Trip to dentist leaves Edmonton girl, 4, brain damaged, in pain

[MrMastodonFarm]

"She had front teeth decay and some molar cavities," Singh said. "So the doctor recommended her to a specialist because, according to him, this needed to be done under sedation."

Maybe I'm treading on anti-vax territory here but why is sedation necessary? My (then) four year old niece had something similar last spring and I was shocked when told she had to go under sedation, much less a procedure. Now I haven't been four years old in a coons age and certainly there have been revelations in modern medicine since then... but these teeth still eventually fall out right?

And yes, I'll admit to being a bit of an anti-dentite.

[cracher]

Thanks for the reply. Now I'm even more confused.

So do dentists with this specialization function as anesthesiologists or is the program strictly to allow them to run their own anesthesia as they do their cases? From what my anesthesiologist buddies tell me, local dentists mostly use facilities like Riverview (where there is a MD anesthesiologist in the room). So what exactly is the advantage of doing your own anesthesia? I've done thousands cases in 14 years, and not a single one was without the help of an expert at the top of the table. I'm not sure why anyone would even consider running it themselves.

Originally Posted by Dentoman

I believe it includes all of the above, but I cannot say for sure. There are no dental anesthetists in Calgary so I have not had any direct interaction with one outside of dental school ... which is a long time ago.

Here is some info from the U of T's program:

Extensive training is provided in the clinical application of anaesthesia as it relates to dental treatment. Individual instruction in anaesthetic techniques for dental care is provided within the Faculty's outpatient anaesthetic suite. A wide range of anaesthetic techniques is utilized, including conscious sedation, deep sedation and general anaesthesia.

A large portion of the resident's clinical anaesthesia training is provided through hospital rotations. This extended clinical program is provided at both the adult care (eight months) and paediatric (six months) teaching hospitals affiliated with The University of Toronto. Two months are also spent in medicine rotations in affiliated hospitals.

Course work includes: anatomy, clinical epidemiology and biostatistics, seminars in oral biology, clinical conferences, weekly in-service rounds, a weekly journal review course, seminars in anaesthesia for dental procedures, and seminars in anaesthesia for medical procedures (in conjunction with Faculty of Medicine, Department of Anaesthesia).

[Erick Estrada]

Originally Posted by llwhiteoutll

I'm your opinion, how should he have interacted with the father?

If he had coming running out of the room screaming and losing his ####, all you do is rile up everyone else up and you end up with a bunch of people freaking out. None of which is conducive to the response required during an emergency

Umm you read the article did you not?

"He told him he already called the paramedics, nothing to worry about, she'll be OK. They might need to take her to the hospital for a checkup.

It's serious enough for him to call paramedics to do CPR on the girl so I'm sorry but "nothing to worry about" doesn't cut it. This guy messed up and it just happens to be a profession where if you mess up someone could die or have serious injury. I'm not calling for him to be nailed to a stake but for crying out loud accept some responsibility.

[Dentoman]

Originally Posted by cracher

Thanks for the reply. Now I'm even more confused.

So do dentists with this specialization function as anesthesiologists or is the program strictly to allow them to run their own anesthesia as they do their cases? From what my anesthesiologist buddies tell me, local dentists mostly use facilities like Riverview (where there is a MD anesthesiologist in the room). So what exactly is the advantage of doing your own anesthesia? I've done thousands cases in 14 years, and not a single one was without the help of an expert at the top of the table. I'm not sure why anyone would even consider running it themselves.

I honestly can't answer that due to a lack of personal knowledge. The oral surgeons and pediatric dentists I deal with all use an MD anesthetist for their general anesthetic cases. Oral surgeons have their own accredited surgical suites in their offices that is staffed by an MD anesthetist. Paediatric dentists would go to ACH or one of the private facilities.

[Amethyst]

Originally Posted by MrMastodonFarm

Maybe I'm treading on anti-vax territory here but why is sedation necessary? My (then) four year old niece had something similar last spring and I was shocked when told she had to go under sedation, much less a procedure. Now I haven't been four years old in a coons age and certainly there have been revelations in modern medicine since then... but these teeth still eventually fall out right?

And yes, I'll admit to being a bit of an anti-dentite.

Yes, but the cavities can be painful, make eating and speaking properly difficult, and if they aren't dealt with can lead to larger dental problems.

[Amethyst]

If the dentist truly said that there's nothing to worry about and everything will be okay, I think that was a mistake. He didn't need to cause a big scene, but I would think guaranteeing a positive outcome isn't the norm for medical professionals in this kind of situation. Although if that's the father remembering it, he was obviously very stressed out and could have mis-remembered.

Very sad situation.

[NuclearFart]

Originally Posted by cracher

Thanks for the reply. Now I'm even more confused.

So do dentists with this specialization function as anesthesiologists or is the program strictly to allow them to run their own anesthesia as they do their cases? From what my anesthesiologist buddies tell me, local dentists mostly use facilities like Riverview (where there is a MD anesthesiologist in the room). So what exactly is the advantage of doing your own anesthesia? I've done thousands cases in 14 years, and not a single one was without the help of an expert at the top of the table. I'm not sure why anyone would even consider running it themselves.

This is what I don't understand either. One of the central tenets of being an anesthesiologist is vigilance. If you are doing the procedure yourself, you sure as heck aren't monitoring the general anesthesia competently.

[Zarley]

I really question the need for sedation for these procedures - seems like a huge cash grab for dentists.

