child dental death

[painstop]

It's always sad reading about these cases regardless of the credentials of the providers involved.


3-Year-Old Stockton Girl Dies During Dental Procedure

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[Planktonmd]

It's always sad reading about these cases regardless of the credentials of the providers involved.


3-Year-Old Stockton Girl Dies During Dental Procedure

I wish we had more details.

 

[anbuitachi]

yea, that article is pretty detailess,

perhaps she had anaphylaxis to one of the meds

 

[anbuitachi]

Though from the article, i did learn that you can become a anesthesiologist by going to DENTAL school!. You do not have to go to MD or DO school. You can do a 2-3 year residency in dental anesthesiology and have equal priviledges as MD anesthesiologists. DDS anesthesiology residencies are 2-3 years in length. Sounds like a great and economical way to become an anesthesiologist

All the attending anesthesiologists in that dental center are DDS anesthesiologists
Children's Dental Surgery Center - dental care for children, dentist for children, pediatric dentistry, pediatric dental care

 

[urge]

Though from the article, i did learn that you can become a anesthesiologist by going to DENTAL school!. You do not have to go to MD or DO school. You can do a 3 year residency in dental anesthesiology and have equal priviledges as MD anesthesiologists. DDS anesthesiology residencies are 2-3 years in length. Sounds like a great and economical way to become an anesthesiologist

All the attending anesthesiologists in that dental center are DDS anesthesiologists
Children's Dental Surgery Center - dental care for children, dentist for children, pediatric dentistry, pediatric dental care

Scary how little some people know their own field.

 

[anbuitachi]

I dont think it's that commonly known.... esp if you never worked/rotated thru a dental practice

 

[Tuohy]

Looks like they may need to update their FAQ section:

Frequently Asked Questions FAQ's - Children's Dental Surgery Center - dental care for children, dentist for children, pediatric dentistry, pediatric dental care

"Pediatric Dentists and Dental Anesthesiologists have an extensive safety record in anesthesia procedures. At this time, we are not aware of a single case of morbidity or mortality when the American Academy of Pediatric Dentistry guidelines have been followed conscientiously."

I am curious as to what the standards/parameters are for a dental anesthesiology residency.

 

[BLADEMDA]

Looks like they may need to update their FAQ section:

Frequently Asked Questions FAQ's - Children's Dental Surgery Center - dental care for children, dentist for children, pediatric dentistry, pediatric dental care

"Pediatric Dentists and Dental Anesthesiologists have an extensive safety record in anesthesia procedures. At this time, we are not aware of a single case of morbidity or mortality when the American Academy of Pediatric Dentistry guidelines have been followed conscientiously."

I am curious as to what the standards/parameters are for a dental anesthesiology residency.

Dental Anesthesiology

Advanced Education and Residency Program in Dental Anesthesiology | School of Dental Medicine | University of Pittsburgh

https://www.adba.org/diplomate-resources/residency-programs/

 

[caligas]

The only dental I do is in the OR: nasal intubation, GA. What is typically used in the office setting? Propofol infusion?

Not sure about not having a secure airway with the dentist mucking around in the mouth, but maybe that's common?

 

[nimbus]

yea, that article is pretty detailess,

perhaps she had anaphylaxis to one of the meds

People always bring up anaphylaxis and underlying heart issues but they are just red herrings. Most of the time it's airway.

 

[anbuitachi]

People always bring up anaphylaxis and underlying heart issues but they are just red herrings. Most of the time it's airway.

yea but the clinic is saying they are not sure what caused the death. if its airway, you'd think the anesthesiologist at least can tell that it was cause of airway.

but i guess could be something like laryngospasm needing succinicyocleine causing cardiac arrest

 

[nimbus]

yea but the clinic is saying they are not sure what caused the death. if its airway, you'd think the anesthesiologist at least can tell that it was cause of airway.

Sometimes they say they don't know rather than admit they f***ed up an airway e.g. Joan Rivers. They were pulling all kinds BS on that one too....but it was pretty obvious once the story unfolded.

 

[BLADEMDA]

The only dental I do is in the OR: nasal intubation, GA. What is typically used in the office setting? Propofol infusion?

Not sure about not having a secure airway with the dentist mucking around in the mouth, but maybe that's common?

Yes, that's the typical approach: Sedation with an unsecured airway in the office.

 

[anbuitachi]

Yes, that's the typical approach: Sedation with an unsecured airway in the office.

im guessing propofol mainly? kind of like egd?

