A 34-year-old Taiwanese woman died ten days after undergoing surgery to extract 20 teeth from her mouth. Her cause of death, however, was listed as “pneumonia”.

The deceased, known with the surname Cheng, fell into a coma on 5 November after being treated at Chiayi Christian Hospital for tooth decay on 4 November.

She was then immediately rushed to Chiayi County Hospital and was pronounced dead ten days later.

Ms Cheng’s family has filed a police report against Chiayi Christian Hospital as they suspected the death might be related to the tooth extraction infection.

UDN reported Ms Cheng’s father as saying that he had accompanied his daughter for the surgery which took nearly four hours.

When being told by the dentist after surgery that 20 teeth have been extracted, the father was shocked and asked whether it is too much and if his daughter could bear it.

The dentist, however, replied saying, “There is no difference between extracting one tooth and 20 teeth.”

Chiayi Christian Hospital stated that Ms Cheng was referred from the clinics to the oral and maxillofacial surgery department in its hospital for treatment at the end of October due to a mouthful of tooth decay.

The dentist had conducted preoperative examinations and explanation of surgical risk assessments before performing the tooth extraction on Ms Cheng on 4 November, said the hospital.

It added that Ms Cheng had her 20 teeth removed under general anaesthesia and was discharged from the hospital after ensuring her post-surgery condition was good.

In the face of the accusations from the patient’s family, the hospital also expressed their respects to the family, adding that they will await the results of judicial investigation.

According to Chief Prosecutor of the Chiayi District Prosecutor’s Office Tsai Yingjun, preliminary results of an autopsy performed on 18 November showed that Ms Cheng has died of aspiration pneumonia in her right lung.

He pointed out that they will conduct the investigation of the relevant evidence to determine whether the cause of death has any relation with the tooth extraction.

This was not the first time that a patient had died after having teeth removed. BBC reported that on 13 November 2018, a disabled woman passed away after having all her teeth removed by a dentist over severe tooth decay.

She collapsed after being discharged from the hospital she underwent an operation and had spent days on a life-support machine in the hospital before her family told that the was nothing more doctors could do for her.

Is it safe to remove 20 teeth at one time?

Responding to a question on whether it is safe to remove 20 teeth at one time, Dr Lai from Cambridge Oral Surgeon shared on his Facebook page on Wednesday that dentist will perform a tooth extraction in sequence based on six sections, which are upper jaws, lower jaws, right front, right back, left front and left back.

For cases such as Ms Cheng, who was a disabled person and may struggle to co-operate with dentists during the treatment, Dr Lai pointed out that the safest way is to perform general anaesthesia on patients.

However, he warned that the biggest risk of general anaesthesia is intubation, because if something happens during the intubation process, a patient may die within five minutes.

Even after general anaesthesia, a patient may also suffer from adverse reactions such as vomiting, bleeding wound and medicine contraindications.

As such, most of the dentists would rather spend more time treating the wound than performing general anaesthesia on the patients.

“The wounds of a tooth extraction or 20 teeth extraction after being well-treated is nothing compared to the risk of having general anaesthesia,” Dr Lai remarked.

What happens if the tooth decay left untreated?

Dr Lai also explained that if the decayed tooth is not removed, it will not only cause pain but also lead to bacterial infections where the infections can spread to the lungs, contributing to aspiration pneumonia.

What’s worse, when the bacteria enter the bloodstream running through the entire body, it may also lead to serious infection such as cellulitis, endocarditis and even death in septic shock.

As reported by Tai Sounds, the number of teeth being removed as well as the extent of tooth decay depends on the evaluation of dentist, given that the wound and complication from removing a deeply decayed tooth may sometimes be more severe than having five teeth extracted.

Among the serious consequences of not removing decayed teeth are bacterial infections of the bone that may lead to cellulitis, pharyngitis and septic shock, infections that lead to swelling and compression of the respiratory tract, deep neck infections and others.