[FlamesAddiction]

Heart breaking to see something like this. Sedation should always be a last resort.

I don't trust dentists at all. They aren't held to the same standard as doctors and I have heard way too many stories of them recommending work that really doesn't need to be done.

[MoneyGuy]

Originally Posted by Zarley

I really question the need for sedation for these procedures - seems like a huge cash grab for dentists.

With a young child maybe the parents wanted sedation. There are adults who ask for sedation because of their fear so I could see a child being terrified.

Something I've always wondered is if dentists are true doctors. Chiros call themselves doctors also but I don't buy that as it's a title administered by their governing body and they're not doctors. Are dentists the same?

Anyway, what a sad story. There is a gofundme campaign for this poor child and her family. I'm sure the dentist is also heartbroken for what has happened. It's all so sad.

[Erick Estrada]

Typically there should be a fasting period and the girl ate breakfast and had the surgery later in the morning because of an unscheduled opening. Typically fasting periods are to be in the range of 8-12 hours so that was not followed and to me at least this looks like a dentist trying to fill out his day without proper regard for safety as every time I've ever been sedated I have had paperwork detailing how to prepare in regards to food and water consumption.

[cracher]

^Based on what I know, I would say they are. The education is comprehensive. At the place I did residency, there were 4 dental positions with 2 of the spots moving on to maxillofacial. Those 4 residents went through the same transitional year as everyone else and outperformed many. To me, there is no question that they've earned it.

[NuclearFart]

I think the problem is that after training they become far too narrow in scope spending long periods deep in their comfort zone, leading to rusty complacency and a one dimensional skill set that will get them into trouble when veering into the general medical/non-dental realm. This "Anesthesiologist" would fit this paradigm, as he (allegedly) blatantly disregarded the basic prep of general anesthesia. Do these hybrid dentists have some sort of mandated MOC program to keep their skills up?

I would exclude the hospital OMF surgeons from this category though, as the are essentially overtrained ENTs using all their skills on a daily basis.

[Red Slinger]

My cousin died under somewhat similar circumstances 18 years ago. She was getting her tonsils removed and the anesthesiolgist was drunk on the job and essentially killed her. This was in Moscow so he got off with a slap on the wrist. Her parents were destroyed and never the same after losing their 13 year old daughter.

I hope for everyone's sake that this was legitimately an unfortunate accident rather than negligence.

[Hack&Lube]

The article mentions that in British Columbia:

"all dental procedures" that involve general anesthesia require five qualified professionals: the anesthetist, the operating dentist, the operative assistant, the recovery supervisor and the office assistant.

In Alberta, a dentist is allowed to administer anesthetic at the same time as performing a surgical procedure."

That's a bit troubling to me and I would feel far safer and confident in BC's system if I were ever to get a sedation dentistry procedure.

[taco.vidal]

Originally Posted by Hack&Lube

That's a bit troubling to me and I would feel far safer and confident in BC's system if I were ever to get a sedation dentistry procedure.

People seem to be using the terms sedation and anesthesia interchangeably in some posts in this thread. Sedation can include general anesthesia but sedation dentistry more often refers to oral or IV administration of drugs to calm you down rather than being put fully under. From the artciles out there, it sounds like this girl was knocked out rather being merely sedated how you hear described in commercials for sedation dentistry.

What Is Sedation Dentistry?
Sedation dentistry uses medication to help patients relax during dental procedures. It's sometimes referred to as "sleep dentistry," although that's not entirely accurate. Patients are usually awake with the exception of those who are under general anesthesia.

The levels of sedation used include:

Minimal sedation -- you are awake but relaxed.
Moderate sedation (formerly called "conscious sedation") -- you may slur your words when speaking and not remember much of the procedure.
Deep sedation -- you are on the edge of consciousness but can still be awakened.
General anesthesia -- you are completely unconscious.

[cracher]

Agreed, defining terms is important in understanding this situation. The distinctions you made are important. However, I'm not sure I'd call GA a type of sedation. Sedation is a part of GA (usually the early and late parts) but the GA is far more involved. GA probably should not be represented as a turbo-sedation.

The other thing to consider here is that the line between "minimal" and "deep" sedation is very thin when dealing with a skinny 40lb kid with a liver that isn't trained to chew up the meds. The deeper you get, the more you have to worry about. I don't see how anyone can focus on doing a procedure when dealing with this at the same time.

[Amethyst]

Originally Posted by Hack&Lube

The article mentions that in British Columbia:

"all dental procedures" that involve general anesthesia require five qualified professionals: the anesthetist, the operating dentist, the operative assistant, the recovery supervisor and the office assistant.

In Alberta, a dentist is allowed to administer anesthetic at the same time as performing a surgical procedure."

That's a bit troubling to me and I would feel far safer and confident in BC's system if I were ever to get a sedation dentistry procedure.

The Alberta policy makes me very uncomfortable. I had my wisdom teeth removed under general anesthesia and there was a separate anesthetist. It was awhile ago, so I can't remember everything involved, but I was very nervous about the procedure, as I knew someone in high school who died from the anesthesia during a dental procedure.

[Snuffleupagus]

My goodness! that's just awful, I once knew a girl that spent 3 months in hospital learning to walk again due to complications getting her wisdom teeth out under anesthesia. I never heard what exactly went wrong though and thankfully she recovered.

[para transit fellow]

Reactions to anesthesia do occur. They are rare and when one does happen, most of us never hear of it.

this is the most famous incident I recall:

http://www.cbc.ca/news/canada/albert...right-1.202849