Meditrina

Here is the link: Dentist visit turns life threatening

and here is the article:


My co-worker turned around and asked me if I go into the dentist office with my children. Once I did not. My daughter was getting a cavity filled and the dentist told me that children react differently with the parent around, I was told to wait in the waiting room. My chest was hurting so much, I could not stand not knowing what was happening. Never, ever again. I will always go in the room from now on. If my dentist does not like it, I will bring a printed copy of this article.

Is it common practice to make the parents wait outside when sedating a child? I sure hope not.

If you have children, do you go in to the dentist office with them? If you don't, will you now? What are your thoughts on this?

In reading the article, I am curious why a 5 year old would have to get caps on her front teeth that are probably still baby teeth?

(This is my first time posting an article. If I did it wrong or it is in the wrong place, please let me know.There was a video too, with more details. But I was not sure if I could post it, or even how to)

Here is the link to the video. Just in case.

http://abcnews.go.com/Video/playerIndex?id=2491909

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stevie667

Thats alot of sedatives, when i had my fillings done i got a shot in my gum and held onto the seat. Definatly a fault there. I've heard a few cases of kids being given too many sedatives by dentists over here, which given the fact that dentists are not anethatists doesn't suprise me too much when it happens, even though it is horribly tragic.

What i'm curious about is why does a 5 year old need two fillings? Sheesh.

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Cynthetiq

seems like a little much for a 5 year old...

my parents did not go into the office while I was getting cavities filled from my earliest dental memories to even when I was a teen having braces put on.

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shakran

Dentist, doctor, whatever, I'm in the office with my kid. I suppose if he had major surgery I'd consent to be in the viewing area just outside, for sterility purposes, but I wouldn't even be happy about that. Hell I go back with my dogs when they're at the vet.

Fact is there are a lot of people out there who are lousy at their jobs, and the medical profession is not immune to that. If they won't let me go back there, I find a different doctor.

ngdawg

Why on earth did he give her all that when a single shot of novacaine was enough? I can't help but feel had her mother been in there, she would have at least questioned all that....if that kid dies, I would fully expect the dentist to be charged with negligent homicide.
I only went in with my kids their very first visits, but then again, they have never needed fillings or other work done except for cleanings and flouride sealings.
I seem to recall my mother being in with me at first, until the actual work started.
There are protocols to be followed regarding administering anesthesia that go by age, weight, etc. My sister's friend died as a young teenager from an OD of anesthesia during surgery to correct her scoliosis. That was always in the back of my mind each surgery I went in for....and while it's certainly rare to happen, it shouldn't happen at all.

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ShaniFaye

they were putting caps on a FIVE year old?

my daughter fell when she was about 7 and broke her front two perm teeth....when I called to make the appt the Dentist asked me to make sure I was going to be there for the appt because he would be using gas and didnt want her in the room without me

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guthmund

Absolutely.

My niece, who is all of six, went into surgery last Wednesday where the dentist capped nearly all her back teeth....in silver. They put her under anesthesia to cap them, slap in spacers and clean her front teeth. My sister said it took all of 30 minutes and she was second in a group of five kids undergoing the procedure that day.

When she told me that, I was floored. I'm 27 years old and had a number of procedures done; the most I've ever gotten was some nitrous. And I didn't have any semi-serious surgery until the permanent teeth kicked in. Until then it was "We'll keep an eye on it" or "We're just going to yank it out."

Edit:
I don't have any kids and I don't take my sister's kids to the doctor, but if I did, I would certainly be back there. Not that I would know what to look for; just to be around.

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kutulu

There is a perfectly good reason to keep the parents out of the room. People freak out and can become distrations (not justifying what happened though).

Daniel_

Following a number of similar deaths here in the UK, this was outlawed years ago.

It is no longer allowed for a dentist to anaesthetise a patient in the dental practice - only a licenced anaesthetist (in American it's anestesiologist, I think) may put someone under.

There is a real chance (in the region of one or two percent) of serious complications with any anaesthetic - including death.

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Ustwo

I don't care if parents are in the office when I'm working BUT.....

There are parents so overprotective and babying that their little darling will use that to manipulate the parent. I see it quite often and when their parents leave suddenly their little darling doesn't seem to be in so much discomfort and has no problems with the procedures.

If this is the case, then I ask them to leave. Some dentists are not as patient as I am with it and just don't let anyone back. Overall its better if they are not back, but understanding parents I don't think its a good idea myself.

In reading the article, I am curious why a 5 year old would have to get caps on her front teeth that are probably still baby teeth?

Very baddly rotted teeth do require a form of temporary cap in a child. The story says 'two cavities' but I rather doubt thats the full diagnosis.

