OT; Dental work advice please

My DD (4yo) needs some dental work done. She has 4 molars with cavities,
and in one of them she needs what they are calling a "baby root canal",
although it's apparently not really a root canal but a pulpectomy (sp?).

Anyway, after having a traumatic time at the dentist I have been using (not
a ped dentist, mistake #1), I took her to a pediatric dentist. All was
great, she got the x-rays the other place was not able to get for her last 2
visits, and this is when we found out she needed this work done (today).

They managed to get to the point of numbing her up without ANY fuss, but as
soon as they came in with the drill she was saying it hurt her. The dentist
assured me that she was completely numb and couldn't possibly feel it, and
my DD does tend to be extremely dramatic, so I didn't doubt what the dentist
was saying. However, DD was saying it felt "cold" and she didn't like it.
TO cut a long story short, dentist decided she did not want to further
traumatise DD and put a temporary filling over the partially drilled tooth
and recommended we get the rest of the work done under general anesthesia
another day, then sent us home.

I am extremely hestitant to put her under for a few reasons.
1) I don't really want to start having to have her put to sleep every time
she has dental work done, starting at such a young age.
2) There are inherent risks with every anesthesia and I don't relish the
thought of having her out for this kind of relatively minor work.
3) It's also not covered by our insurance and they are telling us $650 just
for the anesthesia. This is so out of our budget it's not even funny.
4) She is also terrified of shots and the last well child visit we went to,
the doctor told her she doesn't have to have any more shots until she is 11.
I feel like we'd be going back on a promise if she did have the shot

The other option is what the dentist is calling "oral sedation". Dentist
says she will get drowsy, but not completely asleep, and she will be aware
of what is going on. Both DH and I are favoring this option, but the
dentist isn't recommending it. given her "history". The downside with this
is, it will be the same stuff that happened today except instead of nitrous
oxide gas, it will be a heavier sedation (maybe Valium, not sure),but also
she will have to go twice, because they don't like to do the whole mouth
under oral sedation.

So, I am in a bind, I don't know what to do. I am beating myself up about
whether I should have had the dentist press on today just to get it over
with, but it wasn't a pretty scene (she was batting the drill away, which
looked dangerous, and the office had a policy of not holding kids down, so
they were not about to do that).

So, can anyone share any stories with me? Do you think I should yet another
dentist? Am I over thinking this? Opinions on whether oral or IV sedation
is better in this situation? Ideas about how we might get the sedation
covered if we DO end up going that way? (I've already called the health
insurance and they only cover it for kids 3 and under). It's hard to be
making an objective decision because the money issue is in the way, so I'd
like opinions from other moms please!

Thank you!

CY

Hi CY

I used to work in ped cons dentistry, so I hope I can be of some help.

Had she not already freaked, I would have suggested taking her in for a
"training session", where she'd get to see all the instruments first, looks
in your mouths with the mirror etc, just to get used to the sites and
sounds... It might still work, depending on how bad she was. It's also worth
asking the dentist if you can lie in the chair, with her laid on you as
comfort.

Otherwise, I would recommend the IV sedation. They should put a cream on her
hand first - "magic cream", or lignocaine, so she won't feel it, then they
put the injection in. She'll still be awake, but she won't remember any of
it. If she's easily stressed, the gas won't work as it's best to be relaxed
when you're about to have it.

Having had both myself, I would still recommend the IV. The gas mask can be
a bit itch on your nose and mouth and depending on the quality, it can smell
funny, which might also freak her. I have no memory of having my wisdom
teeth out under IV, although I was still able to function.

4 molars is a lot to treat if she's going to be that unhappy... Having IV
doesn't mean she'll need it every time, just give her chance to get used to
it - 4 is still very young.

Good luck!

Lucy


"CY" wrote in message
news:tBSHg.153645$1i1.132935@attbi_s72...
My DD (4yo) needs some dental work done. She has 4 molars with cavities,
and in one of them she needs what they are calling a "baby root canal",
although it's apparently not really a root canal but a pulpectomy (sp?).

Anyway, after having a traumatic time at the dentist I have been using
(not
a ped dentist, mistake #1), I took her to a pediatric dentist. All was
great, she got the x-rays the other place was not able to get for her last
2
visits, and this is when we found out she needed this work done (today).

