Another child dies at the dentist

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capisce?

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A 2 year old died in houston after going in for routine dental care. There was no apparent sedation but it looks like it was a possibly adverse reaction to the mepivicaine. I'd be curious if he followed the dosing recommendations...the max anesthetic on a 2 year old can be reached very quickly! Scary and sad.



http://abclocal.go.com/ktrk/story?section=local&id=4655238&ft



Girl, 2, dies after routine visit to the dentist
Appointment to fill cavities turns into tragedy
KTRK By Gene Apodaca

(10/12/06 - KTRK/HOUSTON) - A grieving family is demanding answers because their two-year-old girl died after a routine visit to her dentist. Yesenia Valles died last Saturday, following a morning visit to her dentist.

The medical examiner has not yet ruled on a cause of death, and her father is growing anxious to find out what killed her. This tragic death happened just four days ago. But Eyewitness News has learned that both the Houston Police Department and the state dental board have opened investigations. The little girl's father, though, remains frustrated over a lack of answers.

On the same day David Valles laid his little girl to rest, this Houston father finds himself angry -- not knowing exactly how his baby daughter unexpectedly died.

"You the man, you got your daughter... Somebody got responsibility for that," Valles said.

Yesenia Valles, 2, died, according to a police report, after a visit to a dental clinic in southwest Houston. The little girl was there being treated for cavities. Her mother was in the waiting room during what was supposed to be a routine visit.

David Valles said, "She heard the kid's crying about 10 minutes. After 10 minutes, everything's quiet."

According to Houston police, the report indicates the dentist used a drug called Carbocaine. It's a short-acting, local anesthetic commonly used to treat patients by numbing the affected area. Shortly after administering the drug, the report indicates the doctor noticed something was wrong.

The girl was unconscious and he tried to revive her. Yesenia would later be pronounced dead at the hospital. Her cause of death is still unknown.

The dentist said, "I understand the parents and everything. I feel awful about the whole thing for everyone. I feel horrible."

Eyewitness News is not identifying the dentist because he has not been charged with a crime. When we spoke with him he would not talk specifically about what happened in his office the day Yesenia died. But he did tell us he felt he did nothing wrong.

We asked, "Do you feel that a mistake was made, anything you could have done differently?"

"No, I never treated the patient, period," the dentist answered. "But every patient comes in, and we'll be as thorough as we can."

The state board of dental examiners has launched a full-scale investigation into the death. Houston police are also still investigating. Yesenia's father says he won't rest until he gets answers.

"The life is too short," Valles said. "I got to live."

We checked the dentist's license. In 2004, he was given a warning by the state for failing to make, keep and maintain adequate records. He was ordered to complete a continuing education course and complete a jurisprudence exam. He has not had any other actions taken against him since then.

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We asked, "Do you feel that a mistake was made, anything you could have done differently?"

"No, I never treated the patient, period," the dentist answered. "But every patient comes in, and we'll be as thorough as we can."

This doesn't quite make sense. But it sounds like everyone quoted in the article can't speak gooder english.
 
I thought the quote above sounded wierd too. I took it to mean that he had injected her but had never actually drilled on any teeth, maybe?? Not sure about that second half of the sentence
 
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possible methemoglobinemia???? Easily treated if recognized. I've never seen a case before, and I'm not sure I've ever heard of one occuring so rapidly after injection (before he began "drilling").

The safest local anesthetic to use on children according to Malamed and the American Dental Society of Anesthesiology is 2% lidocaine with 1:100,000 epi.

Anybody else feel like pissing in the wind????....
 
possible methemoglobinemia???? Easily treated if recognized. I've never seen a case before, and I'm not sure I've ever heard of one occuring so rapidly after injection (before he began "drilling").

The safest local anesthetic to use on children according to Malamed and the American Dental Society of Anesthesiology is 2% lidocaine with 1:100,000 epi.

Anybody else feel like pissing in the wind????....
I wondered about that, but I thought methemoglobinemia only caused problems with prilocaine. Oui? Non?
 
Prilocaine is the biggest culprit, but they all can cause it...

The greatest risk is with the 3% and 4% local anesthetics.... hence in children, stick to 2% Lidocaine with 1:100,000epi. Stick to proper weight-based dosing as well for the local anesthetic as well as the epi.
 
the toxic effects and methemoglobinemia potential of our routine dental topical (20% benzocaine) is often overlooked. Slathering this carelessly will inevitably lead to ingestion, providing a potentially lethal outcome in a 2 year old child who probably weighs about 20kg. And the fact that they make these in palatable flavors doesn't help the situation.

although the treatment is simple, do general dentists typically have methylene blue in their office? and even if they have, do they have IV equipment, fluids, etc and know how to start an IV (in my dental school they didn't teach us how to start an IV)?
 
the toxic effects and methemoglobinemia potential of our routine dental topical (20% benzocaine) is often overlooked. Slathering this carelessly will inevitably lead to ingestion, providing a potentially lethal outcome in a 2 year old child who probably weighs about 20kg.

