Tragic death during dental procedure

[greatnt249]

"Are you incapable of reading more than a few sentences? Do you have a learning disability? Let me keep my responses to you short as it seems you are unable to coherently synthesize information."

I believe this is really where this conversation ends. I sincerely hope you nor your colleagues do not talk to anyone like this in the real world, and certainly not your patients.

and @schmoob the fact that a 2nd year dental student recognizes that and you don't is also embarrassing to our profession

I'm not an anesthesiologist. I do, however, recognize the value of staying within my own lane.

---

Members don't see this ad.

 

[nimbus]

No idea what that means. Everyone take a deep breath.

How Much Does Wisdom Teeth Extraction Cost?

www.wakedentalcare.com

I still have all my teeth😁

 

[nimbus]

Nothing to see hear. This has been normalized.

“Bad reaction to anesthesia”=poor management of common anesthetic problems.

Who’s watching the children at the dentist’s office?

You may have read about the recent tragic deaths of two healthy children – Marvelena Rady, age 3, and Caleb Sears, age 6 – in California dental offices. Unfortunately, they aren’t the first childre…

apennedpoint.com

 

[IMGASMD]

Something about milk teeth I think.

 

[nimbus]

View attachment 349816


Something about milk teeth I think.

I work with an oral surgeon who ordered a Bugatti, then sold it before he took delivery of it because someone offered him $500k more than he paid for it. I belong to a hifi club and one of our meetings was hosted by an oral surgeon. He lives in an oceanfront home that most MDs can never dream of. And his stereo cost more than most homes in the US. Their potential is nearly unlimited, especially if they have a busy implant practice. By the looks of it, they can afford to pony up for a dedicated anesthesia provider.

 

[epidural man]

This thread has added nothing of value. Nothing about this thread is helpful or professional.

I think you have made a great point (which others may agree with you in private but not on here after this $hit show) - and your point is…that if someone spends day after day doing something, they will became extremely good at it and their credentials don’t mater much …at some point, real word experience trumps a degree they got 20 years previously. It’s a good point.

Nonetheless -

You should have stepped off long ago. Many points made that I think you are missing, or seemingly arguing against just because that is how we act as humans. But they are excellent points by experienced and smart people.

I would suggest take the loss and move on.

 

[nimbus]

No anesthesia is “minor”

It’s a nightmare that doesn’t end for the family of 24-year-old Marek Lapinski, who suffered cardiac arrest recently during the removal of two wisdom teeth in a southern California oral…

apennedpoint.com

 

[lOuDMoUTH]

More death statistics, including the 3 most populous states in the country:

California - 55 dental sedation deaths originally reported by the Dental Board of California over 4 years (which they later revised to 24 deaths over this period after requests were made for further information.)

Texas - 85 dental sedation deaths from 2010 to 2016

New York - at least 31 dental sedation deaths from 2004 to 2013, based on insurance payout data for deaths

North Carolina - 6 deaths from 2014 to 2021, from the CEO of the North Carolina dental board.



I'm posting this for information so the public looking up dental sedation deaths can see:

1. the mortality risk for dental sedation ("1 in a million") quoted by dentists significantly downplays the risk involved,

2. the alarmingly high mortality risk with dental sedation can often be attributed to inappropriate level of training, monitoring and lax standards of care



“It sure looks like they [dental boards] are trying to cover up something,”
- Dr Mashni, DDS practicing dentist and past president of the American Society of Dentist Anesthesiologists

Not sure if I'm looking in the wrong place, but could you post the links to those stats?

Also, it's important to identify cases that involve a board certified OMFS vs all other cases (i.e. CRNAs, anesthesiologists, or even GPs). I believe the case Bergus is trying to make is that of board certified/eligible OMF surgeons. Unless all of those cases relate only to OMF surgeons who were both providing care and sedating patients, I doubt the stats are relevant to the current debate.

The room is tense, so let me add that I'm in no way picking a side. Just here for the information and I'll jump back to the dental forums lol.