They managed to get to the point of numbing her up without ANY fuss, but
as
soon as they came in with the drill she was saying it hurt her. The
dentist
assured me that she was completely numb and couldn't possibly feel it, and
my DD does tend to be extremely dramatic, so I didn't doubt what the
dentist
was saying. However, DD was saying it felt "cold" and she didn't like it.
TO cut a long story short, dentist decided she did not want to further
traumatise DD and put a temporary filling over the partially drilled tooth
and recommended we get the rest of the work done under general anesthesia
another day, then sent us home.

I am extremely hestitant to put her under for a few reasons.
1) I don't really want to start having to have her put to sleep every time
she has dental work done, starting at such a young age.
2) There are inherent risks with every anesthesia and I don't relish the
thought of having her out for this kind of relatively minor work.
3) It's also not covered by our insurance and they are telling us $650
just
for the anesthesia. This is so out of our budget it's not even funny.
4) She is also terrified of shots and the last well child visit we went
to,
the doctor told her she doesn't have to have any more shots until she is
11.
I feel like we'd be going back on a promise if she did have the shot

The other option is what the dentist is calling "oral sedation". Dentist
says she will get drowsy, but not completely asleep, and she will be aware
of what is going on. Both DH and I are favoring this option, but the
dentist isn't recommending it. given her "history". The downside with
this
is, it will be the same stuff that happened today except instead of
nitrous
oxide gas, it will be a heavier sedation (maybe Valium, not sure),but also
she will have to go twice, because they don't like to do the whole mouth
under oral sedation.

So, I am in a bind, I don't know what to do. I am beating myself up about
whether I should have had the dentist press on today just to get it over
with, but it wasn't a pretty scene (she was batting the drill away, which
looked dangerous, and the office had a policy of not holding kids down, so
they were not about to do that).

So, can anyone share any stories with me? Do you think I should yet
another
dentist? Am I over thinking this? Opinions on whether oral or IV
sedation
is better in this situation? Ideas about how we might get the sedation
covered if we DO end up going that way? (I've already called the health
insurance and they only cover it for kids 3 and under). It's hard to be
making an objective decision because the money issue is in the way, so I'd
like opinions from other moms please!

Thank you!

CY

CY wrote:
I am extremely hestitant to put her under for a few reasons.
1) I don't really want to start having to have her put to sleep every time
she has dental work done, starting at such a young age.

I think you're making a big assumption here that this would establish a
protocol for her childhood. When she's a bit older and understands
more, if she needs another procedure, she'll probably handle it awake
just fine.

2) There are inherent risks with every anesthesia and I don't relish the
thought of having her out for this kind of relatively minor work.

I completely understand this. My son has had to be put under
anesthesia twice in his short little lifetime (he's not quite three
months). Both were for diagnostic tests, not a necessary surgery or
anything. The first time was not really general anesthesia -- he was
given chloral hydrate orally, which made him extremely drowsy so he
would remain still during a CT scan. The second time was general
anesthesia, and I was extremely scared, considering the rare but
possible complications. But it all turned out fine. He handled it
beautifully, was comfortable during the procedures, and the medical
staff was more than able to handle him (and me!). I realize now that
though he wasn't having a life-saving procedure, they were necessary
tests, and it was much better to do them than not to. Your daughter
might not -need- dental work the way someone might -need- a particular
medication or something, but in the end, it's probably far better for
both of you to go through this scary, but temporary, unpleasantness now
than to have her having tooth pain or problems for a long time.

3) It's also not covered by our insurance and they are telling us $650 just
for the anesthesia. This is so out of our budget it's not even funny.

I don't know what to do about this. With DS's health problems, we've
had a lot of financial woes. All his medical bills, plus all the
visits to the specialists (each trip takes about $150 in gas and hotel
room bills alone) has left us far short. We are just paying it bit by
bit, hoping for the best, knowing he is worth it. Will the dentist
accept payments? Do you have a family member you can borrow the money
from? I would think a grandparent, if able, would be happy to loan or
give money for something like this.

The other option is what the dentist is calling "oral sedation". Dentist
says she will get drowsy, but not completely asleep, and she will be aware
of what is going on. Both DH and I are favoring this option, but the
dentist isn't recommending it. given her "history". The downside with this
is, it will be the same stuff that happened today except instead of nitrous
oxide gas, it will be a heavier sedation (maybe Valium, not sure),but also
she will have to go twice, because they don't like to do the whole mouth
under oral sedation.

