THE INCIDENT
In December 2019, a five-year-old male patient experiencing pain in his mouth was brought by his mother to the Pilbara Dental Centre clinic in South Hedland. He was attended to by Dr. Ananda Krishnan, who could not thoroughly examine him as he was not willing to open his mouth. He was then ordered by Dr. Krishnan to come back to the clinic the following day for his dental treatment.
The next day, the accompanying parent, his mother, was asked for details about the patient, including his weight. The mother then verbally told Dr. Krishnan her son’s estimated weight. Using this information, Dr. Krishnan administered 10 milligrams of midazolam to help the five-year-old patient with his anxiety. Midazolam is a cardiac and respiratory suppressant, whose effectiveness and safety has not yet been studied in children below eight years of age.
The dental procedure was completed, but the effects of the midazolam lingered. For instance, his parents observed that though the procedure required conscious sedation, their child was only semi- conscious after the dental procedure was done. They also noted that the patient still appeared to be affected by the sedative one day after visiting the dentist.
The incident was eventually reported to the authorities.
THE INVESTIGATION AND FINDINGS
After looking into the case, the State Administrative Tribunal or SAT confirmed that Dr. Krishnan compromised the health and safety of the five-year-old patient in several ways.
First, he failed to provide adequate pre-operative clinical care when he did not weigh the patient and instead relied solely on the mother’s approximation. Second, he administered 10mg of midazolam, despite not having any knowledge, skill or judgment in doing so. Third, he conducted an off-label use of a drug whose efficacy for children eight years and below has not been established yet. Fourth, he left the sedated patient with dental staff who were not adequately qualified to address any serious medical emergencies that could have arisen from the use of midazolam. Then, during the treatment, he also failed to properly monitor the child’s heart rate, respiration rate, blood pressure and oxygen levels. Last, Dr. Krishnan discharged the patient, even when he still had not met all the discharge criteria.
The tribunal’s judgment also stated that the dose given to the young patient could have caused the child to stop breathing altogether, potentially leading to his death.
THE VERDICT
Despite Dr. Krishnan admitting his wrongdoing and expressing remorse for his erroneous conduct, the State Administrative Tribunal still ordered that he be disqualified from practicing dentistry for four years. This forced him to surrender his registration as a dental practitioner back in 2020. He was also required to pay a hefty fine of 6,000 AUD to the Dental Board of Australia.
KEY TAKEAWAYS FROM THIS CASE
If you forget all the details of this case and remember only one thing, it should be this: that Sleep Dentistry a.k.a Sedation Dentistry should be treated with precision and expertise, just as this Brisbane clinic does. All medications and practices that put patients to sleep during dental procedures should only be administered by dentists with recognized certifications. Sleep or Sedation Dentistry is not to be taken lightly and not to be done recklessly.
It is also equally important to understand that you don’t choose dentistry as a career – it chooses you. Dentistry requires certain traits like detail orientation, trustworthiness, reliability, expertise, compassion, patience, and manual dexterity. Someone interested in this field must keep in mind that with the personal perks of prestige, schedule flexibility, varied cases and patients, and good earnings come the task of caring for the oral health of the community and, consequently, their general health and wellbeing.