20kgs is pretty big for a 2 year old, the avg for a child that age would be around 13 or so kgs. You must be somewhere in the the midwest, where everything is bigger. I ordered large scrubs this year and jabba the hutt could have sqeezed into those bad boys. We've come to the conclusion that the midwest has it's own sizing system for clothes to accomodate the few extra rolls of it's populus.
 
20kgs is pretty big for a 2 year old, the avg for a child that age would be around 13 or so kgs. You must be somewhere in the the midwest, where everything is bigger. I ordered large scrubs this year and jabba the hutt could have sqeezed into those bad boys. We've come to the conclusion that the midwest has it's own sizing system for clothes to accomodate the few extra rolls of it's populus.

we have a Mcdonald's in our hospital...
 
I have always heard that Lidocaine 2% with 1:100k epi was best for children from OMFS because the epi reduces the risk of the LA entering the systemic circulation on top of that it has 18mg less of LA compared to 3% mepivicaine. This makes sense to me but the baby sitters in pedo taught us to use 3% mepivicaine ?????
 
This event and the Chicago one is a tragedy for all involved. Speaking as an outsider, I wonder if both incidents send up a caution flag for individual practitioners who might face taking on potentially high risk cases at their own clinics. Would it be more prudent, when possible, for individual practitioners to consider arranging for such cases to be handled at hospital dental clinics or larger clinics that are staffed with dental anesthesiologists, nurse anethesiologists, RN's etc in addition to GP's & Pedos. If something of this nature does goes awry (which seems more likley to occur when dealing with healthy very young as opposed to healthy older populations), would it be prudent to have a team on hand that knows immediatley how to diagnose and react to such situations. I don't know. What would the experts here suggest?
 
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I have always heard that Lidocaine 2% with 1:100k epi was best for children from OMFS because the epi reduces the risk of the LA entering the systemic circulation on top of that it has 18mg less of LA compared to 3% mepivicaine. This makes sense to me but the baby sitters in pedo taught us to use 3% mepivicaine ?????


What school is teaching that?
 
I have always heard that Lidocaine 2% with 1:100k epi was best for children from OMFS because the epi reduces the risk of the LA entering the systemic circulation on top of that it has 18mg less of LA compared to 3% mepivicaine. This makes sense to me but the baby sitters in pedo taught us to use 3% mepivicaine ?????

There are systemic risks with any local anesthetic. The best way to minimize them is to make sure you aren't depositing directly into the bloodstream and knowing the max you can give your patients. Every time I sit down to treat a child, I check their weight from their last recall and do the quick math to figure out the maximum amount I can safely give.

It's not necessarily the mg of LA...I will use septo and infiltrate on lower primary teeth instead of blocking. While it's 4% and has 36mgs of LA, the max is around 7mg/kg so the max dosage balances out in a way in comparison w/ lido.
 
...I will use septo and infiltrate on lower primary teeth instead of blocking. While it's 4% and has 36mgs of LA, the max is around 7mg/kg so the max dosage balances out in a way in comparison w/ lido.

septocaine has 68mg/carpule. i don't know what kind of math you do in pedo world but 4% in a 1.7mL cartridge is 68mg ( had to get you back for making fun of missouri fat children)
 
septocaine has 68mg/carpule. i don't know what kind of math you do in pedo world but 4% in a 1.7mL cartridge is 68mg ( had to get you back for making fun of missouri fat children)

yes tis true, not sure why i doubled the "18 less" mentioned by the person i was quoting versus the 36 in lido.

and the kids in cincinnati can probably rival the obesity of missouri-ites (or is it missourians, or san diegoans, or san diegoites0
 
How much LA would be necessary to induce the methemeglobinemia?
If LA is given within the specified max dosage per kg of the child and not placed in a blood vessel would this still be possible?
 
while on the topic of lacking information....:rolleyes:

:D

You should change your line from the already lame statement Doctor of Dental SEXINESS to Grammar Police.

Thanks for the notes. I'll make sure to run spell check on here :rolleyes:
 
Somebody should learn Capisce some gooder english.
 
The safest local anesthetic to use on children according to Malamed and the American Dental Society of Anesthesiology is 2% lidocaine with 1:100,000 epi.
??....


Sheesh... Don't even get me started on f&*#ing Malamed...
 
Sheesh... Don't even get me started on f&*#ing Malamed...

Dude, I know, I know... I'm using him as an example for our "dental" buds because most of them have his books on Anesthesia and Management of Medical Emergencies in the Dental Office and because they believe the quotes they read claiming him to be "Dentistry's Leading Expert in Medical Emergencies In the Dental Office"

Whatever it takes for them to get it in their head about what is safest to use when treating patients... right??????

And I had the luxury of listening to him last year at the American Dental Society of Anesthesiology conference in Chicago... DUDE HE IS SOOOO BORING!!!!!
 
And I had the luxury of listening to him last year at the American Dental Society of Anesthesiology conference in Chicago... DUDE HE IS SOOOO BORING!!!!!


That, and half the stuff he presents isn't even his. He 'borrows' it from other people who actually do know what they are talking about...
 
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