"Is it safe?"
Posted on 10/25/2016 11:01:23 AM PDT by nickcarraway
Editor’s note: The Dental Board of California is accepting public input on dental anesthesia until Friday, Oct. 28. If you’d like to voice an opinion, e-mail Karen Fischer, the board’s executive director, at: Karen.Fischer@dca.ca.gov.
Mariela Montoya sobs when she recalls the day she took her two-year-old son to the dentist and he never came home.
Acting alone in February 2015, the dentist sedated 2-year-old Alejandro with a local anesthetic to treat a rotten molar.
But following the procedure, Alejandro was rushed to the hospital where Montoya says the diagnosis was brain damage.
“They said it was probably from the anesthesia,” she said. “It was a lot.”
Montoya then had a heartbreaking choice: whether to keep Alejandro on life support.
“It was hard,” she said, crying. “I knew he wasn’t going to wake up… I knew then that he was gone.”
Alejandro’s death echoes the case of Caleb Sears. He’s the 6-year-old boy from Albany who died after visiting a dentist who simultaneously administered anesthesia and removed a tooth.
The circumstances are somewhat different, but the outcome is the same. Both little boys are dead. And the state accused both dentists of failures in drug dosing and monitoring.
After Caleb’s death in 2015, the state legislature ordered the Dental Board of California, which licenses and polices dentists, to study the safety of dentists giving kids anesthesia.
“I keep thinking I wish someone else had done this,” said Eliza Sears, Caleb’s mother. “I wish someone else had done this years ago and saved Caleb.”
The state has never before tracked how many kids’ die. NBC Bay Area tried, but discovered records that are heavily redacted and inconsistent. Some dentists send in detailed reports when something goes wrong; others submit just a few sentences.
Dentist Bruce Whitcher reviewed the same data for the board. His study found nine deaths over the past five years. Whitcher spoked at an October board meeting.
“There doesn’t seem to be a clear pattern,” he said.
Still, the board is considering change -- steps that many states have already taken.
Requiring more expertise for dental assistants.
“I think we’re doing a lot of things right; I think there are some things we can do better,” Whitcher said.
But several experts say these possible changes don’t go far enough.
The American Academy of Pediatrics is calling on the board to ban dentists from performing anesthesia themselves.
Pediatrician Dr. Paula Whiteman spoke to the board.
“Not one more healthy California child should suffer a potentially preventable death in a dental chair,” she said.
Some experts say even the cases that don’t end in death are important. Yet those aren’t tracked either.
So, NBC Bay Area spent months reviewing 380 state accusations against dentists. In those involving anesthesia, some patients recovered, but others were left with conditions as severe as brain damage.
Loma Linda University Dental Professor Larry Trapp argues the era of dentists administering anesthesia themselves should end.
“We’ve got to go with the highest level of care until proven otherwise,” he said. “And that to me, is having an anesthesiologist and a surgeon assigned to each case.”
Board president Doctor Steven Morrow acknowledged the stark contrast between the board’s preliminary fixes and testimony of several experts. Yet, he said the dental board is open to change.
“We will take those additional comments under consideration and we will continue to develop our recommendations. They are not finished yet,” he said.
The board has heard from multiple interest groups: dentists, pediatricians, oral surgeons, anesthesiologists, etcetera. Yet, it has heard from exactly zero patients like you -- the people their decision will impact the most.
There are still four days left for you to speak up.
The Dental Board of California is accepting public input until October 28. If you’d like to voice an opinion, e-mail Karen Fischer, the board’s executive director, at: Karen.Fischer@dca.ca.gov.
The board plans to make recommendations in early December.
No matter what the dental board does, you always have the final word. It you want a separate anesthesiologist to sedate you, ask for one. If your dentist won’t honor your request, you have the right to cancel the procedure and find one who will.
You can die from drinking too much water. Life is dangerous.
A rotten molar in a 2 year old ? Bad parents ?
Accidents happen, even in the most benign circumstances. People need to learn to live with this fact. Call it an “act of God,” whatever gets them through the day.
Illegals
He got a local.
"Is it safe?"
I had an oral surgeon extract some teeth recently to prepare for implants. It was a two-step procedure separated by four months, and in each case I was put under general anesthesia. I was very worried the first time about being put under, but the procedure was so relaxing I found the whole thing a pleasant experience. When I went to a post-op after the first procedure, I told the oral surgeon that I couldn’t wait to come back and do it again in a few months. He stepped back and looked at me before he said “I don’t believe you”. Still, it was true: I just drifted off and drifted back, and was relaxed for days afterward.
Two of the three dentists in our office are licensed for sedation. . . and one is an examiner for the California Board of Sedation Dentistry who is certified to examine other dentists who are seeking that specialized license.
