Sunday, October 01, 2006

Sedation Tragedy

Her name was Diamond. The little 5 year old who died the other day. She had lapsed into a coma after receiving sedative medications for treatment in a Chicago dental office. We don't yet know what happened. Reports are that she received medications via three different routes including IV. We do not know if the child had any predisposing medical conditions. It appears she went into a deep sedative state and lost her respiratory function; she stopped breathing on her own. We don't yet know what occurred.

This is a very rare event, in fact:

No child has ever died as the result of any dental sedation that has been done in accordance with the Academy of Pediatric Dentistry's guidelines. I know in our state (Alabama) you can only intentionally put the child in a state of conscious sedation (not deep sedation), otherwise you have to follow different protocols, equipment and licensure requirements, like a hospital. I personally have never know of any severe complications in our area.

Most kids do quite well without any kind of extra medication to accomplish treatment. However, sometimes medications are needed to help kids to be comfortable and cooperate to accomplish treatment. Sometimes it is even necessary to do treatment under General Anesthesia in the Hospital. Many times, however, the hospital is not an option due to lack of insurance coverage, limited treatment needs, or parental preference. The option of in office conscious sedation has been a good option to help kids and parents. After extensive training and experience, I use this valuable method of providing treatment nearly every day and am very confident in the use of medications to relieve discomfort, reduce anxiety and provide a safe environment through concious sedation. Every time a parent puts their child in my care, I pray I have the knowledge, skill, and compassion to keep that child safe. Things can be unpredictable. Bad things can happen to anyone, but knowing that, like the Boy Scout motto says: be prepared. God willing, this will never happen again no matter what the reason.

More information here: Sedation in Pediatric Dentistry

Update August 17, 2007: I just saw a news piece on Fox News. Now I like Fox News, but the "news report" was a little overboard. Although the story alluded to the incident with Diamond, most of the story really had little to do with that particular incident. One of the physicians speculated that Diamond had a pre-existing medical condition (which is not improbable). However, the headline of the story was "is laughing gas safe?". What? Patients are awake during nitrous oxide administration. The doctors on the program did give a rational answer that it is safe. In fact, it likely had nothing to do with this unfortunate incident. These very rare problems tend to arise with over-dosage of much stronger medications and the interaction between them combined with pre-existing unknown medical conditions and improper monitoring of the patient. Even local anesthetic can interact with other medicines to create an adverse reaction. I think this news piece will just create unnecessary anxiety in parents that is not based on any scientific or rational information.

Update December 2007: In "Pediatric Dentistry Today" Sept. 2007, Volume XLIII, Number 5, it was reported the child had very large dosages of multiple oral and IV medications. My conclusion is that it was primarily an overdose situation that was not monitored nor handled correctly all along the way.


Anonymous said...

Just curious if you've blogged about the 12 year old who died from not getting tooth extracted. If so I would like the link.


Dr. Dean Brandon said...

Here is a link to the AAPD press release on this issue. That was an instance of a child not receiving recommended dental treatment in time due to various reasons:

AAPD Press release link

sumone said...

My son is 8 years old and still now none of his tooth has fallen. iam worried because at this age tooth should fall and new teeth should be coming. for same age kids i have seen teeth falling and new teeths has come. is there any problem with his tooth or should i take him to any dentist for this reason???

Dr. Dean Brandon said...

The "average" age reange for the first permanent tooth to fall out is 6-7 years of age. 8 is a little late, but not unheard of. Get your dentist to check. They can tell with an x-ray more about timing.

jusmeamom said...

Dr. Brandon, I just happened accross your blog and have been reading some posts. I have not seen you comment on the MTHFR polymorphism which can actually cause brain damage or developmental delays when a child is give Nitrous Oxide or other forms of anesthesia for sedation. It is much more common than you would think and involves the Methylation Pathway. I would encourage you and your readers to look it up. The test for this genetic polymorphism can be done via Labcorp and Quest, it is a blood test and after insurance it can cost as little as 5$ to less than a $1 for the patient. My son is homozygous and we would not be aware had he not been tested.

Anonymous said...

Dr. I have MTHFR (Homozygous 1298C) and worry about my toddlers. One just did trauma to her frenulum and two front teeth. They have turned gray. What are your views on sedation with MTHFR considered?

Dr. Dean Brandon said...

MTHFR is a genetic related condition (as I am sure you are aware). There are many considerations with dental treatment depending on how it manifests. Still, if a kid bumps their tooth and it turns dark, that is likely from the trauma and is quite common. I cannot say, but I would suggest reading my post on "my child's tooth is turning dark", and see your pediatric dentist who can give you a better answer as to what to do.

Bram said...

my 23 old month doughter had fused teeth 52+53, she also has medium teeth decay in her uper teeth, we took her to dentist and they recommanded filling her teeth under anesthesia, I am not so sure.

Kristi said...

jusmeamom - I wish I could thank you personally as I've been thankful a thousand times over in my heart. I knew my daughter needed dental work requiring sedation, but my husband and I felt no peace to move forward. Long story short, your comment led me to test for MTHFR and I found out she's homozygous C677T! Aha, the reason we had no peace. So rather than going to a recommended dentist in the boonies that would do the procedure in his office with nitrous oxide (what we felt no peace about), we opted for a dentist in town who did the procedure in a hospital. The dentist, anesthesiologist & staff were not previously aware of MTHFR, but researched it thoroughly and worked to provide safer options for our daughter.

And thank you Dr. Brandon for addressing this issue and promoting awareness of the dangers and the choices.