Hyderabad: Timeline of events leading to man’s death after routine dental procedure

Hyderabad: Laxmi Narayan Vinjan (28) was excited about his upcoming marriage and wanted to get his teeth fixed. A fortnight after consultation with doctors of FMS International Dental Centre at Jubilee Hills, he took an online appointment and visited the clinic on February 16 for his dental procedures. He never came back alive.

Sequence of events on fatal day

Dr Rama Krishna Reddy, maxillofacial surgeon furnished a detailed account of what transpired on February 16, the proceedings of which have also been recorded by the CCTV cameras installed at the clinic.

“After a prior consultation on January 30, Laxmi Narayan arrived at our clinic at 2:30 pm on Friday. The patient, who already had dentures (prosthetic devices constructed to replace missing teeth) fixed on his lower front teeth, wanted to get his teeth changed and fixed properly before his marriage. Through interaction with the patient, the doctors came to know he had no comorbid conditions, nor was he taking any particular medication. However, he had undergone root canal treatment for two teeth one-and-a-half years ago at some other clinic. The root canal procedure is not possible without regional anaesthesia and therefore it is evident that the patient had prior exposure to anaesthetic drugs and he was not allergic to these,” said Dr Reddy.

Tooth structure needed adjustment

The elective procedure started at 3:30 pm, the doctor continued, and the first procedure was to cut down the existing dental bridge and check the condition of his natural teeth.

No anesthesia was required and the patient was absolutely fine. He was also checking his phone and informed his father that he would be back home after an hour or so. A CT scan of the tooth structure was taken and he was explained that his tooth structure needed to be adjusted before placing the new bridge on the small natural teeth. Since the patient would feel high sensitivity during this procedure of adjusting the edges, local anaesthesia through infiltration (which requires a minimal dose of anaesthesia compared to the nerve blockade process) was injected adjacent to the natural canine teeth at two corners.

The amount of anaesthesia given through infiltration was 0.3 ml on each side which is a total of 0.6 ml. This process was smoothly finished and the patient was also talking normally with the presiding doctor.

‘A total of 1.1 ml of anaesthesia was given through infiltration’

Next, since his natural teeth size was very small, and the gum was higher, he required a crown lengthening procedure. The gum height had to be reduced to make the teeth structure inside bigger. This time, infiltration (0.2 ml for each tooth) was again given on the outer side for the two teeth, which needed to be modified and 0.1 ml was administered on the inner side of the teeth, but not under the tongue. So, a total of 0.5 ml of anaesthesia drug was given to him this time. The crown lengthening process was also smoothly done and the patient was normally communicating.

For block anaesthesia, mostly performed during tooth extraction and root canal treatment, 2.5 ml to 3.5 ml of the anaesthetic drug is usually given depending on the particular case and condition. However, for this particular patient, a total amount of 1.1 ml (0.6 and 0.5 ml) infiltration anaesthesia was given, which is far less than nerve blockade anaesthesia.

The beginning of patient’s problems

After the crown lengthening process, the patient complained of little pain, which is also normal after dental procedures.

It was around 7.15 pm. He was given a usual painkiller mixed in water. He took the first sip and wanted to throw up. He was taken to the restroom upstairs. He complained of stomach cramps, and nausea and was unable to stand at the reception. He was immediately taken to the recovery room and was told to lie down and rest. He was given an antacid and anti-allergy tablet but he couldn’t take either and spat out both. He was folding his hands and legs and started having seizures. The doctors checked his BP and oxygen level and a life-saving steroid injection (adrenaline) was also given and CPR (cardio-pulmonary resuscitation) was continuously done. His BP had fallen to 80/50 and his pulse rate was failing.

An ambulance was also called by the doctors at the dental centre, which came in 15 to 20 minutes. The ambulance was fully equipped and he was given oxygen and CPR was continued. He was taken to Apollo Hospital, Emergency Room at Jubilee Hills, where despite all efforts to revive him, the patient did not respond. His family members had called on his cell phone, which was received by a doctor from the dental clinic, who had accompanied the patient to Apollo Hospital and asked his family members to come down owing to the emergency.

Dr Rama Krishna Reddy, who was on leave that day, rushed to the Apollo Emergency after the dental clinic told him about the patient, said, “It is unfortunate that we lost a young man but we can say that there was zero negligence on the dental centre’s part and during the entire procedure, the patient was all right, talking and checking his phone. Similar procedures are performed routinely at the hospital where patients from various states also come down. The only thing the doctors noticed was he was anxious throughout. Perhaps the anxiety issue was due to the family functions coming up and his marriage. The patient had prior exposure to nerve blockade anaesthesia when he had root canal treatment 1.5 years ago. So, we can say that he was not allergic to anaesthetic drugs. Also, an overdose of anaesthesia as the cause of his death can be completely ruled out because the anaesthesia required for him was much less, just 0.6 ml and 0.5 ml for the crown lengthening procedure in two phases. At this point, we are unable to understand the cause of his sudden death. We hope expert doctors concerned can look into this matter and find out.”