 

[deleted162650]

Propofol + open airway + throat pack

 

[leaverus]

i hate to say it but, i think certain race(s) ignore the NPO thing because they feel like they're needlessly "punishing" the child before surgery. my guess is aspiration from a full stomach.

also, dds anesthesiologists can practice fully within the same scope as MD/DO? they can work in a regular OR environment like us??

 

[urge]

In before it is closed.

 

[urge]

i hate to say it but, i think certain race(s) ignore the NPO thing because they feel like they're needlessly "punishing" the child before surgery. my guess is aspiration from a full stomach.

also, dds anesthesiologists can practice fully within the same scope as MD/DO? they can work in a regular OR environment like us??

Ouch!

 

[Robotic Wis-Hipple]

Pretty sure dental Anesthesiologists train to be almost entirely office based.

The residency program i'm aware of had the dentists rotate on about half of the rotations/services that the MD/DO residents did, for 1 less year. They were not involved in the didactics as they had their own, they had lectures and clinical half days at the dental school. From a rotation standpoint they did no neuro, thoracic, or cardiac. Aside from peds, they did a lot of ortho and cysto.

 

[ElmerFudd]

It's always sad reading about these cases regardless of the credentials of the providers involved.


3-Year-Old Stockton Girl Dies During Dental Procedure

The article said "anesthesiologist".

Knowing what we know about the media, that could mean an actual anesthesiologist, a dental anesthesiologist, a nurse-anesthetist, or an anesthesiology assistant.

As it turns out, it was a dental anesthesiologist. Not as bad as a CRNA - at least you know this guy was intellectually gifted enough to get into dental school - but he's still some schmuck without a medical degree who got two to three years of training in anesthesia.

 

[Robotic Wis-Hipple]

Propofol + open airway + throat pack

Open airway AND a throat pack? What could go wrong?

 

[anbuitachi]

Pretty sure dental Anesthesiologists train to be almost entirely office based.

The residency program i'm aware of had the dentists rotate on about half of the rotations/services that the MD/DO residents did, for 1 less year. They were not involved in the didactics as they had their own, they had lectures and clinical half days at the dental school. From a rotation standpoint they did no neuro, thoracic, or cardiac. Aside from peds, they did a lot of ortho and cysto.

I think most of them do end up going into dental anesthesiology. They get paid well there. But legally they can do anything anesthesiologist can. I read there are dental anesthesiologists doing Cardiothoracic in some hospitals

 

[Robotic Wis-Hipple]

I think most of them do end up going into dental anesthesiology. They get paid well there. But legally they can do anything anesthesiologist can. I read there are dental anesthesiologists doing Cardiothoracic in some hospitals

I'm gonna call shenanigans on that. They don't take ABA boards, and as a relatively new specialty I can't imagine there's a bunch of them out there grandfathered into hospital OR jobs.

 

[ElmerFudd]

I think most of them do end up going into dental anesthesiology. They get paid well there. But legally they can do anything anesthesiologist can. I read there are dental anesthesiologists doing Cardiothoracic in some hospitals

Where did you read this? I'd love to read that story.

I'd be hard-pressed to find any state that would consider providing anesthesia for an aortic valve replacement to be the practice of dentistry.

I also have an extremely hard time believing that any hospital with access to anesthesioligists would hire or credential a dentist to provide anesthesia for any kind of surgery, let alone cardiac procedures.

 

[Arch Guillotti]

I read there are dental anesthesiologists doing Cardiothoracic in some hospitals

Provide source otherwise this is fake news.

 

[Pooh & Annie]

i hate to say it but, i think certain race(s) ignore the NPO thing because they feel like they're needlessly "punishing" the child before surgery. my guess is aspiration from a full stomach.

I've sometimes felt like Medicaid or charity-care patients push things, my interpretation being that they feel like they're being taken advantage of for being poor or "looked down upon." I've NEVER felt like compliance with NPO requirements was influenced by "race." But I guess I haven't lived everywhere.

 

[facted]

We had a dental anesthesiologist at our institution (and had a few trainees as well). As attendings, the guy only did dental anesthesia cases for the vast majority. I heard reimbursement from insurers was lower for non dental cases of he did the cases vs regular attending.

 

[drmwvr]

First hand experience with a DDS anesthesiologist at a New England VA that did Thoracic to vascular on down the list. That was over 20 years ago though...in his 30's. I assume he stayed there.

 

[ElmerFudd]

First hand experience with a DDS anesthesiologist at a New England VA that did Thoracic to vascular on down the list. That was over 20 years ago though...in his 30's. I assume he stayed there.