 

[WholeLottaGame7]

I think you have made a great point (which others may agree with you in private but not on here after this $hit show) - and your point is…that if someone spends day after day doing something, they will became extremely good at it and their credentials don’t mater much …at some point, real word experience trumps a degree they got 20 years previously. It’s a good point.

Nonetheless -

You should have stepped off long ago. Many points made that I think you are missing, or seemingly arguing against just because that is how we act as humans. But they are excellent points by experienced and smart people.

I would suggest take the loss and move on.

Home boy doesn't strike me as the "learning from his mistakes" type. He strikes me more as the "ah crap, I f'd up this anesthetic my first year out, wait, I forgot I was awesome, I'm just going to call it an "anesthesia reaction," even though it was an airway event a CA-2 could have handled, too bad I only did the easy half of a CA-1 year" type...

 

[GassYous]

Not sure if I'm looking in the wrong place, but could you post the links to those stats?

Also, it's important to identify cases that involve a board certified OMFS vs all other cases (i.e. CRNAs, anesthesiologists, or even GPs). I believe the case Bergus is trying to make is that of board certified/eligible OMF surgeons. Unless all of those cases relate only to OMF surgeons who were both providing care and sedating patients, I doubt the stats are relevant to the current debate.

The room is tense, so let me add that I'm in no way picking a side. Just here for the information and I'll jump back to the dental forums lol.

There is no debate. The whole thing is ridiculous

 

[schmoob]

Na, too busy shucking wizzies my friend

You mean too busy practicing drilling plastic teeth because you’re not ready to touch a human yet. Stop talking like an oral surgeon wannabe. You can’t even do a proper filling nor have you extracted a single tooth in your life. Learn to drop the box first with fellow students before arguing with anesthesiologists.

“Shucking wizzies” is just an obnoxious way of saying extracting wisdom teeth; something he has never done before.

As a dentist, I agree with the anesthesia docs. I don’t like the operator/anesthetist model. I worked with one OS who would start running sedation in one room while sedating and extracting in another room. Of course she would add a few extra 15min billing codes. I brought this up to my boss and said what happens if there is an emergency with both patients? I sure as hell am not jumping in to help. Why? Because I’m not qualified to. I was told to pack sand because they were getting money.

 

[coffeebythelake]

Not sure if I'm looking in the wrong place, but could you post the links to those stats?

Also, it's important to identify cases that involve a board certified OMFS vs all other cases (i.e. CRNAs, anesthesiologists, or even GPs). I believe the case Bergus is trying to make is that of board certified/eligible OMF surgeons. Unless all of those cases relate only to OMF surgeons who were both providing care and sedating patients, I doubt the stats are relevant to the current debate.

The room is tense, so let me add that I'm in no way picking a side. Just here for the information and I'll jump back to the dental forums lol.

All the data I presented is google-able information, although it does take a little bit of searching.

And if you want verification, you can put in an information request with your state dental board and malpractice insurance carriers and ask them. This is how the journalists, dentists and physicians that put in the leg-work got their data. I doubt they make a distinction between OMFS vs non-OMFS. That sort of data might not exist. @bergus95 wasn't presenting evidence of OMFS only outcomes.

 

[coffeebythelake]

I work with an oral surgeon who ordered a Bugatti, then sold it before he took delivery of it because someone offered him $500k more than he paid for it. I belong to a hifi club and one of our meetings was hosted by an oral surgeon. He lives in an oceanfront home that most MDs can never dream of. And his stereo cost more than most homes in the US. Their potential is nearly unlimited, especially if they have a busy implant practice. By the looks of it, they can afford to pony up for a dedicated anesthesia provider.

But they won't because that means they only make $3M that year instead of $3.25M
Greed, arrogance, hubris, whatever they are doing.. it isn't about patient safety.

 

[chessknt]

A couple days a week I have to do bariatric endo where 400lb people with multiple comorbidities get deeeeep sedation (i.e. an unprotected airway general anesthetic) while an endoscope is shoved down their redundant tissue-laden gullets.

