[amitsa]

Bryanna,

I am Amit again from Mumbai ,India. I had my root canaled tooth removed three months ago and its been great for me. Its like I have got a new life coming back from the doorsteps of illness.My health has improved
by leaps and bounds.

I wish to ask you a question.It is not concerning me though. On June 29th exactly two weeks ago,a very unfortunate incident occured in Pune which is just three hours drive from Mumbai. A three year old girl went to a paediatric dentist for a root canal. The dentist administered her local anaesthesia probably xylocaine.. After that,she went sleepy very unusually as per her father who was with her near the dentists chair. The dentist continued to drill her teeth and her parents asked him why is she behaving like that. The dentist said its normal. He continued to work ,then stopped and put cotton in her mouth. When her father lifted her from the chair and shook her,she was unconscious. He asked the dentist why is she not waking up. The dentist's attitude was indifferent. He said she will wake up in a minute or two.But if you have any doubt in your mind,please take her to a paediatrician. Her father quickly took her to the paediatrican who said she should be taken to the hospital. She was rushed to the hospital where she was declared dead before admission.

The autopsy reports are yet to come. The case is with the police. This case is the first of its kind in India and has received huge media hype and public protest.Medical experts think it could be due to some anaphylactic action. The dentist refuses that there was any overdose because it is at high volume though that would come out in the autopsy. He said it is a one in a
one lakh very very rare case.

My first question is
' Was it possible to save this girl assuming this was a death due an anaphylactic reaction ? '

My second question is
'Is the dentist guilty if it was an anaphylactic reaction ? What does the US law say in this ? '

Please see these links -

http://timesofindia.indiatimes.com/c...w/47918656.cms

https://www.youtube.com/watch?v=H_AakRXt0Mo

Thank you .
Amit.

[Lara]

Why would a 3 year old child be needing a root canal treatment?

[Bryanna]

Hi Amit,

I am glad to hear that you are doing so well

However, I am heartbroken to hear of the tragedy of this little girl. There are several things that come to my mind when I read the report and watch the news video.

* A 3 year old cannot actually have a root canal like adults can because the root structure of deciduous (baby) teeth are very short unlike adult teeth which are long. If a child has a deep cavity or bad break in a tooth, the center area of the tooth called the pulp chamber can become infected. The procedure to remove the nerve tissue of the pulp chamber is called a pulpotomy and that is what this little girl had done. Some dentists refer to a deciduous pulpotomy as a baby root canal because the procedure removes the vitality from the tooth just like a root canal procedure does in an adult tooth. The difference is that the pulpotomy is quick and takes one visit unlike a root canal which can take an hour or more and more than one visit.

* There is a possibility that this child was given nitrous oxide. Although that was not mentioned in any report that I have seen, it is something that should be questioned because N2O can cause the patient to become unconscious and if the gas is not flushed from the system with pure oxygen the result can be fatal.

* There is a possibility that the girl had an allergic reaction to the local anesthetic and/or she was given too much. Either one of those incidents could result in anaphylaxis or even cardiac arrest depending on the anesthetic given.

* It appears to me that all of the facts have not been disclosed because from the way the story has been told, the dentist was definitely negligent for not responding to an emergency situation. That alone would cost him in the very least temporary suspension of his dental license until the case was solved.

Again, this story is truly heartbreaking. I have known of a few cases of this happening and I have personally witnessed similar situations that fortunately had a better outcome. My heart goes out to this family.......

Bryanna

Originally Posted by amitsa

Bryanna,

I am Amit again from Mumbai ,India. I had my root canaled tooth removed three months ago and its been great for me. Its like I have got a new life coming back from the doorsteps of illness.My health has improved
by leaps and bounds.

I wish to ask you a question.It is not concerning me though. On June 29th exactly two weeks ago,a very unfortunate incident occured in Pune which is just three hours drive from Mumbai. A three year old girl went to a paediatric dentist for a root canal. The dentist administered her local anaesthesia probably xylocaine.. After that,she went sleepy very unusually as per her father who was with her near the dentists chair. The dentist continued to drill her teeth and her parents asked him why is she behaving like that. The dentist said its normal. He continued to work ,then stopped and put cotton in her mouth. When her father lifted her from the chair and shook her,she was unconscious. He asked the dentist why is she not waking up. The dentist's attitude was indifferent. He said she will wake up in a minute or two.But if you have any doubt in your mind,please take her to a paediatrician. Her father quickly took her to the paediatrican who said she should be taken to the hospital. She was rushed to the hospital where she was declared dead before admission.

The autopsy reports are yet to come. The case is with the police. This case is the first of its kind in India and has received huge media hype and public protest.Medical experts think it could be due to some anaphylactic action. The dentist refuses that there was any overdose because it is at high volume though that would come out in the autopsy. He said it is a one in a
one lakh very very rare case.

My first question is
' Was it possible to save this girl assuming this was a death due an anaphylactic reaction ? '

My second question is
'Is the dentist guilty if it was an anaphylactic reaction ? What does the US law say in this ? '

Please see these links -

http://timesofindia.indiatimes.com/c...w/47918656.cms

https://www.youtube.com/watch?v=H_AakRXt0Mo

Thank you .
Amit.