Are you aware that 20 years ago dental anesthesiology was a one year training program? If CRNAs can't learn much about cardiac and pulmonary physiology in 24 months of training, then a dentist can't learn it in 12.

 

[BLADEMDA]

Are you aware that 20 years ago dental anesthesiology was a one year training program? If CRNAs can't learn much about cardiac and pulmonary physiology in 24 months of training, then a dentist can't learn it in 12.

Most hospitals demand ABA eligibility then certification these days to stay on staff. Stop worrying about 20-25 years ago as that's not relevant to this discussion any more than a CRNA who got his or her "Diploma" from a local hospital in the 1950s.


https://www.adba.org/


Adequate experience in the unique aspects of dental anesthesia care with and without the use of an anesthesia machine and operating room facilities should be provided. Supervising dentist anesthesiologists shall have completed a CODA-accredited dental anesthesiology residency program or a two-year anesthesiology residency for dentists consistent with or equivalent to the training program described in Standard 2. A one-year anesthesiology residency for dentists completed prior to July 1993 is acceptable provided that continuous significant practice of general anesthesia in the previous two years is documented.

 

[BLADEMDA]

Are you aware that 20 years ago dental anesthesiology was a one year training program? If CRNAs can't learn much about cardiac and pulmonary physiology in 24 months of training, then a dentist can't learn it in 12.

I believe the last year of the "one year programs" was 1993. Today, the requirements are much stricter and a "Board Certification" with exams is in place. Anyone who is giving sedation in a dental office since 1993 is likely competent and experienced enough to continue doing so. I wouldn't worry about "competition" from the Dentists at your local hospital or even ASC. Instead, these people typically take cash or credit cards only at the Dental office and tell the patients to file their own insurance claims (if they have insurance).

CRNAs are providing lots of "dental office sedation" with less training than these modern Dental Anesthesiologists. If a CRNA can provide sedation in an office setting to pediatric patients then so can these Dental Anesthesiologists.

 

[BLADEMDA]

Deaths of Children During Dental Procedures Raise Safety Concerns
Anesthesia complications suspected; state rules differ




http://www.anesthesiologynews.com/P...ocedures-Raise-Safety-Concerns/36890/ses=ogst

 

[BLADEMDA]

Meet The Anesthesiology Provider Coral Springs FL | Oral Surgery CRNA


Why are kids dying at the dentist?

 

[BLADEMDA]

I.V. Sedation Services

We are pleased to introduce Robert Rota C.R.N.A., Ph.D. who has been providing us with I.V. sedation services in our office for patients who require it. Mr. Rota is a Mayo Clinic School of Anesthesia graduate (1977) with over 25 years experience and 25,000 cases to his credit.

We’ve chosen this professional for I.V. expertise in our office because of both safety and efficiency. Our team approach allows the anesthetist’s constant, personal and state-of-the-art electronic monitoring while we remain focused on providing quality endodontic or implant care without distractions. This provides for single-visit endodontic treatment, usually in 1-2 hours. Because your comfort and safety are our main concern, we do require that you bring a friend or relative to drive you home following an I.V. sedation procedure.

To provide you with the best service and personal attention, I.V. Sedation services require at least two weeks advance scheduling. A $400 deposit is required upon scheduling and must be secured by credit card. This deposit will be applied toward your final billing for sedation services. A two week cancellation notice is required and failure to do so will result in the loss of your deposit. The anesthetist’s fees are separate and distinct from those charged for service provided by Endodontic Specialists. Payment for Mr. Rota’s services are required at the time of service in the form of cash, personal check or credit card. Generally I.V. sedation services for dental procedures are not covered by insurance, however, Mr. Rota will provide you with a billing statement to submit to your insurance for reimbursement.

Base Fee:
$495—includes all medications, I.V. supplies, monitoring equipment, pre-treatment consultation and medical history.

The base fee also includes the 1st hour of the anesthetist’s services.

Additional Fees:
$75 per 15 minute increment following 1st hour.



Thank you for your effort to save a tooth. It is a wise decision and we are pleased to be part of the effort.


I.V.Sedation Services Colorado Springs CO, Endodontic Specialists of Colorado, PC

 

[BLADEMDA]

Large Malpractice Firms all want this case: UPDATE: Daleyza Avila Hernandez Died After Dental Procedure In Stockton at The Children’s Dental Surgery Center

 

[anbuitachi]

Deaths of Children During Dental Procedures Raise Safety Concerns
Anesthesia complications suspected; state rules differ




http://www.anesthesiologynews.com/P...ocedures-Raise-Safety-Concerns/36890/ses=ogst

Got to love it when the CRNA Juan Quintana is referred to as Dr. Quintana all over this article.
And it's also confusing when the ASA says "
Being a medical specialty, the American Society of Anesthesiologists (ASA) “has no authority or position regarding dentistry—that would fall under the state dental boards,” said Andrew Herlich, MD, ASA’s liaison to ADA’s Committee on Anesthesia. “Safe anesthesia care is our top priority.”

