is a former assistant professor of anesthesia and pain management at the University of Washington who will soon join the anesthesiology department faculty of the University of Illinois in Chicago.

"The point of the article was that these media stories might represent something, and the only way that we will know what they represent is through the creation of a national database," Lee said in an interview.

"We need to know, are they blips on the radar or are they signals that represent some serious trend? We are highlighting the need for more serious and systematic review of these adverse events, and we can’t do that with the data that’s available now."

The parent of a toddler herself, Lee said she feels frustrated there is not more information available.

"I think the reaction everyone has when they read stories like the ones you’ve been reporting on is, ‘We have to fix it.’ I don’t think it’s a simple solution. I think the solutions need to be informed around data analysis."