By Mary Jo Melone
5/26/2010 © Health News Florida
The American Academy of Pediatric Dentistry maintains that sedation for children is safe. But it has sent memos to members telling them how to answer questions from the media in the wake of four highly-publicized deaths. And the letter doesn’t even mention three deaths that occurred in Florida, raising the question of whether the problem is real, not just a public-relations nightmare for the profession.
It’s hard to tell whether these cases represent tragic anomalies or signs of a trend. Dentists say pediatric dental deaths are extremely rare, but they admit nobody knows for sure, because no national statistics are kept.
The Academy does not keep such statistics because it is not required to and, given the litigation that frequently shrouds the cases, it is difficult to do, according to Academy spokesman Dr. Stephen Wilson.
The memo tells dentists to use the following talking points: "The health, safety and welfare of children is a top priority...Our deepest condolences go out to the family ... (and) Deaths due to sedation and/or anesthesia are extremely rare..."
The memo stresses the "paramount" importance of discussing "the risks and benefits of anesthesia with parents and care givers."
The Academy has had guidelines for 25 years on how children should be sedated. While it says pediatric sedation is safe if carried out properly, dentists say it can be deadly if the drugs are excessive, interact with other medications or are given to a child with an unknown, underlying medical condition.
In its recent memo, the Academy said it supports efforts by state societies to restrict the use of anesthesia to those who have been "appropriately trained."
Wilson, an authority on pediatric sedation, says deaths are typically reported to state authorities who regulate dentists, he said. Such cases are handled by dentistry boards as individual disciplinary complaints, if substandard care was involved. Such a case was that of Dasia Washington, 10, from Pompano Beach.
Her death in 2006 made headlines in South Florida and led to the end of two dentists’ careers: Edward R. Walters of Coral Springs and Abbe Silverberg-Aroshas, who worked for Walters.
The case was complicated because the child suffered from head and facial deformities that caused breathing and eating problems. Until a month or two before her last visit to the dentist, she needed a tube in her trachea to breathe.
According to state records, Dasia was given nitrous oxide, lidocaine, and epinephrine. She was strapped to a board to keep her still, but she thrashed and fought against the constraints.
The medical examiner later concluded the death was caused by lack of oxygen. A contributing factor, he reported, was Dasia’s asthma.
Her dentists paid more than $1.6 million to settle malpractice cases, state records say.
An expert who reviewed the case for the state, Lakeland dentist Victor E. Spiro, faulted Walters for failing to pick up on Dasia’s oxygen problem and perform CPR in time. Also, Spiro wrote, Walters shouldn’t have let the less-experienced Silverberg-Aroshas treat a patient with serious medical complications and use the nitrous oxide machine when she wasn’t certified to do so.
He called the case “a stain on our profession.”
In a phone interview, Walters disputed some of the assertions in the records and said he had treated Dasia 30 times before the last encounter.
“I walked away from about a $3 million practice and closed it,” he said. He gave up his license, he said, because “I couldn’t deal with it anymore.”
Silverberg-Aroshas struck a similar note. She gave up her license, she said, because, “I did not have the economic or financial or emotional energy to fight with the Board of Dentistry.”
She said they didn’t do anything wrong. “It’s really sad…It’s just one of those horrible things.”
Two more recent cases in Florida, described by Health News Florida on May 4, were those of Dylan Stewart of Cedar Key, 5, who died last month, and Cory Moore Jr., a 9-year-old in Tampa, who died in February 2009.
Four cases were mentioned in the Academy memo:
--Last December in San Antonio, TX, 22-month-old Maddoux Cordova was given anesthesia for a dental procedure and morphine afterwards.
--In 2008 in Riverside, CA., 7-year old Jacqueline Martinez swallowed a tooth while under anesthesia for an extraction and died.
--Jenna Bautista, 5, of California, died under sedation when a cotton roll fell down her windpipe.
-- On May 11, Jacobi Hill, age 6, died under anesthesia for dental work at Virginia Commonwealth University Dental Faculty Practice in Richmond, according to news accounts. He had been taken there to have caps put on several of his teeth.
--Mary Jo Melone is an independent journalist in Tampa. Questions and comments may be sent to Editor Carol Gentry.