Any of your OMFS buddies have some sedation tips for a lowly board certified anesthesiologist like me?

They would mask ventilate the patient like in the boards scenario duh. In fact that answer gets 100% score to every question. Board certified mother****er.

 

[chessknt]

As a dentist, I agree with the anesthesia docs. I don’t like the operator/anesthetist model. I worked with one OS who would start running sedation in one room while sedating and extracting in another room. Of course she would add a few extra 15min billing codes. I brought this up to my boss and said what happens if there is an emergency with both patients? I sure as hell am not jumping in to help. Why? Because I’m not qualified to. I was told to pack sand because they were getting money.

That is hilarious because that would be qualified as malpractice in medicine and if reported would result in a medical board action.

 

[Southpaw]

I was told to pack sand because they were getting money.

Money drives lots of poor decisions in medicine. Oral Surgeons aren't immune and neither are anesthesiologists. No field is. And let's not even get started with hospitals and insurance companies. Unfortunately not everyone can see beyond the money to what's best for the patient.

 

[schmoob]

That is hilarious because that would be qualified as malpractice in medicine and if reported would result in a medical board action.

I’m no expert but I’m pretty sure it’s malpractice in dentistry as well. I made it explicitly clear that I will not be assisting in any emergency because I would be opening myself up for all sorts of board actions and lawsuits. I haven’t taken ACLS so I’m not qualified.
I stopped referring to her even though she was out in-house OS. God, even watching her take some teeth out was cringey because it was like a barbarian. She needed two assistants to hold the patients head in place. She’s garbage.

 

[D1Bound]

Best kept secret muahaha 🤫

You mean too busy practicing drilling plastic teeth because you’re not ready to touch a human yet. Stop talking like an oral surgeon wannabe. You can’t even do a proper filling nor have you extracted a single tooth in your life. Learn to drop the box first with fellow students before arguing with anesthesiologists.

“Shucking wizzies” is just an obnoxious way of saying extracting wisdom teeth; something he has never done before.

As a dentist, I agree with the anesthesia docs. I don’t like the operator/anesthetist model. I worked with one OS who would start running sedation in one room while sedating and extracting in another room. Of course she would add a few extra 15min billing codes. I brought this up to my boss and said what happens if there is an emergency with both patients? I sure as hell am not jumping in to help. Why? Because I’m not qualified to. I was told to pack sand because they were getting money.

You clearly take comments on student doctor WAY too seriously pal

 

[schmoob]

You clearly take comments on student doctor WAY too seriously pal

I guess I do, chief.

 

[GassYous]

You clearly take comments on student doctor WAY too seriously pal

Says the guy agitating to close the thread because his feelings are hurt

 

[pgg]

I think bergus and d1bound should be quiet for a while. Enough is enough.

 

[drmwvr]

yikes...been away from this site for a little while...I just hope this is all alcohol fueled bleating...'cause if it isn't there's a few man cards need turning in.....

 

[propadope]

Looking at the North Carolina Dental Regulations regarding anaesthesia/sedation; the oral surgeon requires 2 auxiliaries (with BLS) with one dedicated to monitoring/charting. This is ridiculous. There is no way a dental assistant is qualified for this role (even with a weekend course🙄). Wether or not that factored into this catastrophe remains to be seen. You can’t treat something if you don’t recognize it. And if you do recognize it, you better recognize it early. Once its too late, its too late.

 

[IMGASMD]

I actually find it particularly interesting the title of the parallel threads.
Death during dental procedure.
Death due to anesthesia.

 

[coffeebythelake]

Looking at the North Carolina Dental Regulations regarding anaesthesia/sedation; the oral surgeon requires 2 auxiliaries (with BLS) with one dedicated to monitoring/charting. This is ridiculous. There is no way a dental assistant is qualified for this role (even with a weekend course🙄). Wether or not that factored into this catastrophe remains to be seen. You can’t treat something if you don’t recognize it. And if you do recognize it, you better recognize it early. Once its too late, its too late.

