Questions arise about oversight of pediatric dentists Date: 03/18/14
By Mary Otto
The state of Hawaii continues to investigate the death of a three-year-old girl who went into a coma after visiting a dentist’s office.
Last month, I wrote about the good coverage by Susan Essoyan of the Honolulu Star Advertiser.
I also put together a pediatric anesthesia tip sheet with links to some helpful resources.
In the meantime, reporter Alia Wong has also been following the tragic story of the death of Finley Boyle and weighed in with a long Jan. 21 piece for the Honolulu Civil Beat.
Wong brings us up to date on the kinds of questions that are being raised in the wake of the child’s death.
She writes in her piece that questions are being raised about whether dentist Lilly Geyer, who was treating Finley, should have been advertising herself as a "children's dentist."
And she explains that “pediatric dentists do a rigorous and competitive two-year residency program in which they get training in specific skills such as child sedation while general dentists aren’t required to do a residency program.”
Q: It doesn’t sound like it’s clear whether dentist Lilly Geyer completed a pediatric residency because the state of Hawaii doesn’t distinguish between specialists and general dentists when it issues dental licenses. In your reporting, did you get a sense that other states handle this licensing issue differently?
A: I found that most states are like Hawaii in that they issue just one type of dentistry license. The American Dental Association published a list in 2009 showing that 10 states had licenses for specialists, while another seven issued specialty certificates. It's hard to say, however, whether the list is up-to-date, as dental licensing policies are always changing.
Q: It also seems unclear whether Geyer had earned the necessary credential to administer sedation in Hawaii. Can you tell us a more about the requirements for the credential? Is it a matter of public information whether someone has this credential?
A: Dentists need to be certified to administer sedation in Hawaii, a credential that requires successful completion of a course that covers at least 10 categories of anesthesia and clinical experience, among other prerequisites. They then need to get written authorization from the board and renew that authorization every two years. It's unclear whether Geyer complied with those rules because the Department of Commerce and Consumer Affairs wouldn't disclose that information, citing its pending investigation into her dental practice. It's also unclear whether Geyer was qualified to administer sedation on such a young child, as pediatric dentistry guidelines entail specific protocol for child sedation and anesthesia. One certified pediatric dentist who markets himself as a sedation-free practitioner did tell me that the "best practices" for sedation are very subjective and that every dentist uses his or her own regimen. He suggested that the focus of my story should be on Geyer's pediatric qualifications rather than what was amiss about her sedation practices.
Q: Has the case of Finley prompted calls for change in the way Hawaii oversees dentists? If so, what kinds of changes are being discussed?
A: The Finley case has definitely galvanized support around efforts to improve state oversight of dentists, including two bills that are advancing through the Legislature. One of them would create specialty licenses for dentists. Strangely enough, a third bill has the potential to loosen the regulation of dentists by drastically changing the composition of the state dental board. The measure would increase the number of dental hygienists and decrease the number of dentists on the board – a proposal that has caused much alarm among local dentists.
Q: In your reporting, you talked with experts about the benefits and risks of conscious sedation, which, according to legal documents, appears to be the type Finley received. What did you learn about what might go wrong?
A: One dentist told me that conscious sedation is typically used on "tense cooperative children" who need a lot of work done on their teeth. But it can cause the children to lose their inhibitions and become more difficult to control. That can make it challenging for a dentist to intervene when a child's oxygen levels start going down. That's why it's so important to regularly and frequently monitor a child's heartbeat and oxygen levels.
Q: Are you planning a follow-up on this story?
A: I did one follow-up on the relevant legislation that has been introduced since the incident. I am also keeping my eyes on other legislation and have been staying in touch with some of the sources who contributed to the first piece. Generally speaking, I'm very interested in doing more coverage on issues involving children's dental care and safety as well as state regulation of professional industries. All these subjects are on my radar.
Q: Any advice for other reporters on the best way to untangle the strands of a tragedy such as this?
A: I really benefited from speaking with a wide array of experts. It became clear as the story developed that opinions on best practices vary greatly among professionals and that I should take every piece of input with a grain of salt. Doing that allowed me to find common threads in their concerns and subsequently tackle the root problems rather than focus on the "he said-she said" aspects of the case.
Q: And finally: In a 2012 story, you wrote about the lack of community water fluoridation in Hawaii.
“Most cities add fluoride to their community water supplies to help prevent tooth decay – particularly among children and adolescents,” you noted. But when it came to statewide fluoridation rates, you found Hawaii ranked last, with just 11 percent of the population receiving fluoridated water.
In 2004, the Honolulu City Council formally banned fluoride from all publicly supplied water, pointing to the spiritual significance of water in Hawaiian culture.
Has anything changed in terms of fluoridation efforts since then? In the wake of Finley’s death, has anyone renewed the call for water fluoridation in Hawaii?
A: As far as I know, nothing has changed with regard to water fluoridation, and it's unlikely that anything will in the near future. Water fluoridation is a particularly touchy subject here in Hawaii given the profound connection to the land and natural resources in the Hawaiian culture. Whereas in other parts of the country water fluoridation might be seen as an innocuous and cost-effective public health service, in Hawaii many people oppose adding fluoride or any other foreign substance to public water sources. That frustrates many local dentists and public health advocates who point to the high rates of tooth decay among Hawaii's children, particularly those from low-income families. I haven't heard any talk of potential changes to current policies in the wake of the Finley case.
Alia Wong covers education news for Civil Beat. A Honolulu native, Wong returned to the islands in May 2012 after graduating from Boston University. Before the birth of Civil Beat, Wong wrote for Honolulu Weekly. She also had a number of jobs while in Boston, including as a fellow in Boston University’s writing center and a research assistant.