Dentists and anesthesia - Issues?

[MmacFN]

This is an article and im looking for responses

The article can be found HERE (http://abclocal.go.com/ktrk/story?section=local&id=4655238)
(10/12/06 - KTRK/HOUSTON) - A grieving family is demanding answers because their two-year-old girl died after a routine visit to her dentist. Yesenia Valles died last Saturday, following a morning visit to her dentist.

The medical examiner has not yet ruled on a cause of death, and her father is growing anxious to find out what killed her. This tragic death happened just four days ago. But Eyewitness News has learned that both the Houston Police Department and the state dental board have opened investigations. The little girl's father, though, remains frustrated over a lack of answers.

On the same day David Valles laid his little girl to rest, this Houston father finds himself angry -- not knowing exactly how his baby daughter unexpectedly died.

"You the man, you got your daughter... Somebody got responsibility for that," Valles said.

Yesenia Valles, 2, died, according to a police report, after a visit to a dental clinic in southwest Houston. The little girl was there being treated for cavities. Her mother was in the waiting room during what was supposed to be a routine visit.

David Valles said, "She heard the kid's crying about 10 minutes. After 10 minutes, everything's quiet."

According to Houston police, the report indicates the dentist used a drug called Carbocaine. It's a short-acting, local anesthetic commonly used to treat patients by numbing the affected area. Shortly after administering the drug, the report indicates the doctor noticed something was wrong.

The girl was unconscious and he tried to revive her. Yesenia would later be pronounced dead at the hospital. Her cause of death is still unknown.

The dentist said, "I understand the parents and everything. I feel awful about the whole thing for everyone. I feel horrible."

Eyewitness News is not identifying the dentist because he has not been charged with a crime. When we spoke with him he would not talk specifically about what happened in his office the day Yesenia died. But he did tell us he felt he did nothing wrong.

We asked, "Do you feel that a mistake was made, anything you could have done differently?"

"No, I never treated the patient, period," the dentist answered. "But every patient comes in, and we'll be as thorough as we can."

The state board of dental examiners has launched a full-scale investigation into the death. Houston police are also still investigating. Yesenia's father says he won't rest until he gets answers.

"The life is too short," Valles said. "I got to live."

We checked the dentist's license. In 2004, he was given a warning by the state for failing to make, keep and maintain adequate records. He was ordered to complete a continuing education course and complete a jurisprudence exam. He has not had any other actions taken against him since then.

[lgscrna]

Carbocaine (Mepivicaine) is related to bupivicaine but somewhat less cardiotoxic. The key here is "somewhat". Not knowing the total dose given, concentration used, size of the child, or anything else, except her age, it is hard to comment, other than to say I would NEVER have used this drug in a 2 year old. There are way too many safer alternatives available. If the child was pronounced dead at the hospital, my first suspicion would be cardiotoxic overdose. Guess we will all have to wait on the toxicology. Regards, Lou

[SproutCRNA]

I believe there was another case recently where a child received sedation at the dentist's office and was found by her mother slumped over in the chair. The child was in a coma for a few days and then died.

I would like to hear some other opinions regarding sedation at the dentist office. When my daughter was 4 she had to have a couple of cavities filled and she was given some PO versed and N20. My husband is a paramedic and sat by her side during the entire procedure so I felt comfortable with that.

My concern regarding this practice is that children are administered nitrous concentrations and some with versed and there is NO pulse oximeter in the place!! I guess all the "what ifs...." come to mind. What are some other opinions regarding this??

Sprout

[RN29306]

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CHICAGO - A 5-year-old Chicago girl who never awoke from her sedation during a visit to the dentist died Wednesday at Children's Memorial Hospital, a hospital official said.

Kindergartner Diamond Brownridge had been in a coma and on life support since the weekend dentist visit, said Julie Pesch, a spokeswoman for Children's Memorial Hospital.

Family members have said Diamond received a triple dose of sedatives — an oral agent, an intravenous drug and nitrous oxide gas — during Saturday's exam at Little Angel Dental. The girl was having two cavities filled and caps placed on her lower front teeth.

The girl's mother, Ommettress Travis, has said she was asked to leave the room during the half-hour procedure. When she returned, her daughter was lying in the dental chair, not breathing, Travis said.

The girl's dentist, Hicham Riba, was certified to administer anesthesia to patients and his state license was current, said Susan Hofer, a spokeswoman for the Illinois Department of Financial and Professional Regulation.

Speaking to the Chicago Sun-Times before the girl died, the 40-year-old Riba said he was traumatized by what happened. "I don't think I will ever go back to a normal life after an experience like this," he said.

The telephone rang unanswered at Riba's home Wednesday night.