Bottom line the type of sedation some of these dentists do is high risk. Open air deep sedation/
general anesthesia with secretions and debris stimulatjng reflexes and potentially falling jnto the airway. Inadequate training, monitoring and equipment compounded by desire for high turnover of cases and lax culture of safety. And yet they think they can handle it. Clearly not. Many times given such depth of anesthesja without medical necessity. And by the comments made by some dentists on SDN, the risks massively downplayed to patients so a meaningful informed consent about such risks does not exist.

I actually find it particularly interesting the title of the parallel threads.
Death during dental procedure.
Death due to anesthesia.

We blame the dentist. The dentist blames the anesthetic even though jn most cases they were the ones that administered it.

 

[propadope]

Bottom line the type of sedation some of these dentists do is high risk. Open air deep sedation/
general anesthesia with secretions and debris stimulatjng reflexes and potentially falling jnto the airway. Inadequate training, monitoring and equipment compounded by desire for high turnover of cases and lax culture of safety. And yet they think they can handle it. Clearly not. Many times given such depth of anesthesja without medical necessity. And by the comments made by some dentists on SDN, the risks massively downplayed to patients so a meaningful informed consent about such risks does not exist.



We blame the dentist. The dentist blames the anesthetic even though jn most cases they were the ones that administered

Agreed. That plane of anesthesia is often Stage 2. I always prefer a tube or minimal/moderate sedation.

 

[Dantrolene FC]

Agreed. That plane of anesthesia is often Stage 2. I always prefer a tube or minimal/moderate sedation.

Serious question from a resident here. Does stage 2 exist for intravenous anesthetics?

 

[Arch Guillotti]

Serious question from a resident here. Does stage 2 exist for intravenous anesthetics?

I don’t think it really does at least like with volatiles.

 

[coffeebythelake]

Serious question from a resident here. Does stage 2 exist for intravenous anesthetics?

Not the way it is described jn the textbooks. Used more colloquially here. Laryngospasm doesn't occur with light and moderate sedation. It can occur during deep sedation or light general anesthesia, and particularly with changing planes of anesthesia depth. I think that is what @propadope getting at.

 

[Onefellswoop87]

Serious question from a resident here. Does stage 2 exist for intravenous anesthetics?

So Guedel’s stages of anesthesia, to be very precise with terminology, technically refers to anesthesia when the sole agent is a volatile anesthetic. Historically he devised these stages with diethyl ether. He also noted eye gaze and pupil size that was associated with the stages. But colloquially and functionally, stage 2 (with relation to a “light anesthetic” that can predispose to larygospasm) can occur with intravenous anesthetic agents.

Stages of Anesthesia and a Re-Classification of the Signs... : Anesthesia & Analgesia

An abstract is unavailable. This article is available as a PDF only.

journals.lww.com

 

[lunaire]

Aye, "stage 2" can occur with IV anesthetics, especially if you have a lot of distribution/redistribution.

The stages of anesthesia is kind of an obsolete concept, though. You're either light enough to safely maintain the airway, or you're too deep and you need an airway/reversal. The gray area isn't really clinically useful.

 

[propadope]

Another thing to consider is that placing an implant involves lots of water to irrigate and cool the drill bit. Obviously a potential for laryngospasm there. Not only that but the implant, guide pin, screwdriver etc… are small and can easily cause foreign body airway obstruction. All that stuff should be ligated with dental floss so that 1. As a reminder 2. To retrieve it should it get displaced. Add sedation/anesthesia with airway reflexes hyper-reactive or obtunded combined with a patient thats disinhibited and moving is a recipe for disaster.

 

[GassYous]

Another thing to consider is that placing an implant involves lots of water to irrigate and cool the drill bit. Obviously a potential for laryngospasm there. Not only that but the implant, guide pin, screwdriver etc… are small and can easily cause foreign body airway obstruction. All that stuff should be ligated with dental floss so that 1. As a reminder 2. To retrieve it should it get displaced. Add sedation/anesthesia with airway reflexes hyper-reactive or obtunded combined with a patient thats disinhibited and moving is a recipe for disaster.

