Pediatric Dentistry's Horror Stories

Everyday, several “Dental missions” dental outreach programs are being conducted in the Philippines, serving around 100-300 per program with most of the dental procedure being tooth extraction. While these outreach programs maybe beneficial especially to the indigent Filipinos, several risks arises in the provision on such services on a repetitive and big scale. Problems such as cross infection between patients, since most dental missions do not practice adequate aseptic techniques during such programs. In connection to this, there is an increase in the spread of HIV and Hepa B infections, with a number of the infected patients that do not know where it came from. Could our dental missions be a contributing factor in the increase of these infections? Are we really extending our help during outreach missions or are we just facilitating the spread of infection? Infection-free dental treatments need not be confined to private patients. It is our professional obligation to ensure our patients’ safety indigent or not.

With most missions being conducted without sufficient screening and availability of Emergency Response Team most patients in dental missions are at risk for cardiovascular problems such as myocardial infarction. Another issue that we need to focus is patient after care. With most dental missions having tooth extraction as the main procedure, bleeding problems intra and post-operatively are another thing that we should look out for.

The lecture will focus on the statistics of such problems and will provide a review of already existing policies and present a culturally relevant way on how to prevent such problems/accidents from happening.

At one point or another, a clinician may inadvertently induce complications on their patients in their practice. And these complications may pose certain degree of severity, from minor to a more complex one. This lecture will present three different actual cases of dental procedure which resulted to iatrogenic setbacks. This case presentation will include discussion of the sequelae, its appropriate remedies and ways to avoid to avoid them.

Tooth aspiration is a potential complication of a simple dental extraction. This complication necessitates prompt recognition and early management to avoid serious and life threatening medical issues. This risk is a challenge that dentists’ face in daily practice thus practitioners must understand the clinical signs, the health complications and the possible legal sequelae. This lecture will present an actual case of tooth aspiration in the dental clinic and the adverse events that followed.

"Is sedation safe? What are the risks of this treatment to my child?" These are the most common questions asked by parents regarding conscious sedation in pediatric patients. Intravenous Conscious Sedation is a widely used treatment option for oral rehabilitation in pediatric patients. However, lack of knowledge, proper protocols, and training could be a large cause of morbidity and mortality in this kind of treatment. This lecture will discuss a case of patient mortality who had complete oral rehabilitation under conscious sedation. Proper patient assessment and management will also be discussed to further eliminate the risks of dental treatment under sedation.

Pediatric dental sedation involves a multi disciplinary approach in order to give the best care to those children who may require it. The dentist, pediatrician, and the anesthesiologist must be able to understand the current physical and psychological state of each patient so that an appropriate treatment plan can be done. The skill of the dentist and anesthesiologist are important determinants for a successful procedure, as well as, the capability and preparedness of the dental clinic and staff to rescue a patient if in case an emergency situation arises. Continuous monitoring and vigilance of any patient under sedation should always be a shared responsibility of everyone involved with the child's care. Lastly, a thorough post operative instruction as to what to expect, and how to care for the child post sedation should be given once all discharge criteria are met.

Objectives:

1. To determine whether the clinic, dentist, anesthesiologist, and staff are well equipped to conduct procedures under sedation
2. To be able to know who are good candidates for sedation
3. To know the necessary requirements for a child prior to sedation
4. To be able to recognize different levels of sedation
5. To know how to monitor patients under sedation
6. To know the discharge criteria necessary to achieve prior to sending a patient home