Since 1955, 218 people have died under general anesthesia, including multiple children. In several cases, aspiration was a contributing factor or even the cause of death. This is a small mortality rate compared to the millions of dental procedures performed annually. But no death is an acceptable outcome in dentistry, and aspiration is almost always a preventable tragedy, or at least a treatable one. A few simple strategies can mitigate the risk and ensure safe patient outcomes.