In spite of this, the pediatric dentist performed surgery in this case — and in a dental office, not a hospital operating room. “Some insurance companies now will not pre-approve operating room [treatment] unless there has been a failed attempt in the dental chair,” says Dr.
Marc Ackerman, director of orthodontics and a fellow member of the ethics advisory committee at Boston Children’s Hospital.
But that was “vastly overstated,” according to the Pediatrics authors. Man Wai Ng developed an early childhood caries protocol that is becoming the standard of care nationally, according to Ackerman.
Ultimately, the specialists who wrote this piece were aiming at their professional colleagues, to spread word of the standard of care. Real health equity would require a radical alteration of social conscience and political will.But perhaps the preventable death of a child may serve as added impetus.When he still couldn’t tolerate the surgery, he was given more Versed.The procedure done, the dentist left the child in recovery with a dental assistant.But justice is just one of the foundational principles of ethics that have been butchered in this perfect storm of ethical blindness.
A dentist who was apparently ignorant of professional guidelines could not get true informed consent from the mother.Even better is preventing caries in the first place.The broader indictment from this tragic case in Pediatrics is that it represents “a societal failure to develop programs to prevent that disease,” the authors write. Maybe it always was, but it’s backsliding now — with Congress letting both the Children’s Health Insurance Program and federal funding for community health lapse in September. Tooth decay in children can affect speech, sleep, learning, relationships and quality of life right into adulthood.Conscious sedation in a pediatric dentist’s office is most common on the West Coast, Ackerman says, and much less common in the Northeast than in other areas.Surgery and deep sedation used to be considered worth the risk when tooth decay in childhood was thought to cause subsequent decay in permanent teeth.A toothbrush and floss should not be symbols of privilege. More serious attention to social determinants of health, including dental health.