7-year-old's death ruled an accident

The death of 7-year-old Jacqueline Martinez, who died after a dental procedure earlier this year, has been declared an accident by officials who have been investigating the case.

Martinez went to New Smile Dental Office in Riverside, CA, on March 4 and died after choking on an extracted molar.

According to a San Bernardino County coroner report, the official cause of death was hypoxic encephalopathy -- lack of oxygen to the brain -- due to tooth aspiration during the dental procedure.

Martinez was very nervous before the procedure and given anesthesia on the buccal gingival, the report states. Her left upper molar was elevated and extracted with forceps, and at the time of extraction she made a sudden movement. As a result, the tooth fell, Martinez accidentally aspirated it, and she started choking.

The Heimlich maneuver was immediately performed and the dentist, Thien Luong, D.M.D., asked his assistant to call 911. A patient in an adjacent room who happened to be a paramedic came over to assist with the Heimlich maneuver. The effort was unsuccessful and Martinez lost consciousness so they began CPR.

By the time the paramedics reached the dental office, there was little they could do, Riverside Fire Department Division Chief Mike Fisher told DrBicuspid.com at the time of the incident. They tried advanced life support methods and reached for the tooth with McGill forceps, but couldn't get it from behind the vocal chords.

"The Riverside Fire Department attempted to visualize and/or remove airway obstruction," the autopsy report confirms. "Attempts to remove the obstruction were unsuccessful."

Martinez was rushed to a Riverside hospital and lapsed into cardiopulmonary arrest en route. She had no spontaneous respiration so she was intubated and placed on a ventilator.

Later she was transferred to the pediatric unit at Loma Linda University Medical Center, where doctors used suction to try and remove the tooth but only managed to push it further into her right lung.

"According to Loma Linda University Medical Center records, the tooth was in the right mainstem bronchus," the autopsy report states.

At Loma Linda, Martinez continued to decline and was pronounced brain dead twice, once on March 6 and finally on March 7.

"There are still unanswered questions as to the exact events following the tooth aspiration that occurred in the dentist's office," the report states. "Attempts have been made to obtain these details from the dentists; however, it has been met without success."

Dr. Luong continues to practice at New Smile Dental Office. His office deferred all questions to an attorney, who told DrBicuspid.com that he had not reviewed the autopsy report and was unable to comment on it.

The incident is also under investigation by the Dental Board of California. However, the board will not comment on the case until the investigation is complete, said Russ Heimerlich, spokesperson for the California Department of Consumer Affairs.