Wow what a fluff piece on ABC (just watched it) showed nothing of value, just a scare the parents thing.

Anyways either they gave her too much/the wrong anesthetic, or the child had an undiagnosed condition which caused the issue with the anesthetic.

I'm meeting a pediatric dentist on Thrusday, I'll ask him if he knows anything about the details.

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*Nikki*

I remember when my brother and I were small and my mom took us to the dentist. My brother got to the point where he would not even get in the car to go and was scared to death of the "seatbelts" or "straps" as he called them, in the car. My mom could not understand why all of a sudden my 5 year old brother was terrified of seatbelts. Turns out they had been strapping him down with black belts of some sort as the dentist and my mom had no idea because she was not allowed in the room. Needless to say, she didn't take us there anymore.

While I can understand that parents might hinder the process while being in the room, I don't think as a soon to be parent I would ever consent to having my child anestisized at the dentist.

snowy

Jesus. I had major dental work done as a child (three teeth extractions, had some bottom teeth shaved to make room for the others, and had many, many fillings and seals done) but I NEVER received an intravenous sedative. My dentist, who was a pediatric dentist, would give me some Valium before the procedure (only for the tooth extractions and shavings) and then nitrous oxide during the procedure along with a shot of Novocaine. The Valium would knock me out completely.

I can't imagine why a child would possibly need an intravenous sedative when I found Valium and nitrous oxide to be more than enough. I remember one time after a tooth extraction that I woke up enough in the dentist's office for them to let me go home, and then once in the car I conked out for another hour.

Furthermore, a good dentist doesn't mind if a parent is there during a procedure--they have nothing to hide.

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Marvelous Marv

If the kid was lying there unattended, after being sedated, that is horribly wrong.

That said, there are dentists licensed to sedate. There are offices in which an anesthesiologist handles the sedation. If those are unacceptable to the patient, or the patient's parents, the only other option is general anesthesia at a hospital. Much bigger $$$, and it's a bit of a crapshoot as to whether insurance will cover it.

Just trying to fill in some blanks.

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The_Jazz

Ustwo - I was hoping you'd respond to this thread. I'm very interested to hear what you find out as well as any other opinions you've formed.

edit: as far as whether or not anesthesia use is proper for a 5-year old, I think that there's only one active member of TFP qualified to make that judgement, and he's licensed to do so. Anyone else here critisizing the doctor for its use in general isn't qualified in any way, shape or form to do so.

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jorgelito

Thanks Ustwo for the dentist's perspective and insider look on things. As horrifying as the article was, we still need to keep in mind that we may or may not have all the facts (annoying media).

I don't ever recall any of my parents with me in the dentist office, but my dentist was a children dentist. His office was decked out for kids. There were toys, kids magazines (Dynamite anyone?), balloons and lots of flavored flouride. Oh and stickers too. My favorite part was that he had the hottest, prettiest dental assistants and I just loved it when they leaned in close to "prep" me or start the cleaning on my teeth etc. I think I was 7-12 or so. Loved it! It got to the point whereI would eat some Oreo cookies right before the cleaning so that it would take longer. I loved those girls! Hehehee.... The Oreo thing didn't last too long though.

Pount is I think children's dentists are probably more sensitive to children and parents' needs.

Marvelous Marv

Valium IS a commonly used intravenous sedative. Given orally, its effectiveness is much less predictable. In general, properly administered, IV sedation is safer than oral sedation, since in the event of a problem, an IV line is already open. That means an agent which counters the original drug can easily be administered. However, it looks scarier, and there are certainly people who don't know what they're doing in regard to IV sedation. There are also kids in the world who could readily demonstrate to you why additional sedation is necessary for them.

I'd have to disagree with that statement, at least when it's in blanket terms. As ustwo mentioned, there are times when parents can seriously hinder a procedure. Do all emergency rooms have something to hide as well?

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kutulu

What is the age when parents should start taking their kids to the dentist anyways?

Ustwo

Three and only to get them used to going to the dentist and a quick check.

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kutulu

Thanks. We had asked her doc when she was one and didn't get much of a response from her.

Ustwo

My personal opinon on this.

Sedation is overused in children.

My guess is maybe 20% of the pediatric dentists have NO bussines being pediatric dentists. These are guys who no adult would put up with but can get away with it with kids. Most pedo guys I know are great, but the bad ones stand out.

Sedation is a way of avoiding dealing with children. When I was doing my pedo rotation, I never used sedation once. I also did pedo in a general dental office while in ortho training. Most kids you can talk to as an adult and do ok with. Guys who try to 'ambush' a kid with a needle or pulling a tooth really piss me off. The kid won't trust another dentist again, and when I see adults who are afraid of the dentist its almost ALWAYS due to a bad experiance as a kid.

