The Dental equivalent of the Nightmare in the Gulf:

PCIntern

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Fri Jun-18-10 02:28 PM
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The Dental equivalent of the Nightmare in the Gulf:

A new patient attends a general dentist's office. The patient fills out the medical history and lists the following under the appropriate questions:

1. The patient has a history of two myocardial infarctions and multiple transient ischemic attacks.
2. The patient has been taking Plavix and Aspirin to ensure that blood clots are not formed due to
3. The patient's history of atrial fibrillation
4. The patient has a history of taking biphosphonates due to calcium 'issues'
5. The patient has a terrible toothache involving a lower molar.

Clinical examination revealed a vertically fractured mandibular right second molar. The patient was prepared, draped, and locally anesthetized in the usual manner and the tooth was removed utilizing conventional techniques with a straight elevator and cowhorn forceps. A portion of the distal root of the tooth was remaining, so and East-West elevator technique was utilized and the apical portion of the root was removed. The extraction site was sutured closed, post-operative instructions were given and the patient was dismissed.

Clinical course: the patient returned home. during the 45 minute automobile ride, large liver clots of blood were periodically removed from the mouth and the bleeding was reported to be heavy, although the patient bit down with great force upon the gauze. Upon arriving home, the bleeding did not cease despite multiple attempts to use pressure, and apply teabags which, in the opinion of the patient's spouse, 'should have worked'. After a fitful night of almost continuous bleeding, the area ceased to hemorrhage, but the patient began to complain of chest pains. Removal to the hospital by ambulance, and admission thereto revealed that the cardiovascular condition of the patient was most grave, the atrial fibrillation had increased dramatically and multiple conversion attempts were unsuccessful, and, incidentally, caused the oral bleeding to commence once more. Surgical procedures were accomplished to minimize the bleeding from the dental socket, but the patient began to fail, the BP collapsed, and the patient went into shock. fluids and medications were administered, but the patient was determined to be anoxic for long enough that EEG revealed minimal brain function. The patient was placed on a ventilator and observed. A few days later, necrosis of the jaw became apparent, due to the history of biphosphonate consumption. The patient became gangrenous, hemi-mandibular resection was performed, and the patient eventually succumbed to the conditions.

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Now, to :sarcasm:...as the oil folk say: WHO COULD HAVE POSSIBLY IMAGINED THIS COULD HAVE GONE SO BADLY?

Wasn't it obvious to everyone else? All the rules were broken, no lessons from history were learned and therein lay the tragedy.

This business in the Gulf, as I have posted many times, almost from Day 1, is apocalyptic (note: small 'a', not capital 'A' - no religious intent here) and I'll just be damned when I hear these oil folk express incredulity that this could have possibly occurred.