Dentist uses Nitrous Oxide?

In article ,
Mxsmanic wrote:

Wendy writes:

Should I pursue this further?

You should pursue psychological counseling for your child. I suppose
gneeral anesthetic is an option in this case (although it is likely to
be extraordinarily expensive and awkward), but that isn't going to help
the general problem. The fact that you've gone through so many dentists
without success demonstrates that it isn't the dentists.

I'm not sure that's called for, although a few visits with someone who
specializes in dealing with children's fears couldn't hurt.

I don't oppose using mental health professionals; I haven't seen
anything else that indicates this child is difficult about anything
except this.

However, her primary concern is getting the teeth treated, and not doing
so until psychological counseling gets him over his fear doesn't sound
like a real good idea.


I still think valium would work. But I discussed it with his
pediatrician and two different dentists and no one will prescribe
it.

I don't blame them. It treats only a symptom, not the disease.

But sometimes the symptoms need to be treated, too. For a time, I
struggled with horrible tension headaches. Once we figured out that's
what they were, I was sent for some counseling. Fortunately, in the
meantime the doctor gave me strong enough pain pills to knock out the
headaches -- we both knew that was only treating the symptom, and I had
to find a way to face and deal with some stress in my life -- but he
didn't insist on NOT treating the headaches!


God knows I'm not in favor of sedating the kid in
normal situations, but this extreme fearfulness needs
to be addressed.

You don't address it by knocking him out. He needs to see a
psychologist, or possibly a psychiatrist (who might indeed be willing to
prescribe drugs).

We've had an offer to do the work under GA in a hospital (from the
pediatric dentist I don't like who uses NO for teeth cleanings).
It won't happen until January. I really don't like the idea, though.

There's always a risk to GA, and in minor surgery (and thus all the more
so in mere dental treatments), the risk of GA is higher than any other
risk.

Is GA the way to go? Or do I keep driving him to more and more aborted
dentist appointments as if this is my bizarre new hobby?

You should be driving him to the psychologist's office instead.

Any second now I'm going to be accused of Munchhausen's
by Proxy with this kid.

If this extreme response is limited to dental visits and he has no
dental history to explain it directory, then one tends to wonder how he
has been conditioned by his parents, particularly if one of them has a
morbid fear of dentists.

That's a little harsh, and in this case most likely inaccurate. He does
have some history that would explain his fear, but even if he didn't
there does not need to be conditioning by a parent for a child to
develop fears!

I had two kids develop phobic responses to things that bothered neither
their other parent nor me -- one to bugs (of any sort; lots of fun in
Wisconsin and Massachusetts!) and one to dogs. There did not seem to be
any preceeding event to trigger their reactions.

Kids sometimes develop extreme fear reactions to things; to assume that
a parent has somehow conditioned the child to be afraid is a way of
assigning blame where it doesn't belong: kids are perfectly capable of
developing irrational and extreme fears without their parents' help!


Wendy, who really, really, really hates going to the dentist

Apparently your son senses that.

I'm pretty sure she means since this problem came up; it doesn't sound
like it's been a lot of fun for her OR for her son.

meh

meh
--
Children won't care how much you know until they know how much you care

Sorry but your are most incorrect.

0.3mg per pound is no where near the threshold for respiratory arrest.
Valium has a wide therepetic index. You have a fear for this drug
because you are obviously ignorant of its action. All the better you
shouldn't use it on your patients.





Mxsmanic wrote:

V35B writes:


A higher dose and concurrent use of N2O would work,,,,


... right into respiratory arrest. Hard to handle in a dentist's
office.

In misc.kids Mxsmanic wrote:
Wendy writes:

Should I pursue this further?

You should pursue psychological counseling for your child. I suppose
gneeral anesthetic is an option in this case (although it is likely to
be extraordinarily expensive and awkward), but that isn't going to help
the general problem. The fact that you've gone through so many dentists
without success demonstrates that it isn't the dentists.

My son is starting to freak over mere sensation at this point. It is
definitely psychologically related. He is fearful of rain falling on him,
he is terrified of bandaids pulling against his skin when he clothes touch
him, and he hates the feel of anything against his skin like Q-tips of
analgesic or a dental mirror against his cheeks. Yes, psychological
counseling sounds appropriate.

Wendy, who really, really, really hates going to the dentist

Apparently your son senses that.

This isn't apparent to me. It's only the attempts at restoration that
have caused problems, and the sensory thing is excelerating
it. He didn't freak out until he had the NO. He complained of
having to breath in the funny smelling/feeling thing. He behaved quite
well with X-rays, cleanings and exams. He is compliant in the chair right
up until something feels funny. It's not the dentist he fears, it's the
unusual sensation.

Besides, he does this with his father, too. And I don't *fear* going to
the dentist, I just find it painful and annoyingly necessary. I haven't
shared any pain stories with my son and I have brought him repeatedly to
people I trusted and had no fears for his safety. In fact, I keep wishing
the dentists would stick with it and work with him rather than keep
turfing him!

