By Candace DeLapp, D.D.S., Dentists Professional Liability Trust Executive Director
From the Spring/Summer 2020 Journal of the Colorado Dental Association
I wanted to share an excellent case commentary written by Scott H. Brown, D.D.S., of Utah. I hope it will strike a chord with you as it did with me.
A pediatric dentist was referred an 11-year-old female for orthodontic extractions. After reviewing the medical history, he began administering nitrous oxide. While delivering local anesthetic, the dentist noted that the girl’s gingiva appeared “much more purple” than normal, especially in the upper lip. The dentist’s first thought was that perhaps the nitrous mask was too tight. Upon repositioning, there was no improvement in the tissue color. This prompted the dentist to question the mother further if there were any physical limitations, specifically relating to exertion leading to exhaustion. The mother related that her daughter could not run without feeling winded after a short distance.
With this additional history, the dentist concluded that the patient may have an oxygen perfusion issue. A pulse oximeter was placed, with the patient registering 61%. The patient was given 100% oxygen and after five minutes only reached 64% oxygen saturation. The patient’s pediatrician was consulted and together they determined the patient should be rushed to the hospital immediately.
Arriving at the emergency room, the patient was placed on 15 liters a minute of oxygen for three hours. Her oxygen level never went above 64%. She was subsequently transferred to a chi
| “Behind every tooth, there is a person.” |
ldren’s hospital. A day later she underwent heart surgery for an undiagnosed large hole in her heart, which had been present since birth. As she grew, so did the hole in her heart. The result was a continued lower oxygen saturation. The right side of her heart was much larger than the left as the right side was compensating to deliver more oxygen. She spent the next 10 days at the hospital.
Since the surgery, there has been a long road to recovery. Twice she has required Flight for Life to the hospital for complications requiring additional surgeries. Now, she is back at school with an oxygen saturation in the mid-80s. She remains on oxygen to go to school.
So why did I feel it is important to share this story with you? Because this practitioner used all his skills and knowledge, not just those pertaining to the scope of extracting teeth for orthodontia. Because of him, this young lady will lead a healthier life. The pediatric dentist relates, “I think back to that day and realize that as a dentist our job is much more important than just looking at teeth. I am super grateful that I noticed her color, asked some more questions, and was able to assist in getting her the help she desperately needed.”
Be a doctor, not a tooth mechanic and maybe you, too, will be someone’s hero.
Candace DeLapp, D.D.S., is the executive director of the Dentists Professional Liability Trust of Colorado. Contact her at hdelapp@berkleyrisk.com.