Just put a throat pack nbd

 

[propadope]

Just put a throat pack nbd

You can if they are deep enough!😁

 

[Arch Guillotti]

Laryngospasm doesn't occur with light and moderate sedation.

No it doesn't but if you muck around in the airway enough you can get pretty close.

 

[chessknt]

He is a victim

Of course he is but that doesn’t mean that he didn’t have the knowledge to know that there was serious risk to allow sedation to be administered by a dentist who had no airway skills at all. My GI wanted to administer sedation for an upper gi to me but I refused unless there was an on site anesthesia backup because I knew she had never intubated or probably even bagged anyone before and didnt trust that she could rescue me if she overshot the anesthetic. I am not an anesthesiologist but I respect the risks because training in internal medicine has taught me to do so, same as The physician who tragically died here from the dental malpractice.

 

[coffeebythelake]

Of course he is but that doesn’t mean that he didn’t have the knowledge to know that there was serious risk to allow sedation to be administered by a dentist who had no airway skills at all. My GI wanted to administer sedation for an upper gi to me but I refused unless there was an on site anesthesia backup because I knew she had never intubated or probably even bagged anyone before and didnt trust that she could rescue me if she overshot the anesthetic. I am not an anesthesiologist but I respect the risks because training in internal medicine has taught me to do so, same as The physician who tragically died here from the dental malpractice.

Could have been told he would be lightly sedated so he would be comfortable, relaxed but won't remember much. That proposition sounds pretty harmless. Patient think, "oh it's like taking a couple xanax" and I'll be awake so how could things go bad? Problem js the dentist never actually intended for a light anesthetic, or even moderate sedation, whipping out fentanyl or propofol or ketamine or nitrous or whatever other drugs they have in their goody bag so the patient doesnt move about in the Dental chair.

It's actually very telling how dentists like bergus95 claims a 1 in a million death rate from dental sedation. This seems to be a number a lot of dentists throw around as if gospel. Really shady. What makes you think they aren't lying about everything else they tell their patients. Worse, do these dentists actually know what the risk is or are they systematically being taught by their dental schools and training programs that sedation is EZ and basically risk free?

 

[secretasianman]

There are some things that classify as never events.. like operating on the wrong limb. Dying from sedation at a dentist’s office should be one of those things. I would think the public would agree and have this expectation.

 

[chessknt]

Could have been told he would be lightly sedated so he would be comfortable, relaxed but won't remember much. That proposition sounds pretty harmless. Patient think, "oh it's like taking a couple xanax" and I'll be awake so how could things go bad? Problem js the dentist never actually intended for a light anesthetic, whipping out fentanyl or propofol or ketamine or nitrous or whatever other drugs they have in their goody bag.

It's actually very telling how dentists like bergus95 claims a 1 in a million death rate from dental sedation. This seems to be a number a lot of dentists throw around as if gospel. Really shady. What makes you think they aren't lying about everything else they tell their patients. Worse, do these dentists actually know what the risk is or are they systematically being taught by their dental schools and training programs that sedation is EZ and basically risk free?

I have a hard line to require airway rescue skills which essentially none of these people have unless they are boarded in a specialty that deals with airways. Anyone who has administered enough sedation knows why this is a crucial skill to have and someone who trained in a cath lab should fall in to that category. That line about light sedation works on the uninformed but shouldn’t on physicians, especially ones who have exposure to sedation.

 

[nimbus]

I have a hard line to require airway rescue skills which essentially none of these people have unless they are boarded in a specialty that deals with airways. Anyone who has administered enough sedation knows why this is a crucial skill to have and someone who trained in a cath lab should fall in to that category. That line about light sedation works on the uninformed but shouldn’t on physicians, especially ones who have exposure to sedation.

He was an experienced electrophysiologist so he had plenty of exposure.

