RANCHO CORDOVA (CBS13) — Mother Julie Pinon wants the state to investigate a dentist after she says her 7-year-old left the office with marks on his face, broken blood vessels on his chest and dried blood in his ear.
"It makes me want to cry thinking about it," she said. "The back of his ear was raw. The skin was peeled back."
Her son, Ryan Blue admits he fought back while the dentist pulled one tooth and filled another. It was the second dentist to try treating this fidgety patient. The first one referred him to Dr. Grossman.
"He (Dr. Grossman) said stop it; stop moving or you're going to make more blood come out," Ryan told CBS13 three days after the procedure. "I was trying to tell him to stop, but he wouldn't listen."
He says Dr. Wayne Grossman at Gold River Pediatric Dentistry restrained him, strapping him down to something called a papoose board. Pinon compares the device to a strait jacket. Dentist Dr. Burhenne agrees and compares it to a torture device
"This is a lot like waterboarding," he said. He gave the analogy explaining how patients are strapped down with water sprayed into their mouths.
According to the American Academy of Pediatric Dentistry, a 2010 survey found 72% of pediatric dentists use restraints.
We asked Dr. Burhenne who was trained in dental school how to use a papoose board, to demonstrate how it works. We got permission from the parents of a child and Dr. Burhenne strapped her down to the papoose board with straps and velcro. A strap was also placed around her head.
"She's immobilized," Dr. Burhenne said.
She showed us how she couldn't move. He claims that lack of ability to move can traumatize a patient for life. He also says a patient who can't move while a dentist works in their mouth, would have a tough time telling the dentist if he or she can't breathe or if something hurts.
"There are psychological ramifications after having used that." he said. "It's sort of a dental PTSD."
He prefers sedation which he says is safer. But 40-year pediatric dentist Dr. Steven Perlman disagrees and defends papoose boards saying he often treats the kids no other dentist will see; those with behavioral problems or special needs.
"Medical immobilization is the safest form of treatment," he said.
Dr. Perlman runs a dental practice outside Boston, and says every child reacts differently to sedation. He says sedating kids is unpredictable, can be dangerous and there is no proof papoose boards have psychological impacts. In fact, in his 40-years of dentistry he says the restraints often have a calming effect on kids, as if they're being swaddled or in their mother's womb.
"My job as a pediatric dentist is to raise the generation of children that is not afraid of the dentist," he said. The skill is working with the child so he doesn't have any fears and is a good patient."
The family of 4-year-old Naveah Hall says she suffered brain damage while getting her teeth capped. The Texas girl's family says a dentist strapped her down to a papoose board and gave her sedatives.
"This child was chemically and physically suffocated," said family attorney Jim Moriarty at a news conference earlier this year.
Dr. Perlman says it's important the dentist discusses the options with the parent before the procedure, and has them sign a basic consent form.
Julie admits Dr. Grossman did go over the papoose board ahead of time, and she did sign a waiver saying one may be used, however she says she asked his office staff to notify her before actually using the restraint on Ryan.
"He could've come out to let me know what was going on; maybe try to have me calm him (Ryan) down," she said. "I didn't sign up for my son to be abused."
We reached out to Dr. Grossman who emailed us a statementthat reads in part,"...this case is about a child with an emergency situation, not treatable by others due to his behavior, which could soon suffer a major body infection... According to professional guidelines he was not a candidate for in office sedation or general anesthesia. He was an appropriate candidate for treatment with an immobilizaton/stabilization device...We used this approach with the mother's consent..."
The American Academy of Pediatrics has guidelines on the use of restraints, which state, "A parent has the right to terminate use of restraint at any time."
Julie says she didn't have that option, because she wasn't allowed in the room. She says Ryan has been strapped to a papoose board before when he needed stitches for his head. She says in that case, the medical doctor allowed her in the room.
Julie has filed a complaint with the Dental Board of California. The agency could not talk about this situation, but told us, "The Dental Board of California has no policy regarding the use of child restraints, such as a papoose board. Those type of restraint techniques are taught in dental schools and the use of such restraints in considered within the standard of practice for dentists."
Ryan's marks have since healed, but his mom is afraid of the lasting scars you can't see.
"I just don't want to remember that," Ryan said.
Dr. Wayne Grossman's Full Statement
This patient was sent to our office on an emergency referral. He was unable to be treated by the previous dental office or offices. The parent stated that Ryan could not eat and was in pain. We assessed the child's condition and cooperation level on the first visit. We found a case of dental/medical neglect. Besides the nearly exfoliating loose front tooth that his mother was concerned about, we found a more seriously abscessed back molar tooth and three other back teeth close to abscessing. We found swollen lymph glands that could indicate a systemic infection even though the child was on antibiotics from a previous dental office. Of special concern was his medical history which included having one, partially functioning kidney. It was important to provide speedy treatment due to the danger of systemic like blood infection to his already compromised organs. He had been in a stabilization papoose like device on more than one occasion per his mother for several other medical services where she stated he had been traumatized by those procedures. At our initial evaluation visit, we were able to work with Ryan, but he was unable to keep still or follow directions easily. Given the seriousness of the situation I counseled the mom that we could only provide care with an immobilization device....he was not a candidate for in-office sedation or likely general anesthesia due to his health issues. Hospitalization with general anesthesia is nearly non-existent for Medicaid patients in our county and he could not wait weeks or months required to find and schedule treatment in-hospital for the needed emergency extractions, even if it could be obtained. Due to his behavior history I told the mother that I could only provide the care with safety stabilization of her child, given the urgent status of her son need for treatment. It is a universally understood fact an abscessed tooth if not treated with more than just antibiotics, will continue to be infected and increases the risk of a greater infection. She agreed to the use of this modality in writing and before witnesses. The authorization to do the dental work was expedited by Medicaid and we saw Ryan for treatment 3 days later. Mom did not chose to go elsewhere.