Wendy

In misc.kids Dr. Steve wrote:
Wendy,

I have seen Valium work well in kids and I have seen it work in an opposite
fashion and get the kid more worked up than usual.

I've seen paradoxical effects on several drugs in my kids. I just thought
it was worth a try because of the high anxiety level AND I've seen it work
in this very same kid before.

All you are doing is training the kid to be a rotten dental patient. Take
the kid to the hospital and get the work done under GA. The child will
never remember a thing. It will be done and life will go on. If you keep
up the aborted dental appointments, the child will just learn to fear all
health professionals even more. It is past the time to give up and go the
other way.

I agree. I feel guilty about not taking the referrals that three trusted
professionals took the time to call and pre-screen for me. But I can't
help but think it would be wasted time unless we do the pre-appt sedative.

But I disagree that he fears health professionals. He's fine with health
professionals. He fears pain. His anxiety level about pain is off the
charts. It's spread from pain to mere sensation.

But I did call the pediatric dentist who does hospital dentistry and asked
him to schedule the procedure for January. Why January? They're already
scheduling months out and by putting it in January instead of December I
can save hundreds if not thousands of dollars because a.) we've used up
his dental insurance cap this year and b.) I can put money in a Medical
Reimbursement Plan to pay for it in pre-tax dollars. It also allows
the GA to serve as a backup while I pursue the sedative/new dentist option.

I'm worried that this monetary concern will be considered abuse (the
pediatric dentist is the one who doesn't trust me). I didn't tell them I
was shopping him around at other dentists. (Isn't it funny how lack of
trust engenders lack of trustworthyness?)

-- Wendy

Wendy writes:

He is fearful of rain falling on him, he is terrified
of bandaids pulling against his skin when he clothes touch
him, and he hates the feel of anything against his skin
like Q-tips of analgesic or a dental mirror against his
cheeks. Yes, psychological counseling sounds appropriate.

It sounds like a serious problem, unless there is some physiological
basis for his hypersensitivity, but that is unlikely.

It's not the dentist he fears, it's the unusual sensation.

How long has he been this way?

Most small children are wary of unfamiliar sensations, even non-painful
ones (whence the occasionally fear or crying at the barber shop or when
having nails trimmed, etc.). Your son sounds like he has carried this
to a neurotic extreme.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Wendy,

A parent's fear of dentistry is almost always transferred to the child. The
child watches and listens much more than we (as parents) realize. I will
say that I have NEVER seen a frightened child who did NOT also have
frightened parents. You obviously don't trust the opinions you have
received and moved on to try another office to see if they will do it *your*
way. That sign of mis-trust gets felt by the child. If you don't trust the
dentist and what he/she says, the child will not trust either.

Waiting until January (remember I have not examined this child) may or may
not make the problems worse. I hope you are not post-poning due to fear,
because that will transfer to the child, too. I hope you do not experience
any quilt if waiting 4 more months to get the teeth fixed results in dental
pain, impaired dental growth or development, speech impairment, poor
nutrition due to poor chewing, poor sleep due to pain, etc. I hope the
money you save is worth it to the child. Medical bills never come when we
are prepared for them. That is why we have banks and finance companies.

Get the child's teeth fixed in a fashion that cannot traumatize him further.
Then, find a way to deal with the multiple phobias in your own time,
(hopefully rather quickly).

--
=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+
Stephen Mancuso, D.D.S.
..
~`~`~`~`~`~`~`~`~`~`~`~`~`~`~`~`
Remove all but the last dot to email me


"Wendy" wrote in message
...
In misc.kids Dr. Steve wrote:
Wendy,

I have seen Valium work well in kids and I have seen it work in an
opposite
fashion and get the kid more worked up than usual.

I've seen paradoxical effects on several drugs in my kids. I just thought
it was worth a try because of the high anxiety level AND I've seen it work
in this very same kid before.

All you are doing is training the kid to be a rotten dental patient.
Take
the kid to the hospital and get the work done under GA. The child will
never remember a thing. It will be done and life will go on. If you
keep
up the aborted dental appointments, the child will just learn to fear
all
health professionals even more. It is past the time to give up and go
the
other way.

I agree. I feel guilty about not taking the referrals that three trusted
professionals took the time to call and pre-screen for me. But I can't
help but think it would be wasted time unless we do the pre-appt sedative.

But I disagree that he fears health professionals. He's fine with health
professionals. He fears pain. His anxiety level about pain is off the
charts. It's spread from pain to mere sensation.

But I did call the pediatric dentist who does hospital dentistry and asked
him to schedule the procedure for January. Why January? They're already
scheduling months out and by putting it in January instead of December I
can save hundreds if not thousands of dollars because a.) we've used up
his dental insurance cap this year and b.) I can put money in a Medical
Reimbursement Plan to pay for it in pre-tax dollars. It also allows
the GA to serve as a backup while I pursue the sedative/new dentist
option.

I'm worried that this monetary concern will be considered abuse (the
pediatric dentist is the one who doesn't trust me). I didn't tell them I
was shopping him around at other dentists. (Isn't it funny how lack of
trust engenders lack of trustworthyness?)

