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Recently in Chicago, a pediatric dentist routinely performing dentistry on his child patients suffered the death of a young girl in a sedated state. The situation made national news and is being investigated by all governmental and professional organizations to determine if there were any means that this could have been prevented. In the meantime, our profession has stepped to the forefront in recommending and publishing sedation guidelines.

While many of these guidelines seem to be “common sense” and have been published before, the immediate need was to quantify them to everyone in an established form, particularly to the skeptical general public aroused by this particular case. Now, all of dentistry comes under the microscope again to be re-examined. Providing answers to the public before they have asked the questions and to oversight governing bodies demonstrates that our profession continues to act in the best interests of our patients.

The American Academy of Pediatric Dentistry (AAPD), founded in 1947 and headquartered in Chicago, consists of some 6800 members who are primary care providers for comprehensive specialty treatments for infants, children, adolescents, and patients with special health care needs. As advocates of children’s oral health care, the AAPD works closely with legislators, professional associations, and health care professionals to develop policies and guidelines, to implement research opportunities in pediatric oral health, and to educate pedodontists, pediatric dentists, all health care providers, and the public regarding pediatric oral health AAPD.org.

A separate organization, the American Academy of Pediatrics (AAP), has some 60,000 members in primary care roles as pediatricians, pediatric medical subspecialists, and pediatric surgical specialists who are dedicated to the health, safety, and well-being of infants, children, and young adults www.AAP.org.

In a landmark event, these two groups released joint recommendations for all medical and dental practitioners regarding the management and monitoring of pediatric patients during and after sedation procedures. This reinforces a standardized approach to pediatric sedation procedures across the health professions. The guidelines follow definitions of sedation categories and expected physiological responses currently used by the Joint Commission of Accreditation of Healthcare Organizations and by the American Society of Anesthesiologists.

AAPD President Dr. Phil Hunke stated that the AAPD partnership with AAP has provided extensive, updated sedation guidelines in a monumental step toward ensuring that all children who undergo a medical or dental procedure will receive the safest, most effective treatment in practicing in a manner consistent to benefit all patients and the entire pediatric medical community.

The recent trend in outpatient procedures that involve sedation is becoming more common outside of the safety net of the hospital environment. While proper sedation procedures have long been established, a review that included codification and publication of the procedures was felt to be required to assure the profession’s compliance on a routine basis.

Almost all professionals are familiar with the horror stories of lost patients even in following all these procedures. But any sedative involves some risk, as does the procedure itself. Sedation should not ever be considered routine for simple procedures that could be handled differently without incurring additional risk to the safety of the patient.

Many forms of sedation are becoming more commonplace in the professions as newer medicaments are being developed. But no matter how many times a sedative form is used prior to a procedure, the specter of death looms in the shadows for even the finest practitioner. And the psychological effect on the staff and doctor in losing a patient is irreparable.

In 2002, the PFA Foundation awarded a $3500 grant to the Bay Cliff Health Camp in Big Bay, Michigan, on the recommendation of Michigan Chair Virginia Merchant (Dental World, Jan/Feb 2003, p. 14).

Under the leadership of Dr. Cheri Newman and her tribe of volunteers, several dental personnel ventured into the wilds of rural Michigan to provide dental care to the physically disabled. A couple of those volunteers at that time were past PFA President David Campbell and his wife Janet. They wrote an article about the experience which was shared with the Fellowship in the July/August 2003 issue of Dental World, pp. 2-3.

And though we are in 2007, the Dr. Cheri Newman Dental Tribe of UDM volunteers did venture out to Big Bay, Upper Peninsula, again last summer to continue their tradition of providing dental care to the physically challenged adults.

The Camp was originally established during the Depression years as an outpost to help starving children. It later became a center for treating children with polio and other physical disabilities. Currently, the Camp treats children with any physical disability. Over its 72 years of service, thousands of children have been helped in their lives. In those seven decades, the children have become adults, but serving their needs is still a priority. Bay Cliff Camp has established Camp Independence for “campers” 18 years and older to continue their childhood experience into adulthood. This is where PFA has become directly involved.

That Camp experience is adapted per person per disability to be inclusive, from kayaking, painting, bowling, swimming, photography, to physical therapy, massage therapy, and dentistry.

The dentistry is particularly essential since many of these patients do not have access to dental treatment during the rest of the year. It is not that the families or nursing care homes do not care about their patient’s dental needs, but the time and energy involved in getting the patients dressed and fed for the day is exhausting. Planning preparation for a dental appointment, transportation concerns of getting to a dental facility, and then making a series of dental appointments to take care of these needs is difficult to work into a regular regime and cost. When just taking a glass of water with a straw is a chore, brushing one’s teeth daily is not a high priority item for living. This situation is an everyday reality for many Bay Cliff patients. This is where PFA volunteers make a real difference.

This year’s team consisted of UDM students Tiffany Stafiej, (Foundation Scholarship recipient), Elizabeth Ralstrom, and Sam Blanchard, along with Brad Mattson, RDH Pat Theisen, RDH Stephanie Newman and Dr. Cheri Newman. They performed some 60 hygiene appointments, more than 40 multiple surface restorations, and a few extractions. While it seems strange that these patients are genuinely appreciative of the dental treatments, one understands better when they say, “Thank you. It no longer hurts when I chew.”

At Camp Independence, there are no disabilities, only differently-abled campers. Camp Bay Cliff is a magical place where lives are affected every summer. Volunteers think that they are there to help others. Halfway through the camp they realize that the campers only needed a filling or two, but the volunteer needed the help in realizing another side of real life. They understand that the profession of dentistry is more than a business, and payment is more worth earning when done with thankful smiles and words.

The National Museum of Dentistry in Baltimore (at the University of Maryland Medical Center) opened its newest exhibit last December—“The Narwhal: A Whale of a Tooth.” The exhibition features a 13-foot, life-size model of a male Narwhal with a five-foot tusk growing through the upper lip and jaw.

The exhibition is based on the research of Dr. Martin Nweeia, the principal investigator of Narwhal Tusk Research, and a research associate in the Marine Mammal Program at the Smithsonian Institute. Visitors will hear stories about this “Unicorn of the Sea” and the legends surrounding the sailor stories that has had scientists wondering about the creature for decades.

The most startling revelation is that a Narwhal (Monodon monocerous) has a tusk whose outer surface is composed of 10 million, tiny tubules

that contain neural fibers connected to the single tusk’s central nerve. Dr. Nweeia noted that it is indeed strange to discover such a formation of millions of sensory pathways connected to its nervous system that are exposed to the frigid artic environment. The usual range of this creature is from the Atlantic portion of the Artic Ocean to the Greenland Sea. This is the only currently known mammal to have such a natural physical arrangement.

The single tusk is the only one in nature that grows straight and can achieve a 9-foot length. The adult body form is between 13 and 15 feet long, weighing in at 2200 to 3500 pounds.

This exhibition was supported through a grant from Sunstar Americas. The display will run through August, 2007

Bcooper@DentalMuseum.UMaryland.edu