Hell not long ago I had a parent tell me that the local group practice wanted to give NO2 to a 15 year old for a normal filling. The kid was not afraid and had no reason for it. When I was doing my pedo training, my section had a guy who didn't do sedation and we had no problems. The other side was a instructor who had ALL of the kids on NO2, and his personality put him in that 20% who shouldn't be pediatric dentists.

That being said there are reasons for sedation. IV sedation is not done lightly and normally reserved for difficult children. Some kids NEED the work and behavior wise its not possible to work on them. Also while most parents do not want sedation a sizable minority do want it, and almost insist upon it.

I have no facts to this story as none have been given beyond the coma, but I'm sure there is more too it.

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Gatorade Frost

I'm nearly 20 and if I have to sit through getting a filling, I try to get it. Not because it scares me or bothers me, it's just that if I'm going to sit there for 20-30 minutes having them screwing around with my teeth I might as well get relaxed and zone out.

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Ustwo

Not on a 15 year old who has no use for it. Plus I don't believe in using NO2 as a practice builder for people who want to get stoned but thats another issue.

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Lady Sage

My mom was never allowed back with me as a child... and I had to have all but 2 baby teeth pulled because they wouldnt loosen up. At one point I was in so much pain that they had 4 people hold me down to extract a molar. This of course resulted in a horrid fear of dentists that caused me to not go go back for over 11 years.

Thankfully when I did go back to a dentist I only had one cavity and have a much better dentist now that I like.

If I had kids I would go back with them or they wouldnt work on my child. In my humble opinion a dentist that wont allow a parent with their child to keep them calm must be hiding something. Such as the terrible bedside manner that mine had and/or the lack of charachter to let a child in pain scream and cry rather than give them another shot.

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shakran

Except that, and I'm sure Ustwo will back me up on this, anesthesia is inherently dangerous and can go badly - as we can see from this story. It's not a good idea to be put under unless you NEED to be put under. If they're doing open-heart surgery on me, yeah, I kinda wanna be knocked out. But if it's not absolutely necessary, I'll take a local thank you.

Cynthetiq

more details than the original OP article.

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Meditrina

Thanks for those details.

I understand that doctors/dentists don't want parents in the rooms if they are going to be disruptive. But what about those parents that just sit there quietly and give silent support to their children? Can't a doctor let the parents stay, and if they cause a problem, then ask them to leave?

If my daughter was going under sedation, I'd want to be in the room with her.

I feel for those parents. I hope they get some answers as to what happened to their little girl.

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Lady Sage

UPDATE

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.



I wonder how this will pan out? My thoughts to the family in coping with their loss.

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Cynthetiq

foul......

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analog

A quick note to the people freaking out over not being in the room, and insisting that it's nonsense the mom wasn't in the room, or that you'll be in the room for forever from now on:

She'd have died anyway. You wouldn't have changed anything.

What are you hoping you'd have done? Know better than the doctor with a license in anesthesia? Tell him to stop because you know better than he does?

This is reactionary posturing. There's nothing she could, or would, have done if she was in that room.

Also, to the "3 sedatives sounds like a bit much"... "sedatives" is a very broad word, especially when talking to the general public. Not everything called a "sedative" literally means it puts you to sleep. Some intravenous sedatives simply allow you to relax, like an anti-anxiety drug. Anti-anxiety drugs are often used for sedative purposes, but would not necessarily compound the reduction in the rate of breathing caused by the NO2. Also, children go into respiratory arrest far easier and more frequently than adults do. I am hoping, for the sake of this doctor and the family of the girl, that they find out it was a reaction to something she was given, that could not have been known beforehand.

The ONLY hope would have been if the parent was paying attention to the breathing like a hawk. Given the everyday nature of the events prior to the accident, I doubt very highly that she'd have caught it soon enough for the effects to have been reversible.

The true nature of the story is, she was administered an overdose of anesthesia which stopped her breathing. Even if the mother had noticed the breathing had stopped a little sooner if she'd been in the room AND paying enough diligent attention, the damage would still have been done.

I'm not yelling, or being mean. I'm pointing out the glaring logical fallacy that is causing paranoia and a lot of posturing to go on in here. Calm down. Thank you.

popo

I was asked to comment here so I will.

First off, it's nearly impossible to do so with so little info. What's on ABC News most definitely isn't the whole story. It might seem to most people that IV sedation or general anesthesia is nuts for a 5 year old kid but I can tell you that it's an extremely common procedure. At my institution there are ~20 kids/day given general anesthesia to get dental work done. Some normal kids, some handicapped who just won't tolerate seeing a dentist. It's all very standard and very safe when you consider how many are done and how infrequently tragedy happens.

