Patient dies during 20 teeth extraction

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Who thinks it's the dentist's fault?


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Even a weekend course on conscious sedation teaches you to monitor oxygen saturation
 
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Exactly! Besides, I just don't see WHY he felt the need to extract all 20 teeth in ONE session?!?! That must've put so much stress on the patient!
 
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I hope the patient's family can get some answers soon.
 
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Taking out 20 teeth at a time is not the issue. It is done every day in my clinic. It's all about the patient and his/her medical history. This is a ridiculous poll because we can't judge because we don't have the information. Every death like this is horrible for the field of dentistry. Trolling posts like this don't help anything and don't acccomplish anything.

Conscious sedation is dangerous in the wrong patient. 20 extractions are dangerous for the wrong patient. Walking up a flight of stairs is dangerous for the wrong patient.
 
The fact that other dentists like yourself extract 20 teeth at a time don't make this OK! I'm a dentist too and I would never subject my patient to such an unnecessary trauma. It's as if this patient is not a human being who has emotions like fear, anxiety, etc. It's just about maximizing production and making as much money possible in one visit!
 
You are putting them through multiple traumatic experiences. If you suck at taking out teeth, then it may be an unnecessary trauma. If you are properly trained, you can take out 20 teeth in 20 minutes. If you want what is best for the patient, refer them to an OMS who can sedate them safely in their office or in a hospital setting (likely the best option for the patient we are discussing).

As an OMS, is it better for me to take out 5 teeth and do 4 sedations or take out 20 teeth and 1 sedation? I would make more money by taking out 5 at a time and doing 4 sedations so it's definitely not about money. It's safer to sedate the patient once.
 
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I definitely agree with you that this patient should've been seen in a hospital setting and that having 4 sedations is too much. But then 2 sedations would have made more sense (Left and right sides each time) and it would not be as traumatizing and stressful to the patient as much.
 
You are out of your scope here buddy. So you think sedating a patient and doing 10 teeth at a time is less stressful and traumatizing? In this scenario, do you have the patient come to the hospital twice for double the general anesthesia? This patient didn't survive a conscious sedation. Isn't one sedation still safer than two? Who pays for that substantial second hospital bill if we do it in the OR? Wouldn't you rather just have the patient go through one post-operative period? Why don't I just take out #16,17 tomorrow during clinic, then bring the patient back for the #1,32 at a later date to make it less stressful? Wouldn't taking out 4 full bony wisdom teeth be more difficult and have a tougher post-op period than 20 premolars and anterior teeth that had severe perio disease?

Again, the # of extractions has nothing to do with this case. It isn't any more stressful to the patient. I've taken out 32 teeth before multiple times. I've taken out 28 teeth and placed multiple implants in one setting multiple times. Just because you aren't comfortable with it, that doesn't mean there isn't someone who had additional training that can do it and do it safely. You need the education to be able to decide what is safest and best for that patient. That's what makes you a doctor and not a factory worker. Use that thing 2 feet above your ass.

Realistically, these are your first 4 posts so you are either trying to drum up visits on your personal blog that you wrote or you have a personal vendetta against this dentist. Like I said earlier, this isn't good publicity for dentistry (no matter if you are OMS, Perio, GP, etc) so I hope this gets shut down soon. I still feel like you aren't educated enough about dentistry and surgery to blast this guy. This guy apparently made massive mistakes, but none of us know the details. If you truly are a dentist, be respectful to your profession and your peers.

Is there a "drop the mic" emoticon?
 
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You are out of your scope here buddy. So you think sedating a patient and doing 10 teeth at a time is less stressful and traumatizing? In this scenario, do you have the patient come to the hospital twice for double the general anesthesia? This patient didn't survive a conscious sedation. Isn't one sedation still safer than two? Who pays for that substantial second hospital bill if we do it in the OR? Wouldn't you rather just have the patient go through one post-operative period? Why don't I just take out #16,17 tomorrow during clinic, then bring the patient back for the #1,32 at a later date to make it less stressful? Wouldn't taking out 4 full bony wisdom teeth be more difficult and have a tougher post-op period than 20 premolars and anterior teeth that had severe perio disease?

