Dental "tragedy"

[coccygodynia]

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Anybody read about this?

 

[urgewrx]

Anybody read about this?

What we do is very dangerous.

That was some sloppy writing, btw.

 

[jwk]

Why do I get the impression that there was no pulse ox in use?

 

[leaverus]

What we do is very dangerous.

That was some sloppy writing, btw.

You're right - it was EXTREMELY bad writing. I couldn't follow the story at all; the writer does not seem to know the concepts of paragraphs and transitioning.

 

[Intubate]

You're right - it was EXTREMELY bad writing. I couldn't follow the story at all; the writer does not seem to know the concepts of paragraphs and transitioning.

Canadians...

 

[fakin' the funk]

Anybody read about this?

Um..."some oral surgeons are trained in anesthesiology" ???
"dental anesthesia and pharmacology" ???

Anyone know anything about this?

I do like the bit about how even the paramedics weren't able to bring him out of asystole...as if to ignore the fact that at least one professional resuscitator had been there for quite a while.

 

[Mman]

Um..."some oral surgeons are trained in anesthesiology" ???
"dental anesthesia and pharmacology" ???

Anyone know anything about this?

I do like the bit about how even the paramedics weren't able to bring him out of asystole...as if to ignore the fact that at least one professional resuscitator had been there for quite a while.

Where I went to medical school, the oral surgery residents did 2-3 months of anesthesia. They actually were in the room acting as an anesthesia resident doing the cases. I think that qualifies as a little bit of anesthesia and airway management training and the ones I worked with understood the limitations of what they were learning.

It makes sense considering they will give some sedation for procedures. When I had my wisdom teeth pulled I got some midaz and it's nice to know that they at least have a clue what to do if you start obstructing your airway or go apneic.

 

[Frank Rizzo]

Um..."some oral surgeons are trained in anesthesiology" ???
"dental anesthesia and pharmacology" ???

Anyone know anything about this?

I do like the bit about how even the paramedics weren't able to bring him out of asystole...as if to ignore the fact that at least one professional resuscitator had been there for quite a while.

At my program, the oral surg residents do 3 dedicated back to back months of anesthesia their first year. they act as CA-1 residents. Probably gives them just enough knowledge and know-how to be dangerous. However, most of them know this and seem to take it very seriously.

As far as dental tragedies... After looking in the horrible mouths of all of my patients, I'd say 90% of them are walking dental tragedies.

 

[deleted126335]

.

 

[thegasman]

our oral surgery residents do six months of anesthesia, running their own rooms and doing mostly ez ca-1 type cases - gyn, oral surgery. They are usually pretty smart people too. In their office they do extractions wisdom teeth etc with propofol for sedation/mac. This is usually like ga without a tube, but they haven't had problems. Anyone with comorbities gos to the or with anes. Looking back on this I had my wisdom teeth out in the oral surgery office in college as a similar thing but I think the guy used methohexital. Knowing what i know now it would have been nice to have anes there.

 

[Beck928]

As far as dental tragedies... After looking in the horrible mouths of all of my patients, I'd say 90% of them are walking dental tragedies.

Sounds like your patients may have a high T:T ratio- Tattoo to Tooth ratio!

 

[urgewrx]

They are usually pretty smart people too.

Are you sure about that?

 

[bigdan]

At our school the OMFS Dental residents do 4 months of anesthesiology, 8 months of other ****, and then have the option to either continue in OMFS training, or do the last three years of medical school with us and earn an MD. TO A MAN, the dentists that joined my medical school class have expressed their shock at how little they knew when they were running the cases - yes they can mask a patient well but have no idea how much can go wrong...

dc

 

[2ndyear]

We have OMFS residents for 3 or 4 months at a time. They are all very bright and have a good time with us. Don't forget that in the US, dentists were way ahead of physicians in administering anesthesia. Of course in the case at issue, there was an anesthesiologist present. I agree with the no pulse ox. Probably some combo of midaz/fent/propofol, inadequate resuscitation equipment, possibly an equipment malfunction. Of course I could be way off on this, maybe they had full ASA monitors and an anesthesia machine and the kid just had laryngospasm when they got underway.

 

[CremeSickle]

Maybe the question should be "where was anesthesia when all this was happening??"

My attendings have said in the past that these sortof "shady" practices often attract anesthesiologists of "lower quality" making it even more dangerous.

 

[toofache32]

The accreditation requirements for oral surgeons includes a minimum of 4 months of anesthesia, although many do 6. This isn't the same as the general surgery guys who are only there to intubate and then leave. Oral surgery residents function as an anesthesia resident and run their own rooms. Interestingly, the military uses oral surgeons as "back-up" anesthesiologists. Oral surgeons are required to maintain a state-issued general anesthesia permit to deliver anesthetics. Don't confuse this with general dentists giving "IV sedation" which is an entirely different story and is a small battle within dentistry itself.

The safety record of oral surgeons delivering anesthesia is enviable and recognized by the ASA:

http://www.aaoms.org/docs/media_kits/anesthesia/asa_propofol_letter.pdf

Keep in mind that these office-based anesthetics are short (usually < 1 hour) and are generally performed on patients with few comorbidities. Case selection. I've attached another article for anyone bored enough to keep reading.