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2 kids die in dental chair; why?

By Mary Jo Melone
5/4/2010 © Health News Florida

A lawsuit against a Tampa dentist in the death of a 9-year-old Tampa boy who was being treated under “conscious sedation” was filed the same day that a 5-year-old boy died at a Gainesville dental office under similar circumstances.

Together, the two deaths raise questions: Does parents’ desire to spare their children (not to mention themselves) the anxiety of dental care lead them into taking risks that are unnecessary? Does conscious sedation in children pose too great a danger?

Such concerns are not new. After the 2006 death of a Chicago 5-year-old, Diamond Brownridge, the American Academy of Pediatric Dentistry issued rules on how to handle dental sedation. They require that the person performing the sedation be properly trained and have necessary equipment and backup to use in case of an emergency.

The doctor who sedated Diamond Brownbridge was suspended within days of her death, but the Florida Department of Health has not taken any actions in the Florida cases. Both dentists have clear and active licenses, according to the DOH consumer Web site.

Tampa dentist R. Andrew Powless is the subject of the lawsuit filed April 22 by the parents and personal representative of Cory Moore Jr., who died on Feb. 19, 2009.

The lawsuit against Powless, doing business as Florida Special Care Dentistry, charged that Powless and his staff should have known it was dangerous to sedate the boy. He had eaten prior to the dental procedure. “As a result, Cory Moore Jr. choked on his food, aspirated and died,” the suit charged. 

Cory was put under what the lawsuit called “conscious sedation” – a process in which a patient is aware of his surroundings but feels no pain or anxiety – prior to his dental procedure. The suit did not specify what drug was administered.

The suit charged that Powless failed to provide “appropriate instructions” to the boy’s mother prior to the procedure. Even though his mother, Zondria Williams, informed Powless’ staff the boy had eaten prior to his appointment, the sedation was given, according to the suit.

Dr. James McIlwain, a Tampa pediatric dentist who speaking in general terms without knowledge of this particular case, said “guidelines are standard” that patients neither eat nor drink prior to sedation

“You don’t want anything in your stomach that you could throw up,” he said.

The suit accuses Powless and his staff of delays in recognizing that Cory was choking and in attempting to resuscitate him. The suit did not describe the nature of the dental work the boy was to receive.

Powless declined to comment about the case and referred questions to his lawyer, who could not be reached. Neither could the child’s parents, personal representative Douglas B. Stalley, or attorney.

In the death that occurred two weeks ago, a 5-year-old from Cedar Key died after being sedated prior to treatment by Gainesville dentist Ronnie Grundset. The death of Dylan Shane Stewart remains under investigation, according to the Alachua County Sheriff’s Office.

An employee at Dr. Grundset’s office said the dentist would not comment on that case. Friends of the Stewart family told the Gainesville Sun the boy was sedated with the substance chloral hydrate, which Dr. McIlwain described as an old and safe drug.

Less than 1 percent of his own practice involves sedating patients, McIlwain said. Sedation is typically given to special needs children or those with a large number of cavities or other problems needing repair, he said.

Health News Florida sought comment from the American Academy of Pediatric Dentistry on the suit involving Cory Moore, but officials could not be reached. At the time of Dylan Stewart’s death, however, Dr. John Rutkauskas, the chief executive officer of the organization, told the Sun, “Hundreds of thousands of sedatives are used in pediatric dentistry on an annual basis, and you almost never hear of a fatality.” 

--Mary Jo Melone, an independent journalist in Tampa, can be reached by e-mail.