[Bryanna]

Lara,

Toddlers have deciduous teeth or baby teeth which have a pulp chamber in the center of the tooth that contains nerve tissue just like adult teeth. However the root structure is much different in that the roots of baby teeth are very tiny and short whereas in adult teeth the root structure is much wider and longer.

When decay enters the pulp chamber of any tooth, infection develops and the only options are treatment or extraction. The procedure to remove the infected nerve from that chamber is called a pulpotomy. Because baby teeth have so little root structure, the pulpotomy is the "root canal" on a baby tooth.

Hope that answers your question...............

Bryanna

Originally Posted by Lara

Why would a 3 year old child be needing a root canal treatment?

[Lara]

Thanks.

Yes, I've had babies and watched and learned about teeth development. I just asked because I'd never heard of a root canal proceedure (as called in the news article) in a child so young. Didn't understand how it was possible or why it would be done.

Tragic story. It's possible that the child had some type of pre-existing illness as well. News articles don't tell all the facts. It would be difficult to even speculate what went wrong for the poor child.

[amitsa]

Bryanna,

As per her father's account, when anasesthesia was given ,she first behaved unusually for a min and went into sleep. The dentist continued to drill the tooth in that state. Her father was beside the chair. He asked the dentist why is she not waking. The dentist said it is normal . After sometime ,the girl opened her eyes suddenly. She seemed to be in a state of shock and confused. Her eyes were dilated. She quickly closed her eyes ,never to open them again. When her father asked, the dentist continued to say in a very callous attitude 'All this is normal.She will wake up. Please take her home
or if you are in doubt to a paediatrician'.

Her father further added that the dentist did not even budge from his chair. He personally took her to the paediatrician who was luckily available next door. The paediatrician tried to resuscitate her but to no effect.

It is not just what has gone wrong that matters. The father said the dentist behaved as if nothing unusual happened. The attitude of the dentist was as if he was not involved in it.

The dentists in India do not have any ICU like set up or any resuscitation apparatus with them. They only have dental drugs with them.

My question is -

Do the dentists in USA have an emergency bed, oxygen support,ventilator,resuscitation apparatus etc (ICU like set up) in their clinic in case such an incident occurs ?

[Bryanna]

Amit,

I read the report and watched the news and the video. I still feel there are some things not being disclosed. I can only speculate what they might be.

For a child or any dental patient to appear to suddenly "go to sleep in the chair" does not necessarily mean they are "sleeping". Sometimes patients pass out, they faint, while in the chair. This will cause their body to go limp. Some dentists will not see this as a problem because as long as the patient is breathing okay and their airway is not blocked they will eventually come out of it okay. Other dentists will stop what they are doing and force the patient to regain consciousness. I have seen this occur both ways. When the patient does come to, they are either wide eyed or groggy. It depends on the situation. So this is what may have occurred with this child and the father became alarmed and the dentist didn't. Whether or not she had an allergic reaction to the anesthetic in addition to fainting, or just had an allergic reaction... hopefully the toxicology report will be able to show whether she had an allergic reaction or not.

If the dentist used pure nitrous oxide on this little girl, even only a few puffs of but just enough to put her out... then that would account for her suddenly sleeping and going limp. That would also account for her suddenly awakening. Nitrous oxide can have odd affects on people.

When the father became alarmed, the dentist should not have pushed his concerns aside. If anything he should have checked the girl's vitals and if they were okay then reassured the father. However, he seem to think nothing was wrong. When the girl was obviously not okay after the procedure, the dentist should have checked her vitals and administered CPR immediately if she was not breathing.

There is no emergency medical ICU set up in dental offices in the US. All dental offices are required to have an operating oxygen tank and oxygen masks in the office and the dentist and dental staff are CPR certified and know how to perform CPR. They also by law have to have an emergency kit that contains things like epinephrine, glucose, nitro glycerin, etc. You don't need any equipment for CPR other than your mouth to breathe into the patients mouth and 2 hands to do chest compressions. Anytime that needs to be done on someone, as the person is doing the resuscitation another person calls 911 or the emergency squad to come to the aid immediately.

I think once all of the facts are told, this reason this occurred will then be evident. Until then, what occurred is just speculation based on the facts told so far.

I assume this family will pursue this until they know the cause...? I sure hope so.

Bryanna

Originally Posted by amitsa

Bryanna,

As per her father's account, when anasesthesia was given ,she first behaved unusually for a min and went into sleep. The dentist continued to drill the tooth in that state. Her father was beside the chair. He asked the dentist why is she not waking. The dentist said it is normal . After sometime ,the girl opened her eyes suddenly. She seemed to be in a state of shock and confused. Her eyes were dilated. She quickly closed her eyes ,never to open them again. When her father asked, the dentist continued to say in a very callous attitude 'All this is normal.She will wake up. Please take her home
or if you are in doubt to a paediatrician'.

Her father further added that the dentist did not even budge from his chair. He personally took her to the paediatrician who was luckily available next door. The paediatrician tried to resuscitate her but to no effect.

It is not just what has gone wrong that matters. The father said the dentist behaved as if nothing unusual happened. The attitude of the dentist was as if he was not involved in it.

The dentists in India do not have any ICU like set up or any resuscitation apparatus with them. They only have dental drugs with them.

My question is -

Do the dentists in USA have an emergency bed, oxygen support,ventilator,resuscitation apparatus etc (ICU like set up) in their clinic in case such an incident occurs ?