Hawaii 3-year-old dies after dental procedures

The child was diagnosed by the dentist and scheduled for procedures on 10 teeth, including root canals on four teeth and fillings in the others.

The toddler in Hawaii went into a coma after the procedure Dec. 3 and was later diagnosed as in "a persistent vegetative state,'' Fried said.

Hawaii 3-year-old dies after dental procedures

First tonsil procedure lets 13 years old in coma, now 3 year old very similar story because a dental procedure, could it be something related to anesthetics?

mods please change to general news, i couldn't find the forum

reply to post by Indigent


yeah, i read that earlier, what 3 year old needs root canal treatment and 10 FILLINGS on milk teeth? having problems with my own dentists lazy work, but this is shocking.

Tragic...
The guy was obviously racking up unnecessary procedures to make money.
Who does root canals on baby teeth? Hopefully this will become a criminal proceeding.

Knocking someone out is not easy, it is very dangerous in general to do.

Thats why anesthetization exist as a field, it can be a bit of art and science, what works for one human may not work with another.

Its something anyone should consider as a risk when considering any procedure that would require being put out.

reply to post by Indigent


Halothane and isoflurane- toddlers have a narrow window for efficacy vs adverse effects. im surprised the dentist was even doing these procedures, but it is possible the tot had some other issues that made procedures necessary and contributed to the outcome.

reply to post by benrl


so true, each person is different : height, weight,sex, medications they are on, any preexisting coditions, type of procedure, how long the procedure will last, they compute all this and come up with the right amount to knock you out but, not kill you...it is an art.

that dentist was doing all that work on baby teeth??? that is questionable for sure

If the 4 teeth were her molars which she would need for many years then that would justify the root canals. The fillings I would imagine would only be needed if the teeth were giving her problems/pain or showing a lot of decay.

Baby teeth hold places for the adult teeth. If the child looses them too early it can cause crowding in the mouth when the adult teeth start to come in.

I can not imagine any other reason this much work would be done in this childs mouth, but I do question why so much was done at one time?

reply to post by Indigent

I WAS a DA. FOR SEVERAL YEARS ,never saw a root canal in baby teeth,maybe caps that were comming off after de dentition was completed,strange indeed....

Indigent

First tonsil procedure lets 13 years old in coma, now 3 year old very similar story because a dental procedure, could it be something related to anesthetics?

mods please change to general news, i couldn't find the forum

They're sort of similar. McMath made it out of recovery fine, was awake and talking when she had a hemorrhage from the surgical site and effectively drowned in her own blood. This kid apparently had a post procedure hemorrhage and choked too.

This kid may have been oversedated as well. They didn't use gaseous anesthetics, though, someone said something about isoflurane, you wouldn't normally use that in a dental procedure and it takes an anesthesiologist or nurse anesthetist to administer, plus a really expensive machine.

Kids getting procedures like this, you often give them ketamine, sometimes with propofol, sometimes fentanyl, and you are supposed to have them on a pulse ox, NIBP and heart monitor, maybe a co2 monitor. This guy used atarax, nitrous, chloral hydrate and demerol. Who gives demerol for anything anymore? The beauty of ketamine is that it doesn't have a lot of side effects in kids (not so much in adults), you've got a HUGE range of safe dosing and it works like a charm. If you need them a bit more relaxed, a hair of propofol would do, and fentanyl for pain control. The great part of using fentanyl and propofol is that they have a very short half life. Minutes in a kid.

Demerol, atarax, and chloral, not so much. You give those, and you're stuck with it for hours.

You need at least an RN riding the monitors and drips, with no other duties. And you need a full set of code meds, an AED and an ambu bag and someone with PALS certification in case things go bad. You also want to give them an anti-emetic so they don't barf and inhale it, and you have the RN get vital signs every five minutes from the time you push the meds until the kid is awake and recovered about 75% of baseline. If it's an oral surgery, you have to have suction available and you have to constantly watch for bleeding.

What you don't do is dose them up, get no vital signs, have no monitoring RN and toss them in a room alone to recover on their backs. This guy should get the book thrown at him.

eta: apparently the dentist was trying to get deep sedation with oral meds to avoid putting in a line. Bad bad move. PO sedation lasts forever, and it's totally uncontrollable. You do oral surgery, you put the line in.

reply to post by Indigent


I wouldn't let a dentist put me under with anesthesia let alone my 3 year old. Dentists are not thoroughly trained in anesthesia compared to a registered anesthesiologist. You risk complications with anesthesia during surgery, just think about the heightened risk when it's being applied by a dentist who is not a registered anesthesiologist.

I may be wrong but I thought that a child's first dental appointment was around 5 years of age. Why doesn't the article address the reason for this major dental care? A dentist should know better than to do multiple massive procedures on a toddler. Where were the parents on this decision?

The first question I have is; who in their right mind would even suggest such procedures for a 3 year old? If such was necessary then why was it not done at a hospital where you have proper personnel and equipment to handle an emergency if needed?

The parents of the child should have questioned the necessity first and get a second opinion or even a third before allowing this. The dentist should be facing charges on every point that can not be proved to be 100% necessary to the well being of the child. If the drugs used were not used properly or prescribed usage in this manor, then the dentist should face charges of reckless endangerment of a child and at a minimum unintentional murder and I do not mean manslaughter either.

This whole situation stinks of unnecessary procedures and fraud. On a 3 year old, what lunacy!

being the father of a 5 yr old who has numerous cavities, I have been told that is it quite common now for children 6 and under to have many cavities, even root canals on back molars.

