chronic pain management in a child?

[earthmama369]

Damned if we do, damned if we don't seems to be the way this whole dental saga is playing out. Qualia, my 4-year-old, needed major dental surgery almost two weeks ago due to mismanagement of her enamel condition by her previous dentist. She spent 4 hours under general anesthesia in the hospital and ended up with 7 "just" fillings, 4 extractions, 6 root canals, and 8 stainless steel crowns. The goal was to halt the damage before it progressed to her permanent teeth under the gums and to alleviate the pain and heat/cold sensitivity she was experiencing.

She may simply be healing a bit slower than expected because of the sheer amount of dental work and trauma that was done to her mouth. But signs are starting to point in the direction of her being one of the people who react to crowns with chronic gum inflammation and pain. The crowns in back seem to be doing ok, but where she had crowns and root canals on her front four teeth, she's still experiencing pain in her gums to the extent that she was crying while trying to floss the other night.



We expect her to have these teeth for another 1-3 years. We can't have her in pain for that long. The amount of time she's already been in pain is already way past acceptable. I could just scream. This never should have happened to her.

So, wise folks of MDC...give me some ideas. She can't stay on Motrin all the time if we want her to have functioning kidneys by the time she's 5. Aside from sucking on ice constantly, what are some approaches we could take toward alleviating the inflammation and pain reaction she's having? We need approaches that we can do long term.

[QueenOfTheMeadow]

UGH! That stinks. I'm not sure if she can swollow small soft gels yet, but there is an herbal product that is amazing for any type of inflamation response. http://www.prohealth.com/zyflamend.htm From what I can tell, the ingredients should be fine for children as well as adults. They have tiny tabs that you can get too that are really small. You may even be able to open up the capsules and put them in applesauce or something like that. I used it after I had my wisdom teeth out and it was absolutely amazing.

[mysticmomma]

why not pull the front four? they are not space holders, and at four should not affect speech. We had my dd's four front pulled at 3.5.

[momtoalexsarah]

I would evaluate the doseage of the pain meds, and see if she is becomming resistant to the effects. Giving tylonal to my 3yo is like giving her water for pain - motrin works but only in large doses.
Given the extent of what she had done I would still expect pain - my DD had cleft palate repair and other oral reconstructive surgruy at almost 3 and she was still have pain that needed medication at night at 2 weeks.
If the front teeth are giving issue then I would have them pulled - my DD will have her upper 4 and posibly a lower one or 2 pulled in the fall (along with a bunch of fillings). We where concerend because she already has a severe speech impediment but in the long run I think that is better then root canals on a 3yo.

[earthmama369]

Tylenol doesn't do anything for her. We discovered that in the hospital.

We did talk about the possibility of removing her top four teeth. Understand that no one knew, going into surgery, that she was going to need any root canals. That came up during surgery as a surprise factor and the dentist had to make a call on the spot. Previously we had debated removing her top four teeth if need be versus doing crowns. The dentist and dh and I (and dd!) all agreed that if we could keep her top four teeth, we would, because the chances of her losing her bottom four front teeth was high. Losing all eight front teeth, top and bottom, would have had a big social impact, not to mention difficulty speaking and eating.

I don't know if we made the right decision or not. We understood going in that there was a chance something unexpected might come up and the dentist would have to make a decision in the OR without consulting us. We went over as many possible scenarios as we could, but the root canals were unexpected. Her speech HAS been affected by losing her bottom four front teeth, so I expect that losing the top ones would have had an impact as well. She's a very social, outgoing child and I think the combined social and speech issues were important to think about.

So...where we are right now is that she's functioning pretty well during the day. It's when we floss and brush and when she tries to eat a hard food that we see outward signs of pain. We're not at the point of being willing to put her back in the hospital, under general, to remove her top four teeth. It would be traumatic. Another mother who's daughter had similar surgery last year offered some hope yesterday in that it took her daughter 3-4 weeks to really recover and it seems like her nerves needed to reorganize and connect again after having so much done to them at once. If that's true for my dd, then we've got another week or two to get through. That's pulled me back from the brink a bit.

What do you think about a combo of Motrin as needed at night, arnica, clove oil, and ice/popsicles? Maybe ginger tea with honey, for inflammation, if she'll drink it. Other ideas? She's 4 years old and only 36 pounds, so while we don't shy away from standard pain meds if she needs them, I am cautious about using them too much.

[MCatLvrMom2A&X]

I just wanted to mention that having the teeth pulled could be done without GA. My ds had his pulled at 2.2y with just lidocain and us holding him. It was over in less than a minute and was so much safer than GA.

He will be having more work done with just concious sedation ie meds by mouth to make him sleepy in the coming months.

[mysticmomma]

honeslty, if she is still in that much pain, I would request a narcotic for night time. It's not forever. I would say 3-5 weeks should be the end.