Are they referring to dentistry.. or the anesthesia in dentistry.. (since it is the ASA..). Cause I'd imagine ASA is in a position to comment on any anesthesia practice as long as it's on a human

 

[BLADEMDA]

Pediatric dental anesthesia: The Dental Board gets it wrong
4th January, 2017



Pediatric dental anesthesia: The Dental Board gets it wrong

 

[ElmerFudd]

Meet The Anesthesiology Provider Coral Springs FL | Oral Surgery CRNA


Why are kids dying at the dentist?

What amazes me is the fact that no one has directly addressed the fact that a dental anesthesiologist is a dentist, which means that his or her knowledge of cardiac and respiratory physiology is virtually nil.

My wife is a dentist who finished near the top of her class. We started medical and dental school (respectively) at the same time. So I have some insight into what her education covered. And when it came time for her to do her GPR and she had to get her ACLS certification, her understanding of the material was likewise virtually nil. I had to teach her all of it from scratch, and even then, the underlying physiology was alien to her. She had only a rudimentary understanding of cardiology. There is no way you can take a dentist and turn him into an anesthesiologist with three years of residency. No way.

 

[ElmerFudd]

Got to love it when the CRNA Juan Quintana is referred to as Dr. Quintana all over this article.
And it's also confusing when the ASA says "
Being a medical specialty, the American Society of Anesthesiologists (ASA) “has no authority or position regarding dentistry—that would fall under the state dental boards,” said Andrew Herlich, MD, ASA’s liaison to ADA’s Committee on Anesthesia. “Safe anesthesia care is our top priority.”

Are they referring to dentistry.. or the anesthesia in dentistry.. (since it is the ASA..). Cause I'd imagine ASA is in a position to comment on any anesthesia practice as long as it's on a human

Let dentists kill their own patients. Trust me, we want none of that action!

 

[facted]

I hate to rain on the parade, but my training program also trained dental anesthesiologists and I had one in my residency class. This person was excellent and did all the rotations that everyone else did in anesthesia and they even took the intraining exams, etc...They were wonderful, super smart, were super respected, and could handle an airway and all the cardiac/pulm physiology like anyone else in the residency.

We have no idea what happened in this terrible case, and to speculate about it is really pretty shameful if you ask me. Who knows what happened? Don't assume for a second it couldn't happen to you. **** happens.

 

[waterbottle10]

I think it's pretty stupid to have two different boards. Why is general anesthesia in dental clinics considered to be different? Like the article said, they are resisting cause of financial reasons and kids are getting injured cause of it. Messed up

 

[ElmerFudd]

.

 

[ElmerFudd]

I hate to rain on the parade, but my training program also trained dental anesthesiologists and I had one in my residency class. This person was excellent and did all the rotations that everyone else did in anesthesia and they even took the intraining exams, etc...They were wonderful, super smart, were super respected, and could handle an airway and all the cardiac/pulm physiology like anyone else in the residency.

We have no idea what happened in this terrible case, and to speculate about it is really pretty shameful if you ask me. Who knows what happened? Don't assume for a second it couldn't happen to you. **** happens.

I'm going to call you out on your BS there, buddy.

My wife's understanding of EKGs when she started her GPR was limited to knowing normal EKG anatomy and identifying atrial fibrillation. Beyond the risk of stroke and need for blood thinners in some patients, I distinctly recall that she didn't know that afib had other clinical ramifications. She had no knowledge of what regions of the heart the different leads represented. It wasn't even touched upon in her dental school curriculum. Her exposure to cardiology was really that limited. And I think it's a safe bet that the words "VQ mismatch" would have been equally unfamiliar to her. And again, she finished near the top of her class.

You're going to tell me that you can take someone like this and teach them medicine and anesthesiology.....in one less year than it takes to train us? Fuggedaboutit!

I look at these dental anesthesiologist as being equivalent to CRNAs, with one important difference: they are more intelligent than CRNAs.