Options are to put the child under or use Demerol / laughing gas combinations.

Any dentist office that offers sedation either brings in a registered anesthesiologist, or sends the child to the hospital to have the cavities done there under their anesthesiologist.

It is suggested to only put fillings into teeth that are so rotten that the nerve may become exposed and cause major pain before that tooth comes out naturally.

When I asked my dentist why so many kids have cavities at an early age (since I didn't have any at that age and even the dentist thought it was unheard of when she was young) the response was that things changed dramatically when the local civic authorities chose to not fluoridate the water supply anymore.

if you have fluoride in your water you may or may not have the same situation. Apparently dentists have stats on the rise in child cavities based on the year water fluoridation ended.

I am not advocating anything here about fluoride, it would be interesting to know what the child cavity rate is for locations that have never had water treated.

reply to post by passit

if you have fluoride in your water you may or may not have the same situation.

Quite peculiar how a chemical that's been shown to be effective as a topical treatment only then gets promoted as just as effective via ingestion on very loose and hotly debated 'evidence'.

“Although the prevalence of caries varies between countries, levels everywhere have fallen greatly in the past three decades, and national rates of caries are now universally low. This trend has occurred regardless of the concentration of fluoride in water or the use of fluoridated salt, and it probably reflects use of fluoridated toothpastes and other factors, including perhaps aspects of nutrition.”
SOURCE: Cheng KK, et al. (2007). Adding fluoride to water supplies. British Medical Journal 335(7622):699-702.

it would be interesting to know what the child cavity rate is for locations that have never had water treated.

“In most European countries, where community water fluoridation has never been adopted, a substantial decline in caries prevalence has been reported in the last decades, with reductions in lifetime caries experience exceeding 75%.”
SOURCE: Pizzo G, et al. (2007). Community water fluoridation and caries prevention: a critical review. Clinical Oral Investigations 11(3):189-93.

“A very marked decline in caries prevalence [in Europe] was seen in children and adolescents…The number of edentulous adults in Europe has also been declining considerably.”
SOURCE: Reich E. (2001). Trends in caries and periodontal health epidemiology in Europe. International Dentistry Journal 51(6 Suppl 1):392-8.

^bear in mind the majority of those European countries don't fluoridate.

“During the past 40 years dental caries h as been declining in the US, as well as in most other developed nations of the world… The decline in dental caries has occurred both in fluoride and in fluoride-deficient communities, lending further credence to the notion that modes other than water fluoridation, especially dentrifices, have made a major contribution.”
SOURCE: Leverett DH. (1991). Appropriate uses of systemic fluoride: considerations for the ’90s. Journal of Public Health Dentistry 51: 42-7.

“The current reported decline in caries tooth decay in the US and other Western industrialized countries has been observed in both fluoridated and nonfluoridated communities, with percentage reductions in each community apparently about the same.”
SOURCE: Heifetz SB, et al. (1988). Prevalence of dental caries and dental fluorosis in areas with optimal and above-optimal water-fluoride concentrations: a 5-year follow-up survey. Journal of the American Dental Association 116: 490-5.

“The decline in caries prevalence in communities without fluoridated water in various countries is well documented. The cause or causes are, at this time, a matter of speculation.”
SOURCE: Leverett DH. (1982). Fluorides and the changing prevalence of dental caries. Science 217: 26-30.

reply to post by Lucid Lunacy


Thanks for all the evidence. I guess I'll have to brig this up with our dentist and see what they say. Still, there is something that is causing children to have multiple cavities before the age of 5. There are pediatric dental centres here who are so busy the wait is often many months to get an appointment. And it's not like they are fooling with us, I can see the cavities myself in her mouth.

reply to post by passit


Do you use a decent water filtration system or drink tap? Chlorine is typically added to water supply to fight off harmful pathogens but it also kills beneficial bacteria. This is me just taking a wild stab, but I wonder if chronic oral exposure to chlorine is disrupting the mouths natural defense against cavities.

Lucid Lunacy
Do you use a decent water filtration system or drink tap? Chlorine is typically added to water supply to fight off harmful pathogens but it also kills beneficial bacteria. This is me just taking a wild stab, but I wonder if chronic oral exposure to chlorine is disrupting the mouths natural defense against cavities.

edit on 8-1-2014 by Lucid Lunacy because: (no reason given)

That's some damn good thinking there!

Chlorine killing beneficial bacteria in the mouth... interesting!

I must have a good dentist, because I begged him to knock me completely out to get three teeth pulled (molars) and he said NO! I asked if I could go to the hospital to have it done, and he said NO! I think he understands the dangers of being knocked out for oral surgery and does not want to go that route. He told me I'd be fine with a local and perhaps some valium for nerves.

passit
reply to post by Lucid Lunacy

 

Thanks for all the evidence. I guess I'll have to brig this up with our dentist and see what they say. Still, there is something that is causing children to have multiple cavities before the age of 5. There are pediatric dental centres here who are so busy the wait is often many months to get an appointment. And it's not like they are fooling with us, I can see the cavities myself in her mouth.

My husband works at a grocery store, and tell me about all the parents who come through buying liters of soda or cases of mountain dew, or big things of Sunny D, Tampico, or Hawaiian Punch. I'm going to take a stab and say that children have rotting teeth is, on the bottle or pacifier too long, or one of the above. Not all, but some.

reply to post by Taissa


people can react badly to topical anesthetics too, you could be allergic or have hypertension problems due to it