Was the dentist trained for this? Yes. He had to be by law.

Was too much given? Impossible to say without knowing the details.

Why are 5 year old kids getting crowns? Because they don't brush and have bad habits like going to bed with a bottle. It's way too common.

Should parents be allowed in the operatory? I don't know. It sounds like UsTwo is an orthodontist so he has way more experience dealing with kids than I do. My patients are at the opposite end of the spectrum.

I think that everyone should hesitate before making harsh judgements here. As someone else pointed out before, few here are qualified to pass judgement. What sounds outrageous to you is actually pretty normal procedure. Just keep your kids brushing and importantly, do not show fear of the dentist in front of your kids. That's how they learn to fear it themselves.

analog

Very well said. Kids take their cues on how to react from their parents. If you're all anxiety-stricken over what's going on, you will pass that down to the child.

When I did my EMT rounds, I had a 12 year old girl who passed out in the shower (for a variety of bad medical reasons I won't bother with detailing). The girl was fair to poor, but stable, while we interviewed her, but mom started freaking out when we started to backboard her. The poor girl's vitals started shooting through the roof- her respirations went way up suddenly, she started getting very anxious, and her pressure increased dramatically. I had to tell her to calm down for her daughter, because she was making her very nervous and I needed for that little girl to stay very calm in her condition.

Thankfully, mom calmed down (with the help of dad standing with her) and the girl's numbers all went back to where they were. Talking to her calmly in the back of the ambulance, assuring her that we were doing everything we could to make her feel better, her vitals perked up a bit.

I was told this by every Paramedic I rode with, that a lot of parents do not understand how much their children understand, and how much their reaction is based on your reaction.

ngdawg

It was reported in this morning's Star Ledger that the child has died. The dentist wascertified to administer anesthesia and his license was current . No further details were given.

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Meditrina

Point well taken. The outcome would have surely been the same. I think I'd want to be in there for moral support for my daughter. I would not expect to know more than the expert. I know my daughter would be scared to be sedated. I would stand quietly on the side, just to be there while the sedation was taking place. I'd probably leave while the doctor was doing the procedure because I'd get queasy watching. I would also want to be there when she woke up. I remember getting my wisdom teeth extracted. My mom stayed with me until I was sedated and was there when I woke up. It was greatly appreciated. (Thanks Mom!)

I feel bad for the family as well as that doctor. I can't imagine how he feels.

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stevie667

I've seen this on ride outs too, and watched entire documentaries on the matter. Children immitate their parents, especially when it comes to negative emotions. They take their cues from their parents how to react, so the calmer you can be, in theory, the calmer they should be, in theory.

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Ustwo

My meeting got moved a week, so no new info will be forthcoming.

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shakran

I disagree. The mother FOUND the kid on her side, not breathing. That tells us she wasn't being closely monitored. Fine, but if mom's in the room she's not going to be monitoring the patient one chair over, she's gonna be monitoring her kid. There's an excellent chance that mom would have seen the kid stop breathing and would have raised the alarm. Would it have been in time? We'll never know, but kinda sucks to have that question hanging in the air, doesn't it.

analog

It's possible, yes. Their only hope would have been that she'd noticed the lack of breathing within the first couple of minutes, and the doctor had been alerted to start CPR, awaiting the arrival of an ambulance.

Really, though, the "what ifs" make it impossible to know for sure- and it's ridiculous for paranoia to prevail when we don't yet know exactly what caused the problem in the first place.

The thing that does bother me in general, however, is that there was not even a blood pressure cuff in the facility, let alone a heart monitor.

Marvelous Marv

Analog has spelled it out very well. My question is, WTF was the dentist, who is supposedly certified in sedation of this type, doing working without a pulse oximeter? That's standard of care.

I believe the expert they consulted called it a "finger monitor" in an earlier post.

That alone would likely have prevented the girl's death. Monitoring her most likely would have, too.

Admittedly I wasn't there, but these two things scream out at me.

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Ustwo

Well the mother said he didn't have one and then later said 'they put the thing on her finger and there was no plus' that thing would have been a pulse oximeter.

So in other words we need to wait for details.

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Gilda

Hmmm. My first trip to the dentist was when I was 25. I still try to put off my yearly checkup as long as possible until someone in my family insists that I go, because going to the dentist is one of my least favorite things. Hell, physical therapy was more pleasant than a visit to the dentist.

It's a good thing, though, because it means I didn't have to have braces like all the other kids with crooked teeth did. Dodged a bullet there.

I don't think I'd want to be in the dentist's office with my child. I can't stand to see people I love in pain, especially when there's nothing I can do about it.

Gilda

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