Henry Patel (1966 - 2020) - Obituary

View Henry Patel's obituary, send flowers and sign the guestbook.

www.legacy.com

 

[nimbus]

Laryngospasm is fairly common and easily managed. Death by laryngospasm is rightly rare.

 

[Mman]

Laryngospasm is fairly common and easily managed. Death by laryngospasm is rightly rare.

the worst outcome you should ever really get with laryngospasm is negative pressure pulmonary edema. That can develop very quickly in the right patient even if you recognize and treat appropriately. But that isn't going to kill them.

 

[coffeebythelake]

He was an experienced electrophysiologist so he had plenty of exposure.

Henry Patel (1966 - 2020) - Obituary

View Henry Patel's obituary, send flowers and sign the guestbook.

www.legacy.com

So he worked with plenty of sedation nurses given light to moderate sedation. These sedation nurses do not have advanced airway training and they get through most cases fine. Again this is the idea of having conscious sedation when the reality is stronger sedatives and unconscious sedation.

 

[vector2]

He was an experienced electrophysiologist so he had plenty of exposure.

Henry Patel (1966 - 2020) - Obituary

View Henry Patel's obituary, send flowers and sign the guestbook.

www.legacy.com

The ICs and EPs I work with are unfortunately some of the most clueless medical professionals I've ever encountered when it comes to understanding the risks of sedation and anesthesia.

 

[Gern Blansten]

The ICs and EPs I work with are unfortunately some of the most clueless medical professionals I've ever encountered when it comes to understanding the risks of sedation and anesthesia.

I would agree with this.

 

[chocomorsel]

Good question, not sure how much of it is covered by his insurance and how much he paid out from his own assets. But imagine working 40 years and basically having the cumulative gains from years of work taken from him because he thought he could cut some corners in patient safety to save some money. Talk about penny rich pound foolish.

I would have packed my **** and left the country. For real. Like that’s an insane amount of money. Peoples deaths get settled all the time for less than a Mil. What he did sucks, he totally was greedy but no way. Would have become a fugitive.

 

[chocomorsel]

Kudos to you. This pressure isn't exclusive to your profession and arises due to 1. the infantilization of the American adult and 2. the customer service mentality of healthcare in general.

We are victims of our own success in so many ways with how "easy" and "safe" we make most anesthetics look, which then enables surgeons, schedulers, and patients to feel entitled to request it for in my view inappropriate reasons.

Adults don't need 22 g PIVs. Cataracts don't need the administration of respiratory depressant sedatives. MRIs don't need general anesthesia. I used to try to convey to the morbidly obese claustrophobe that their risk of suffering serious injury or death in the MRI scanner under general anesthesia could be higher than in the main OR having a bigger case done given the remote location, lack of tools, and experienced personnel should an airway emergency arise.

It went in one ear and out the other and I stopped doing it because the average person wants to avoid any uncomfortable situation whatsoever no matter the implications.

I agree with everything you said here except for the 22 gauge IV part. IVs suck. And not everybody uses local. Give me a little wheal of local and you can stick a 16 in me. And I have a pretty decent tolerance for pain. Except for IVs without local.

 

[coffeebythelake]

I would have packed my **** and left the country. For real. Like that’s an insane amount of money. Peoples deaths get settled all the time for less than a Mil. What he did sucks, he totally was greedy but no way. Would have become a fugitive.

They said the 20M lawsuit was settled. They didn't say it was settled for 20M. In any case, something very egregious happened for the nurse to lose their license and for him to be found guilty of every count of negligence and unprofessionalism by the dental board.

 

[Radetzky]

The ICs and EPs I work with are unfortunately some of the most clueless medical professionals I've ever encountered when it comes to understanding the risks of sedation and anesthesia.

Arrives at disaster- “ive only given 10 of versed” 🤦‍♂️

 

[nimbus]

The ICs and EPs I work with are unfortunately some of the most clueless medical professionals I've ever encountered when it comes to understanding the risks of sedation and anesthesia.

We have 3EPs. 2 of them are pretty savvy and understand the issues. The 3rd is clueless but thinks he knows more than he does.