Posted On: January 30, 2013 by John McKiggan

Dental Procedure Causes Brain Damage: The risks of “sleep dentistry”

A client of mine sent me a link to a story about a case in Manitoba. She thought I would be interested in the article because the situation was so similar to a case I was involved in a few years ago in New Brunswick.

According to the article, last month a four year old girl from Manitoba suffered a brain injury following botched dental surgery. Jairlyn Roulette was supposed to undergo a routine surgical procedure on October 11, but ended up with a permanent disability. Jairlyn needed some teeth capped, some fillings and an extraction and her dentist thought it would be best to subject her to general anesthetic.

In other words, Jairlyn was going to be unconscious throughout the dental procedure.

Half an hour into the procedure, Jairlyn went into cardiac arrest. Jairlyn survived the episode, but she has suffered brain damage as a result.

Apryl Roulette, Jairylyn’s mother, told CBC that her daughter was awake but unresponsive. She is worried that:

“She’s never going to be the same little girl running around, laughing, yelling talking. I don’t know if she’ll ever talk again.”

There is currently investigation underway into the incident. Apryl Roulette is reportedly considering her legal options regarding her potential to sue Children’s Dental World.

Déjà Vu

My heart goes out to Jairlyn and her family. Unfortunately, I know exactly what the family is going through because I have been through it with another family.

Five years ago I represented the family of Davey Paul, a little boy who went to George Dumont hospital to have some cavities filled. They did the procedure under general anaesthesia. He also ended up with terrible brain injuries.

Davey’s parents were facing millions of dollars in future medical expenses to care for Davey and they asked for my help. We pursued a claim against Davey’s dentist, the anesthesiologist and the hospital where the procedure was performed. The Moncton Times and transcript reported on the multimillion dollar payment to Davey.

Dangers of Anesthesia

Davey’s case made me realize the huge risks of general anaesthesia.

The Appeal of "Sleep Dentistry"

There is a trend these days to what some dentists are calling sedation dentistry or sleep dentistry. Google both term and you will see what I mean. In sleep dentistry, the dental procedure takes place while the patient is unconscious under general anesthesia.

Sounds good doesn't it? Go to sleep and when you (or your child) wakes up your teeth will be fixed.

Serious Complications

There are many possible complications from general anesthesia. Some of them not particularly serious or life threatening, but some of them are medical emergencies:

• Allergic reaction to anesthetic agents (potentially fatal);

• Cardiovascular problems;

• Depression of respiration (breathing);

• Aspiration causing choking (the risk is higher with children);

• Brain injury from hypoxia ( lack of oxygen);

• Embolism causing stroke;

• Death.

Given the real and potentially fatal risks associated with using general anesthetic, the experience I gained in Davey’s case makes me question why any dentist would do a procedure like this outside of a hospital that is properly equipped to deal with the type of medical emergency that occurred in this case.

Unnecessary risks?

It is common sense that the safest place to undergo any procedure under general anaesthetic is in a hospital where emergency equipment and personnel are available to assist if there are any complications.

In the United Kingdom, the British Dental Association (BDA) requires that general anaesthetic only be used in a hospital which has critical care facilities.

This is not required in Nova Scotia. Instead, the Provincial Dental Board of Nova Scotia permits the use of general anesthesia in a dental office by licensed dentists who have completed an accredited post-graduate anesthesia program.

The big problem, in my view, is not whether dentists have received the proper training to administer general anesthesia; although this is a legitimate concern.

Emergencies Require Critical Care

The real problem is whether dentists’ offices are properly equipped and whether dental staff have the medical training to deal with the medical emergencies that can arise if something goes wrong! As the British Association points out, when things go wrong under anesthesia getting proper care is critical, a delay of seconds can make the difference in preventing serious brain damage or death.

What do you think?

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