 

[Tuohy]

http://www.anesthesiologynews.com/P...ocedures-Raise-Safety-Concerns/36890/ses=ogst

And therein lies one of the problems, each state sets their own standards-just like independent state licensure. Simply a money grab for each individual state and a way to employ a bunch of incompetent bureaucrats in each state. We need nationwide standards.

 

[facted]

I'm going to call you out on your BS there, buddy.

My wife's understanding of EKGs when she started her GPR was limited to knowing normal EKG anatomy and identifying atrial fibrillation. Beyond the risk of stroke and need for blood thinners in some patients, I distinctly recall that she didn't know that afib had other clinical ramifications. She had no knowledge of what regions of the heart the different leads represented. It wasn't even touched upon in her dental school curriculum. Her exposure to cardiology was really that limited. And I think it's a safe bet that the words "VQ mismatch" would have been equally unfamiliar to her. And again, she finished near the top of her class.

You're going to tell me that you can take someone like this and teach them medicine and anesthesiology.....in one less year than it takes to train us? Fuggedaboutit!

I look at these dental anesthesiologist as being equivalent to CRNAs, with one important difference: they are more intelligent than CRNAs.

Yes, you can. My training program did it and these people did just fine on rotations and took our in training exams and did fine.

 

[Pharmado]

We can debate training forever. The fact is that they aren't as well trained as we are. Best case scenario is that they have a year less training in anesthesia, this 2/3 of the anesthesia training that we receive.

Another huge aspect is the conditions they are working under. Doing IV sedation on a kid with an unsecured airway is asking for trouble. By the time you recognize the kid has stopped breathing, get the dentist to move out of the way and adjust the chair so you have access, the kid may already be blue. We all know that kids are generally resilient, but they can also surprise you at unexpected times. To me the bottom line is that the practice of office based dental anesthesia is risky, even under the best of conditions with the most skilled providers. Dentists doing both procedure and sedation aren't in that group, neither are CRNAs or independent dental anesthesia personnel. Things could still go wrong with an anesthesiologist doing the sedation as well.

 

[chocomorsel]

What amazes me is the fact that no one has directly addressed the fact that a dental anesthesiologist is a dentist, which means that his or her knowledge of cardiac and respiratory physiology is virtually nil.

My wife is a dentist who finished near the top of her class. We started medical and dental school (respectively) at the same time. So I have some insight into what her education covered. And when it came time for her to do her GPR and she had to get her ACLS certification, her understanding of the material was likewise virtually nil. I had to teach her all of it from scratch, and even then, the underlying physiology was alien to her. She had only a rudimentary understanding of cardiology. There is no way you can take a dentist and turn him into an anesthesiologist with three years of residency. No way.

There are some dental schools that sit in with medical students during their first two years. So not all dental schools are created equal.

 

[chocomorsel]

I'm going to call you out on your BS there, buddy.

My wife's understanding of EKGs when she started her GPR was limited to knowing normal EKG anatomy and identifying atrial fibrillation. Beyond the risk of stroke and need for blood thinners in some patients, I distinctly recall that she didn't know that afib had other clinical ramifications. She had no knowledge of what regions of the heart the different leads represented. It wasn't even touched upon in her dental school curriculum. Her exposure to cardiology was really that limited. And I think it's a safe bet that the words "VQ mismatch" would have been equally unfamiliar to her. And again, she finished near the top of her class.

You're going to tell me that you can take someone like this and teach them medicine and anesthesiology.....in one less year than it takes to train us? Fuggedaboutit!

I look at these dental anesthesiologist as being equivalent to CRNAs, with one important difference: they are more intelligent than CRNAs.

You know abou ONE dental school. And using that to make a very broad generalization. And arguing with someone who actually trained with a dentist anesthesiologist. Your n=1 of your wife does not apply to all dental schools and dentists.

 

[anbuitachi]

You know abou ONE dental school. And using that to make a very broad generalization. And arguing with someone who actually trained with a dentist anesthesiologist. Your n=1 of your wife does not apply to all dental schools and dentists.

The issue is probably lack of standardization. I am not taking sides, but it sounds like your n=1 as well. So i guess it just shows how much variability there is.

 

[facted]

The issue is probably lack of standardization. I am not taking sides, but it sounds like your n=1 as well. So i guess it just shows how much variability there is.

Eh, I actually know a few dental anesthesiologists who trained at my program and they're all just fine... Though there was only one in my year. Regardless, it's impossible to know what happened in this case and therefore impossible to know if all the training in the world would have made a difference.

I think we can all agree sedated kids without a protected airway with a surgeon working in the mouth in any setting, but esp dental office, is asking for trouble, and occasionally it happens.