Amber Athwal

Amber Athwal, 4, at her family's Edmonton housewarming party in early September. (Athwal family)

External investigators are assisting the Alberta Dental Association and College in its investigation into the case of four-year-old Amber Athwal, who suffered permanent brain damage after receiving general anesthetic at an Edmonton dentist's office.

The ADA&C does double duty as both advocate for the province's dental industry and as a regulatory body for Alberta dentists. It is a setup that has been criticized in the past for creating a conflict of interest because the ADA&C fills both roles.

"I can assure you the investigation will be done in an impartial way. That's why we're seeking external people, why we've involving experts not just in the area of dentistry," said Dr. Randall Croutze, chief executive officer for the ADA&C.

The organization has asked medical anesthesiologists to assist in the on-going investigation of what went wrong in a downtown dental office on Sept. 7.

Investigation is on-going

That's when Athwal went to Dr. William Mather's office and was given general anesthetic. Her father waited in the reception area while the dentist worked on his daughter. According to the girl's family, the doctor came out after an hour and said Athwal had stopped breathing after the procedure.

Paramedics rushed her to hospital. The ADA&C has not confirmed any details of the incident.

Athwal is now staying at the Glenrose and her family says she has suffered permanent brain damage. 

Dentists in Alberta are permitted to administer general anesthetic in an accredited office, after receiving training through dental programs. Medical anesthesiologists, on the other hand, receive five years of specialist training after their medical degrees.

Croutze said those experts will assist the investigation. He could not say, however, when the investigation will be complete or when any findings will be made public. 

"Our commitment is to be open, to let people know what our findings are. We want to make sure Albertans receive safe, appropriate, ethical care."

Croutze said the ADA&C is also reviewing the organization's standard that allows dentists to administer an anesthetic and then perform a surgical procedure at the same time, as occurred in the Athwal case. Alberta is one of two provinces, the other being Ontario, where that occurs.

However, the Royal College of Dental Surgeons of Ontario has launched a formal review of its anesthesia standards.

No promised changes

Croutze could not say if there would be changes to the dual tasks of administering general anesthetic and performing a surgical procedure. He said reviews of anesthesia standards aren't being done any differently than the routine way other standards are reviewed.

"The process of review is an on-going process and one that has been occurring all the time. It's separate from what happened in this (Mather's) situation," Croutze said.

"I think you can be assured it's going to be an important topic for us at upcoming meetings and I'm confident a good deal of time will be spent on this topic."

But, he added, it would be "improper to comment" on what the objective or the result of the review would be. 

The ADA&C has suspended Mather's licence to sedate patients pending the outcome of its investigation.

The case has raised questions about rules governing dental anesthesia. Michael Dare, who teaches safe sedation in dental facilities, was invited by the he Alberta Dental Society of Anesthesiology to speak in Edmonton this week.

"I see a total lack of respect for how serious these drugs are and how easily you can get into a dangerous situation," he said.

"There are many good practitioners in the dental professions delivering high levels of care. But the unfortunate part is we have too many outlying practitioners."