Additional links:
http://cbs2chicago.com/topstories/local_story_289094243.html

And you wonder how crap like this happens? Simple. They are farking idiots without regard as to what our specialty is based upon. Read the last paragraph of this link. http://www.boston.com/news/nation/articles/2006/09/30/ill_dentist_of_dead_girl_5_suspended/

And here is where anesthesia testimony handed his ass to him, court style. http://www.redorbit.com/news/health/695028/dentist_gave_child_3_doses_of_valium_assistant_say s/index.html?source=r_health

[Lydia12]

Quite some time ago, my oldest son had wisdom teeth extracted. I was ignorant in thinking that since he would be in the hands of an oral surgeon, he would be in good hands. So, while he went in the back for his procedure, I sat in the waiting room, as instructed, and read "Readers Digest".
Sometime later someone appeared in the room to let me know it was time to "drive to the back door" and meet my son. I waited by the back door, and watched as it took two employees to "walk" him out to the car, and put him in it. Then, once he was settled (more like slumped in the seat as he was gorked out of this world) was I told of his procedure, and how everything went well. The LPN even went as far to describe to me how he had received Nitrious to start, followed by "some" Versed, and "some" Fentanyl and "some" Propofol" as well as informing me that during the extraction, "when he started to arc up in the chair, I gave him more Propofol until he stopped doing that".
It took him the rest of that day to "wake" up, and he was fine afterwards. But I have always wondered about the what if's and realize how terribly foolish I was at that time.

[MmacFN]

I wonder if the LPN actually did push the drugs, that would explain alot.

[Lydia12]

Well, she said "I gave him more propofol" which indicated or at least implied to me that she gave it. It then just became my impression (later) that she gave him the narcs too. Even if she didnt push the drugs, its still a precarious situation considering the potential of the drugs and the possiblility of respiratory problems, and then an oral surgeon dealing with securing an airway.

[MmacFN]

Unreal and scary.

[FutrCRNA]

My ex is a dentist and he cringes every time he reads stuff like this. The week I started anesthesia school, we were still married and he came to Dallas/FtW with me to attend an IV conscious sedation seminar for dentists so he could get "certified" to use IV sedation in his office - but mainly he just wanted the CEU's. I remember being horrified that because he was a "doctor" (dentist) he could attend a 3 day course to learn all he needed about anesthesia and that was acceptable, but being a "nurse" I would have to go to school for close to 3 years and still have to "supervised" to practice...maybe by someone who'd only taken a 3 day seminar.

In the end, he decided against using IV sedation in his practice because he didn't want the responsibility/liability. (Nor did he want to purchase the $3000 worth of equipment necessary to safely monitor a patient under IV sedation.) He agreed with me that 3 days really wasn't enough education to safely give anesthesia. He was just happy to have the CEU's...

[ed3]

I was just informed by an acquaintance in a dental hygiene program that dental hygienist administer anesthetics. I didn’t believe her (although I didn’t question her), but after researching…I found she was telling the truth. I know dentists administer anesthetics, but a hygienist…? Maybe this isn’t as bad as it seems...?


Dental hygienists work in clean, well-lighted offices. Important health safeguards include strict adherence to proper radiological procedures, and the use of appropriate protective devices when administering anesthetic gas.



Dental hygienists use hand and rotary instruments and ultrasonics to clean and polish teeth, x-ray machines to take dental pictures, syringes with needles to administer local anesthetics, and models of teeth to explain oral hygiene.


In some States, hygienists administer anesthetics; place and carve filling materials, temporary fillings, and periodontal dressings; remove sutures; and smooth and polish metal restorations.

All of these quotes come from here: http://www.bls.gov/oco/ocos097.htm

[ethernaut]

I was just informed by an acquaintance in a dental hygiene program that dental hygienist administer anesthetics. I didn’t believe her (although I didn’t question her), but after researching…I found she was telling the truth. I know dentists administer anesthetics, but a hygienist…? Maybe this isn’t as bad as it seems...?

All of these quotes come from here: http://www.bls.gov/oco/ocos097.htm

oh come on !!

[deepz]

My friend the hygienist tells me that they give local and nitrous -- that's all. No biggy.

[ed3]

My friend the hygienist tells me that they give local and nitrous -- that's all. No biggy.


Oh... :fing02:

[Mophet]

That is both sad and disturbing. As a parent of two small children it makes me scared.

[zippys2k21]

Man oh man, I remember my 3 wisdom teeth getting extracted not too long ago ( maybe 3 years ago), a little lidocaine and then me squeezing my hands very hard together as he was crackin the fused tooth from the mandible. Ahhhh... brain over pain....

[ethernaut]

Man oh man, I remember my 3 wisdom teeth getting extracted not too long ago ( maybe 3 years ago), a little lidocaine and then me squeezing my hands very hard together as he was crackin the fused tooth from the mandible. Ahhhh... brain over pain....

yea, thanks for the image.
looks like i'll be postponing yet another year !!!!

[nojrevorg]

I have had experiences with both. My old Dentist used Sedation, and I felt like crap for the entire day, and could not function. I traveled, had a route canal under local, no problems. very little pain. Agian moved back home and needed some dental work, this time I told the dentist what I was going to allow him to use for sedation, made my own care plan, I felt great. I was awake for the rest of the day. I question his ability to really adequately monitor. He is a fossil, and i think he likes the bill for anesthesia. I dont know I dont trust them very much. It is scary to see that people are now dying under the "pain free dentistry"