Why Did A Routine Dental Visit Cut A Child’s Life Too Short?

A 14-month old Austin, Texas girl (Daisy) was supposed to have two cavities fixed at Austin Children’s Dentistry. It was a routine procedure with general anesthesia. Betty Squier, Daisy’s mom, was asked to comfort her daughter until the anesthesia was administered; then she was to wait in the waiting room. Betty said within 15 minutes, the dentist came out to say he needed to fill six cavities; he would do four crowns on top and two on bottom. Squier said she trusted that the dentist was making the right decisions for her baby girl. A short time later Betty was alerted that Daisy had gone into cardiac arrest, but CPR was performed and the child was fine. But, moments later an ambulance arrived and Daisy was rushed to the hospital; she was already brain dead when she arrived. Five hours later, Daisy’s heart stopped and she passed away. The child had no previous medical conditions.

It is not clear what exactly went wrong that morning; it may take weeks to get answers from the medical examiner. All that is known is Daisy died after a fairly common dental procedure and her parents want answers.

Dentists say it is not uncommon for young children to receive general anesthesia for routine dental procedures, especially when there is a large amount of dental work to be done or when it is not possible to safely perform dental procedures otherwise (such as a young patient who may be anxious or can’t sit still during the procedure). But, they say, it takes extensive training to learn how to administer sedation safely and be prepared to deal with emergencies. Vital signs and respiration for the child while they are in the dental chair have to be closely monitored. Advanced training is necessary for staff that monitors patients, in the event of an emergency. The American Dental Association (ADA) recommends talking to your dentist about any concerns you might have about the treatment plan prior, during and after the procedure, including questions about sedation or anesthesia for your child.

• Who will provide the pre-operative evaluation of my child including their past medical history such as allergies, current prescription medications and previous illnesses and hospitalizations?
• What training and experience does the sedation/anesthesia provider have in providing the level of sedation or anesthesia that is planned for the procedure? Does this training and experience meet all of the standards of the ADA Guidelines for the Use of Sedation and General Anesthesia by Dentists?
• Does the staff assisting in the procedure have current training in emergency resuscitation procedures and other advanced resuscitation courses as recommended by the ADA Guidelines? Is this training regularly renewed?
• Does the state dental board require a special sedation/anesthesia permit or license that allows for the sedation/anesthesia provider to administer this specific level of sedation or anesthesia in the dental office?
• In addition to the use of local anesthesia (numbing), what level of sedation or general anesthesia will be given to my child? Is it minimal sedation (relaxed and awake), moderate sedation (sleepy but awake), deep sedation (barely awake) or general anesthesia (unconscious)?
• How will my child be monitored before, during and after the procedure until the child is released to go home? Are the appropriate emergency medications and equipment immediately available if needed, and does the office have a written emergency response plan for managing medical emergencies?

Tooth decay (and its painful treatment) is mostly preventable by brushing regularly, according to the ADA. Infants should regularly have gums gently wiped with a soft cloth, prior to the eruption of teen to reduce bacteria. As teeth erupt, introduce a toothbrush after each feeding. Use a “smear” of fluoridated toothpaste and a soft, age-appropriately sized toothbrush until age 2, and then a “pea-size” amount for kids ages 2 to 5. Flossing is equally important. It might not be easy, but it is necessary, especially between the back molars, which kids need for chewing until 10 – 12 years of age.

Other important factors to reduce tooth decay include:

• Seeing a dentist every six months, beginning when the first tooth emerges or by the age of one, whichever comes first.
• Early detection is important. Never assume that just because your child looks and acts fine, that their teeth are healthy. Cavities are often found in the back teeth and many kids never experience any kind of oral pain unless there is a significant amount of decay.
• Drinking fluoridated tap water (bottled water generally has little to no fluoride)
• Avoiding too much juice or other sugary beverages.
• Eating a balanced diet.
• Reducing the frequency of snacking.
• Paying attention to proper oral hygiene (including regular brushing and flossing).
• Avoiding sharing utensils or putting your child’s pacifier in your mouth, as tooth decay can be contagious.

For more information on oral health topics for you or your family, visit the American Dental Association’s website.

Mark Bello is the CEO and General Counsel of Lawsuit Financial Corporation, a pro-justice lawsuit funding company.