-- Wendy

In misc.kids dragonlady wrote:

That's a little harsh, and in this case most likely inaccurate. He does
have some history that would explain his fear, but even if he didn't
there does not need to be conditioning by a parent for a child to
develop fears!

In May of 2002 he required emergency surgery for perforated intestines and
peritonitis. This involved three hours of surgery during which
they pulled all his intestines out of his body and went through
them inch by inch. Following the surgery on the ward I cried plaintively
for them to help my son with his pain. I was ignored as a hysterical
mother. He went 12 hours post surgery without morphine until a family
member who's an R.N. showed up and taught me the right language: "Give
him 1 mg of morphine NOW!"

We continued to struggle to get him meds the entire time. He was
frequently in severe pain. Most of the nurses thought he had had
laparoscopic surgery. The rest of them had some puritan reason for not
letting him have morphine. Even when the doctor put him on scheduled
morphine (because they weren't responding to my requests) they still
skipped doses. I frequently had to ask them three times. Once I fell
asleep and they deliberately skipped his 2 am dose. I woke at 6 to find
him in a rictis of pain.

Right before he left a new resident came in and yanked out a drainage tube
that was stitched in place. It was ghastly and painful beyond belief.

Shortly after we got out of the hospital we went for a haircut and the
barber sprayed water on his head and he totally freaked out. He hasn't
allowed us to get his head wet ever since. (Hair washing is very
traumatic at our house.) I don't get the connection, but he's got one.

I have no particular reason to think that the trauma he underwent left him
unscarred. Nor would I call his avoidance of pain "irrational". The kid
has handled more pain in his young life than I hope you ever see.

I don't think giving him anti-anxiety meds before a procedure is such a
bad idea.

Wendy

V35B wrote:

Sorry but your are most incorrect.

0.3mg per pound is no where near the threshold for respiratory arrest.
Valium has a wide therepetic index. You have a fear for this drug
because you are obviously ignorant of its action. All the better you
shouldn't use it on your patients.

Oh shuddup V35B, few posts back you were prescribing 3mg/lb.
Make up your mind, professor. Your hair-brained pharmacology is ok in a
vet clinic or in Bucharest, in the west you go to jail for putting kids
to sleep forever..
Generally for sedating (they don't need to sleep) kids 1-6 years of age
a dose of 1 -6-mg/DAY is enough, older kids 2-10mg/day.
I (and Mxsmanic I think) are aware of the problems of Valium as opposed
to other benzodiazepines.. Respiratory arrest IS a problem, I would
personally never use it in kids outside an OP-room unless a real
indication is there (for example an epileptic fit).


Mxsmanic wrote:

V35B writes:


A higher dose and concurrent use of N2O would work,,,,


... right into respiratory arrest. Hard to handle in a dentist's
office.


--
madiba

In ,
madiba wrote:

*V35B wrote:
*
* Sorry but your are most incorrect.
*
* 0.3mg per pound is no where near the threshold for respiratory arrest.
* Valium has a wide therepetic index. You have a fear for this drug
* because you are obviously ignorant of its action. All the better you
* shouldn't use it on your patients.
*
*Oh shuddup V35B, few posts back you were prescribing 3mg/lb.
*Make up your mind, professor. Your hair-brained pharmacology is ok in a
*vet clinic or in Bucharest, in the west you go to jail for putting kids
*to sleep forever..

Neither hair-brained nor hare-brained pharmacology is ok in a vet clinic,
actually. Just in case anyone is paying attention here.

--
hillary israeli vmd http://www.hillary.net
"uber vaccae in quattuor partes divisum est."
not-so-newly minted veterinarian-at-large

Wrong. The reccommendation is 0.3mg per pound. No matter what you
think, this is the current thinking. And, as another poster noted this
is a safe dose.

OF course there is not sense in arguing with someone like yourself.....


You obviously lack experience and knowledge in this area.

Do yourself and the patient a favor and refer any patients that need
sedation out to someone who can handle it.....

madiba wrote:
V35B wrote:


Sorry but your are most incorrect.

0.3mg per pound is no where near the threshold for respiratory arrest.
Valium has a wide therepetic index. You have a fear for this drug
because you are obviously ignorant of its action. All the better you
shouldn't use it on your patients.


Oh shuddup V35B, few posts back you were prescribing 3mg/lb.
Make up your mind, professor. Your hair-brained pharmacology is ok in a
vet clinic or in Bucharest, in the west you go to jail for putting kids
to sleep forever..
Generally for sedating (they don't need to sleep) kids 1-6 years of age
a dose of 1 -6-mg/DAY is enough, older kids 2-10mg/day.
I (and Mxsmanic I think) are aware of the problems of Valium as opposed
to other benzodiazepines.. Respiratory arrest IS a problem, I would
personally never use it in kids outside an OP-room unless a real
indication is there (for example an epileptic fit).


Mxsmanic wrote:


V35B writes:



A higher dose and concurrent use of N2O would work,,,,


... right into respiratory arrest. Hard to handle in a dentist's
office.