Sedation runs from a simple tablet intended to relax a patient to full intravenous intended to put a patient into an unconscious state. Various levels of monitoring is required at each type. A properly trained response is required with each up to and including calling 911 and getting emergency assistance.
Full monitoring equipment is present for some sedation. Some of what our doctors do is full oral surjury, such as placing full jaw implants.
This emotion laden article is heavy on hyperbole and very short on fact. Yes, there are the occasional bad result from some sedation protocols, but that is the case even when you do have a anaesthesiologist standing right there. There is a risk attendant to anything. Sedation Dentistry has a long and successful history in California with few disasters, but those disasters are sometimes unavoidable because one is working with people who will have unforeseen and unforseeable reactions to the sedation drugs.
To require an anaestheisiologist to be present for every sedation procedure would be a step backwards in California Dentistry, adding thousands of dollars to the cost of simple procedures, and cause many dental phobic people to avoid getting the procedures they need done at all. Certainly, the dental benefits (pre-paid insurance) which is usually only $1000 or $1500 in a calendar year, could not even approach the added costs to cover including an anaesthesiologist. Such plans already balk at paying for the sedation administered by the dentists and usually treat it as a patient option.
I’d want to see a correct report before saying anything more in specific. A “local anesthetic” (e.g. Novocaine) isn’t sedation. However trying to get a 2 year old kid to let a dentist pull a tooth, even WITH Novocaine, is like, well, pulling teeth.
More caution may be worth it for certain populations. Science could continue on so as to be able to determine what those populations are. This is lives being talked about, after all. In an age when it’s easy to be so cold about abortion, I would be leery of other movements that go in parallel directions.
We would not be against requiring any Dentist who only put down a few sentences in an incident where a patient died under sedation be required to make a full narrative report. Frankly, I doubt they'd allow that in the investigation that would follow such an event. Certainly the authorities in the local jurisdiction would not accept "a few sentences" in their investigation.
My mother who had been a member of her local hospital's auxiliary had been in the recovery room waiting area one day distributing coffee to people waiting for their loved ones when the she saw a surgeon who had just finished doing a tonsillectomy on a three year old girl approach her parents who were patiently waiting for the results. He walked up to them and said "She died!" As the mother fainted, he then coldly turned around and walked away. The father barely caught his wife before she hit the floor.
Writing a few sentences about the event that involves a patient dying under the your care during a routine procedure strikes me as being as coldly dismissive as that surgeon.
Working with children is very problematical. One of the issues is the doctor does not want to instill dental phobia in the child for his later life. For that reason it is often desirable to use a hypnotic which does not allow the child to recall the events of the dental visit at all, which is far better than remember the pain of even the injection of Procaine or any other numbing agent in the mouth. Even the looming face of the dentist can be very frightening to a child.
The fact is that the expected rate of mortality from anesthesia is 1 for every 10,000 administrations of anesthetics. . . and that includes it being administered by anesthesiologists in the best of all possible venues. One in 10,000 people receiving it are going to die. There are about 40,000 dentists in California. . . and about 10% of those are licensed to administer sedation. If each of the licensed Sedation dentists in California were to sedate 5 patients per day, 20,000 patients would be sedated every day in California. Assuming a 5 day work week (although some of them do work on Saturday, it's a minority), that's about one million sedation procedures per year by dentists. . . yet you don't hear about approximately 100 people dying in dental chairs due to anesthesia which would be the expected number.
What I suspect we are seeing here in this article is an attempt by the Anesthesia doctors association in California to drum up more business for THEIR doctors.
Ha...my husband just had oral surgery yesterday...they just gave him some lorazepam...he had a great time. Much better than going to his Dentist, he said.
I am probably the only person alive who enjoyed having teeth pulled with only a local
Thanks for your explanation.
There is a risk with anesthetic even in regular surgery, and so much depends on the patient. I’ve had two c sections where I ended up feeling the knife. Yeah not fun. (I have the red hair gene even though I’m blonde)
My son at 5 had something done, maybe a cavity, with the sleepy juice. When I got him home he was stoned out of his mind. Funniest moment: I had him on a king sized bed so he wouldn’t slam himself around and hurt his head, he was so out of it motor wise. He plopped his head face down into a big stuffed animal. With his face lying in the white fur, he said, “Mom! There’s a bunch of people in here! It’s a whole world!” Lol.
This article reads like it was written by a high school dropout who had a dog in the fight.
Or it was written by the dog, after the fight.
I am probably the only person alive who enjoyed having teeth pulled with only a local
Were you in Little Shop of Horrors?
LOCAL anesthesia? The boys died from lidocaine? So sad, but how could a dentist remove a tooth in a 2-year-old without it?
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