Again, the # of extractions has nothing to do with this case. It isn't any more stressful to the patient. I've taken out 32 teeth before multiple times. I've taken out 28 teeth and placed multiple implants in one setting multiple times. Just because you aren't comfortable with it, that doesn't mean there isn't someone who had additional training that can do it and do it safely. You need the education to be able to decide what is safest and best for that patient. That's what makes you a doctor and not a factory worker. Use that thing 2 feet above your ass.

Realistically, these are your first 4 posts so you are either trying to drum up visits on your personal blog that you wrote or you have a personal vendetta against this dentist. Like I said earlier, this isn't good publicity for dentistry (no matter if you are OMS, Perio, GP, etc) so I hope this gets shut down soon. I still feel like you aren't educated enough about dentistry and surgery to blast this guy. This guy apparently made massive mistakes, but none of us know the details. If you truly are a dentist, be respectful to your profession and your peers.

Is there a "drop the mic" emoticon?
+1
 
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Extracting 4 wisdom teeth is way different from the situation here. Even with that, I know many oral surgeons who would not do all 4 quadrants in one visit. Of course those are the more considerate ones unlike you or anyone else who does 28-32 teeth in one session. Just because it's doable it doesn't mean you should do it! And this has nothing to do with trashing our profession. If we are true professionals, we should be able to talk about this at least among ourselves.
 
Extracting 4 wisdom teeth is way different from the situation here. Even with that, I know many oral surgeons who would not do all 4 quadrants in one visit. Of course those are the more considerate ones unlike you or anyone else who does 28-32 teeth in one session. Just because it's doable it doesn't mean you should do it! And this has nothing to do with trashing our profession. If we are true professionals, we should be able to talk about this at least among ourselves.

So at first, it was all about the money and production in one visit. Now, it is because dentists (not just oral surgeons) who extract multiple teeth in one setting in different quadrants are inconsiderate? This is done daily IN DENTAL SCHOOLS.

You realize that you are arguing with someone trained in oral and Maxillofacial surgery, right? If we were arguing about crowns, I may be out of my scope, but no one knows this topic like me. Also, if you know an oral surgeon who won't take out all 4 wisdom teeth at once, then send me their name. They are below the standard of care set by AAOMS. They aren't considerate, they are incompetent.

My new theory is that you are with the prosecution and looking for an expert witness trying to say that 20 teeth was too much. I haven't left the theory that you wrote the blog too and you are prostituting yourself out for webpage visits.

You aren't trained or educated enough to take out 28 teeth at a time. That's fine. That doesn't mean it can't and shouldn't be done.
 
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This case really hit home for me. First and foremost because my 1st job after residency was as an associate IN THAT PRACTICE!! (Dr Patel, the current owner, was years away from graduating dental school and eventually buying that practice from the 2 dentists who owned it while I worked there) Some of the names of employees who work there that have been put forth in my local media here in CT, are names that I recognize as employees when I last worked there about 14 years ago.

As for the merits of extracting 20 teeth at once.... That's tough to say. The patient, pre surgery, was cleared medically for the procedure by her physician. Personally, in my residency taking 20+ teeth out on a patient at once wasn't a big deal, and you likely have to remember that a good deal of these teeth in question had significant periodontal involvement, so it's not like each tooth was a complicated, involved surgical extraction.

The issue at hand was simply one of the Dr Patel not heeding the warning signs that both his monitors and his staff were informing him of, and wanting to finish the entire procedure (the extractions and implants) that day, verses on a different day. There are plenty of times in one's dental career, where for various reasons you'll come across a circumstance that you weren't expecting that will likely have you not completing all that you intended that day.

There is still plenty to be determined about this case....
 
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This case really hit home for me. First and foremost because my 1st job after residency was as an associate IN THAT PRACTICE!! (Dr Patel, the current owner, was years away from graduating dental school and eventually buying that practice from the 2 dentists who owned it while I worked there) Some of the names of employees who work there that have been put forth in my local media here in CT, are names that I recognize as employees when I last worked there about 14 years ago.