At the visit with us, Ryan did not object to the use of a papoose board immobilizer. We placed safety googles, and over that the nitrous oxide nosepiece and attachment. It was only when the injection began that the child protested and struggled when just the cotton swab was placed. My hygienist continued working and was able to complete the injections. When I prepared to treat the abscess, the child forcefully flipped his head side to side unseating the protective goggles and jamming them against his ears and face, scraping the area behind the ear. He also struggled in the stabilizer, forcefully pushing his torso against the Velcro drapes, thereby leaving a short line of petechia redness exactly where the ribbing of the drape was. We were able to successfully extract the teeth and Ryan soon was happily playing video games as the extraction sites were cleaned and monitored.
After successfully performing the urgent treatment and removing the risk of a more serious infection, I spoke to mom and described the treatment and told her of the origin of the red marks she might find and why. Despite our pre-treatment request for a full disclosure of health information, it was only then that she relayed to us that it always took 3 or more people to restrain her son for medical treatments such as blood draws or vaccinations or flu shots...so she understood his behavior. I told her that further non-urgent care would not be done except with general anesthesia, in office if the anesthesiologist thought he was a candidate. If that was not the case I would only use the stabilizer with her present in short sessions to complete the work. She accepted these options and even filled out forms for the anesthesiologist. It was only then that she disclosed that Ryan had trouble waking up from anesthesia when it was used in the past. With that information, I contacted my anesthesiologist who then said that Ryan was not a candidate for in-office sedation or general anesthesia and therefore the options were either restraint stabilization or admission to a hospital. Four hours after the appointment began, mom was at home posting her statements on her Facebook. She included pictures, some with Ryan laughing. I especially noted the one with the pizza box food not authorized post-treatment-soft food and liquid recommended. She subsequently took down that picture.
In summary, this case is about a child with an emergency situation, not treatable by others due to his behavior, which could soon suffer a major body infection, where organs are already compromised. According to professional guidelines he was not a candidate for in-office sedation or general anesthesia. He was an appropriate candidate for treatment with an immobilization/stabilization device which he had been placed in in previous medical situations. We used this approach with the mother's consent. Dental surgical procedures cannot be safely performed on moving or combative children without either sedation or restraint. Although we have many parents accompany their children, previous history and judgement indicated that it would unlikely be helpful in this case as it would cause the patient to be even more active, as reported by the mother had happened in other cases. This child is suffering from pervasive dental neglect, possibly related to his extensive poor relationship with medical providers, lack of regular dental care, poor home care and dietary habits. In the future, his mother should strive to provide all important relevant medical information to his dentist. After the emergency care Ms. Piñon was told in great detail of the procedure and future options. Instead of raising her concerns with our office she was making incendiary and untrue statements on Facebook within two hours of leaving with a smiling child.
Taking care of special needs patients and children with acute medical or dental problems is not easy. When those who accept this challenge are attacked by misstatements or half-truths it does not encourage other healthcare providers to offer services to this already underserved population. Our office did not cause Ryan to have rampant decay, infected and loose teeth. We could have rejected this patient as had the dentist before him and not offered urgently needed care because in-office sedation was not an option, and we would not use stabilization, and leave Ryan with a significant risk of a serious spreading infection. Instead, we offered urgent care with the full knowledge and consent of the patient's mother to the use of restraint.
This case is not about use of papoose boards in dentistry, or the alternative of general anesthesia or sedation. We provided articles about the use of restraints by 73% of pediatric dentists. It is about this individual patient's urgent presentation, medical history and the well accepted modalities for treatment of such patients.
Lastly, general anesthesia and sedation are not simple or risk free, or minor procedures. They include risks that include death. We consider such modalities significant, and provide such anesthesia only through the services of an anesthesiologist, who in this case would not recommend providing in-office anesthesia.
Dental Board of California Statement
The Dental Board of California has no policy regarding the use of child restraints, such as a papoose board. Those type of restraint techniques are taught in dental schools and the use of such restraints in considered within the standard of practice for dentists.
Dental Board records show Dr. Grossman has been licensed since 1975 with no discipline on his record. We asked the Dental Board to supply us the names of California Dentists with actions against them for issues tied to their use of restraints since 2011.
Joo, Hans- DDS 53604
Sabo, Pooney- DDS 42602
Tsai, Julie- DDS 51873
Amores, Arlene- DDS 56164
Dove, Edward- DDS 51010
You can find documents tied to these cases and search for your own dentist on the Dental Board of California's Website.
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