I would bet "oral sedation" is like the chloral hydrate DS was given.
He's way younger than your
DD, obviously, but it worked like a charm for him. He just got a bit
doped up and fell asleep -- it was much nicer than the IV anesthesia,
although the IV anesthesia was absolutely necessary for the second
procedure. I would think something like this sounds like it would work
for your DD, but I suppose they might be concerned she would come out
of it. When DS had oral sedation, they had to do all the unpleasant
things (like putting in IVs) to him -first- because they said pain
could bring him out of the sedation if they did that first.

I know my kids are younger than yours and I have -no- experience with
pediatric dentistry, but I hope it helps a little!

-Carlye
DS 6-2-06
DD 9-29-04

"CY" wrote in message
news:tBSHg.153645$1i1.132935@attbi_s72...
My DD (4yo) needs some dental work done. She has 4 molars with cavities,
and in one of them she needs what they are calling a "baby root canal",
although it's apparently not really a root canal but a pulpectomy (sp?).


Are these 2nd teeth ? She seems awfully young for such extensive dental
work !

I'd ask the dentist what the long term prospects are for these 4 teeth and
if it is *really* necessary for these fillings, or would they be better off
removing them. I can't help thinking that fillings at age 4 means that these
teeth are going to cause nothing but problems (and therefore lots more
expense for you), and might be better off removed completly.

My 8 year old has just had her back 4 molars removed. I'm in the UK, and
all dental work for children is free, so there's no financial worries
involved here.

The 4 molars are (I should say were now) 2nd teeth. DD1 (8 year old) is a
complete and utter wimp when it comes to any sort of pain. She *was* doing
OK with the dentist, until the numpty woman decided to drill one of these
molars on one visit without a jag. DD1 suffered pain from the drilling, and
refused all further work. On an emergency appointment with another dentist
cause she was in pain, he recommended having them removed. He said, she'll
have nothing but trouble (i.e. lots of dental work required, which she won't
tolerate) with these teeth, and they are better off removed.

Her normal dentist agreed, and we were referred to the local dental
hospital.

Aside: all her baby teeth are fine, and her other 2nd teeth are spotless,
there's something "wrong" with those 4 molars. They are totally crap teeth,
bad enamel or something.

At the local dental hospital, the dentist commented that he's seen this a
lot, normal other teeth, but the 1st set of adult molars are "crap". Funnily
enough, I had mine removed at a similar age, so maybe it's a genetic fault
of some kind. He also commented, that when she gets her next molars at
around age 10-12, they'll come forward a bit, to fill the gap, and you'll
never know that she is missing any. As a bonus, having had them removed, it
means she's less likely to have problems when her wisdom teeth come in.

These 4 teeth were removed last week, she was meant to get the anesthetic
that was an injection in her hand, but they couldn't get the vains in her
hands (another genetic inheritence from me I'm afraid). This was very
traumatic for her, they'd put "magic cream" onto one of her hands, couldn't
find the vain, so tried the other hand, and also couldn't get the vain. This
was painful for her and she was very upset. They decided to use the gas mask
instead. The guy was pretty good, told her it would smell funny and that she
should blow it away. She went under no problem.

She recovered fine, although I doubt she'll ever agree to another hospital
visit !

From looking at them, these 4 teeth really are rubbish they look mottled and
brownish, with lumps chipped off them, her baby teeth that have fallen out
are clean and shiny looking in comparison.

Anyway, might be worth getting your dentist to explain the long term
prospects for these teeth, and is really worth working on them if they are
going to cause nothing but problems over the years.

hmm very difficult one, the one thing that occurs to me as that it may
truely be the case that the local anaethestic did not numb her, I don't
respond well to them myself, it's not an insignificant number of the
population for which this is the case. Which makes me wonder, if you can get
someone to say that this is likely to be the case, and thus, deeper
anaethesisia is a medical need rather than a, we can't convince her to let
us do this... that then the insurance might have to pay up.

The other thought is the necessity of doing this work, maybe an extraction
might be less disturbing for her.

Also, your worry number 1, is not really founded, there will come an age
where it's time for her to give it a go not under a GA, I've never had
dental work done, other than extractions and several of those were before
age 10 and under a general, but the extractions I had as a teen were all
local (so many extractions as the dentist had a theory about when baby teeth
were delayed coming out naturally, that they should be removed to give the
adult teeth the best chance of coming through straight, didn't really work,
I still ended up with braces and 4 adult teeth being removed due to lack of
room, but maybe I was doomed from the start), so actually in someways it
surprises me it was even attempted with a local, but I'm sure it is better
to do it that way if possible.

Anne