As for the merits of extracting 20 teeth at once.... That's tough to say. The patient, pre surgery, was cleared medically for the procedure by her physician. Personally, in my residency taking 20+ teeth out on a patient at once wasn't a big deal, and you likely have to remember that a good deal of these teeth in question had significant periodontal involvement, so it's not like each tooth was a complicated, involved surgical extraction.

The issue at hand was simply one of the Dr Patel not heeding the warning signs that both his monitors and his staff were informing him of, and wanting to finish the entire procedure (the extractions and implants) that day, verses on a different day. There are plenty of times in one's dental career, where for various reasons you'll come across a circumstance that you weren't expecting that will likely have you not completing all that you intended that day.

There is still plenty to be determined about this case....
Agree 100%. Issue wasnt the extractions, it was the medical management of a complicated patient. Thanks for your opinion.
 
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Agree 100%. Issue wasnt the extractions, it was the medical management of a complicated patient. Thanks for your opinion.

This. End of story. The procedure itself wasn't even complicated (twenty teeth is nothing). I can do that in my sleep and I'm just a general dentist. Talk to some of the pro's and they'll tell you of the amazing things that you can really do if properly trained. The management of the patient wasn't complicated either. Assuming the facts presented in the article is true, it's simply negligence on the part of the dentist.
 
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The article did not exactly mention whether the pt is under IV sedation or just oral sedation (Halcion pills?). Does anyone know the exact method of this "conscious sedation"? Was it just minimum conscious sedation with 1-2 pills of Halcion 0.25 mg Halcion 30 minutes before the extractions (which should not make the oxygen level dip that low, right?)
 
Haven't seen a report regarding oral vs. IV sedation. Personally, I think oral sedation can be even more dangerous (in the wrong hands). At least you have quick access to your reversal drugs with an IV.
 
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The patient was under IV sedation in this particular case. The doctor was in possession of a valid CT IV Sedation permit at the time of the case in question. His IV sedation permit has since been revoked by the CT State Dental Commission, and prior to the charges that were recently filed (and referenced in the article at the start of the thread) to my knowledge he had completed a mandated remediation series of courses that allowed him to get his suspended dental license back. His sedation permit, to my knowledge, wasn't reinstated
 
The patient was under IV sedation in this particular case. The doctor was in possession of a valid CT IV Sedation permit at the time of the case in question. His IV sedation permit has since been revoked by the CT State Dental Commission, and prior to the charges that were recently filed (and referenced in the article at the start of the thread) to my knowledge he had completed a mandated remediation series of courses that allowed him to get his suspended dental license back. His sedation permit, to my knowledge, wasn't reinstated
ouch, since I do not believe the doctor overdosed the patient (i mean he got an IV sedation permit, he should know the maximal dose); the fact that patient's oxygen level dip that low is hard to explain. Patient must had transfer from conscious sedation state to deep sedation state, which must be supported by proper ventilator machine. But because his equipment only support "conscious sedation" , which patient must independent breath without the help of a ventilator. Anybody has an ideas why patient suddenly enter deep sedation state (given patient was not overdosed with drug)?
 
Deep sedation doesn't need a ventilator. General anesthesia doesn't even need a ventilator if you have the appropriate skills to adequately ventilate a patient. It's all about having the skills to handle the worst-case scenario. Anyone can give a pill and monitor the best case scenario.
 
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I feel sorry for the loss ..... But I do feel the responsibility to put forward the emphasis yet again to educate people that dentistry is not about 32 teeth and just cleaning and filling them. Please take this opportunity to educate ppl and patients that dentistry is more complex than just focusing on mouth, the correlation of dental and medical health.
Every dentist is the best judge of patients treatment plan and treatment needs. I still have to meet a dentist who is willing to sake his/ her licensure for money or one patient compared to life long Practise. This is a totally wrong projection of the field. An emergency in dentistry can be because of extraction of one teeth too. An emergency in dentistry can be because of no extraction but simply anesthesia too...... So why it's ok to accept an emergency in physicians office but not acceptable in dental office. This case was about not being able to handle the dental emergency which every practioner should be focusing on at the moment. It's sad but could happen to any one of us.
 
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