Sedation vs. asleep

[Marlet]

I'm sure that sounds like one and the same.

DD1 has some extensive work needing done on her teeth. She has soft/thin enamel and as a result has had spots that are essentially enamel free (it's a genetic thing....my brothers have it horribly as well). She's been in twice now (she's 4.5 years old). The first time fixed a couple spots on her front teeth that were near the gumline. We picked those first because of their location. The next one we did was on a molar. The spot was in between two teeth. The first time was a dream. She had fun and the dentist was awesome (we know the guy and picked him due to his gentle demeanor etc.). The second time I was a day early. I had written the date down wrong but they had a free afternoon so they let us in anyway. I was so incredibly put off. The dentist was incredibly short with her, rude to me, used bribes and soft threats (teeth will fall out if you don't move...won't get a treat if you don't stop crying etc.). They were rough putting in the numbing agent and didn't give it enough time, IMO, to kick in. Needless to say she freaked. She was in tears and twisting away and there was nothing I could do. Her panic made DD2 panic and freak as well so I had to hold her in order to keep her from tugging on DD1 and causing issues and possible damage. It was NOT a good visit at all. DD1 knows she needs to go back as we have many more to work on and is willing to. She however does not want to go back to him. I don't blame her and am not planning on taking her in.

They are medicaid and I was just going through their approved dentists book and googling various ones. I found one nearby that sounds awesome. Not only does he do sedation but he's a pediatric dentist. I was reading his options for sedation and none are totally what I want. At this point I would prefer to put her under (I know there are risks) and get them all done at once. She currently has 8 spots (that I can see and some are large) that need done. I DO NOT want to space this out. His sedation options are Nitrous Oxide, Oral sedatives, and IV sedatives. The last two have a couple options depending on the severity of the fear/anxiety but he states they will still need pain killer (which obviously they will use).

Should I try one of those and space the appointments or should I keep looking and see if I can't find someone who put her to sleep and do them all at once. I've never had dental work needing anything more than a numbing agent in my gumline. I don't know how nitrous oxide works. I just want to get these done and fixed. Some are starting to hurt her.

There is one 2 towns over who I know is a pediatric dentist and will put her under (both times we went to the former dentist they suggested him if she didn't react well to doing it their way ) but I don't know if he's an approved dentist and it's a bit of a distance. I'd like to stay as local as I possibly can but if that's my only option I'll take it.

For those of who you have done BOTH which did you prefer? What should I do?

[Sailor]

I was put under to have my wisdom teeth removed. That wasn't a bad experience, but I was VERY groggy for the whole day afterwards. My whole body just felt heavy.

I am terrified of the dentist. Like I didn't go from the time I turned 16 to when I turned 24. Finally, I found a dentist that specialized in treating people who are afraid. I do sedation every time I go to him. I have done the nitrous oxide and oral sedatives. Both worked fine, but I prefer the nitrous oxide. You breathe it in via a mask before the dentist begins ... and, seriously, you could care less where you are, and what the dentist is doing.

My dentist also has fun pictures and a TV to look at on the ceiling. Combine that with nitrous oxide ... oh, you're feeling good. Also it wears off fairly quickly. I don't feel awful or groggy for the whole day.

In your shoes, I'd not do asleep ... I just think that's something reserved for emergencies or actual operations. Nitrous oxide works very well for me. Like I said, I have severe fear of the dentist, and I don't feel fear once I breathe that in.

Some people worry about needing more and more nitrous oxide each time you go in, and needing higher doses. But, I go in once a year, and haven't noticed that I need more. Plus, it's either that or never go to the dentist again for me. But, that is something to think about if you will be going in frequently.

[carfreemama]

I think you really have to try to figure out what's best for your individual child.

Dd just had "conscious sedation." Meaning she took Atarax to make her sleepy. This particular ped dentist would not do anything without it. Her previous dentist (who was not a ped dentist) referred her to this guy. For her, the medicine was worse than the procedure. She HATES taking medicine and there was a TON of liquid stuff. It took us over 1/2 hour to get it into her while she screamed. Granted, she did then let them do the procedure and I know it was very involved (2 molars with caries right down to the root).

However, we are going to try another dentist recommended by a good friend. This will be our fourth dentist. Unbelievably frustrating. But for our own particular daughter, I think she'd be better off having several shorter, less-traumatic procedures than all at once. This is contrary to recommendations, but It's my gut feeling about dd. Like you, she had a very trusting relationship with her original dentist and was very cooperative. But her experience with the last dentist was so bad (same things you describe) that she's now terrified to go back. In talking to her, her biggest fears are the dentist, the medicine and the caps. I have reassured dd that I will do my best to find alternatives to these things if I can and she's agreed to cooperate if she's given the option of no sedation. We'll see. Good luck.

[Denali]

Could I just revive this thread?

I am faced with the same dilemma/choice: DS is 2.5 years old, with pretty bad tooth decay, and will have quite extensive work done (4 extractions, a couple of crowns, a couple of cavities). The work should take about an hour, acc. to the dentist.

He offered me two choices:

1. Conscious sedation in his office via oral meds (something like "Midazolam plus Hydroxyzine"?)

or

2. General anesthesia at the local hospital

He is recommending the sedation.....but it just sounds so cruel to me to have to hold DS down for a whole hour, and it's hard to believe that he won't remember it or be traumatized by it

On the other hand, at least they would let me stay with him the entire time.....the dentist says, at the hospital they wouldn't let me into the recovery room, so DS would be alone for quite a while after the procedure, which probably would be really bad for him (he's really attached). Plus, there are more risks involved with GA than with sedation, aren't there?

Some more advice would be appreciated

Thanks

[Otto]

Originally Posted by Denali

He is recommending the sedation.....but it just sounds so cruel to me to have to hold DS down for a whole hour, and it's hard to believe that he won't remember it or be traumatized by it

Midazolam can indeed produce amnesia. Hydroxyzine, on the other hand, is no great shakes--I was fed the stuff for years (as Atarax syrup out of the fridge) as a kid for "tics"; it's basically an antihistamine blunt object. I suppose my main concern would be whether just these two would be strong enough for an hour's work, or if it's possible to keep nitrous as a backup.

[Denali]

Thanks for that info.....he didn't seem concerned at all about the length of time, and it didn't sound like he was offering nitrous at all, he just gave me the two options of conscious sedation via those drugs or general anesthesia at the hospital (actually he did mention a second drug combination with Midazolam + Demerol but said that for little children he preferred the combination with Hydroxyzine).

I guess I should call his office again to ask about a back up possibility......

One more thing:
He never mentioned local anesthesia/pain management....I am assuming that he's not planning on yanking out the teeth without anesthesia, but is there anything I should be concerned about in that respect/be on the lookout for/inquire about?

[baby-makes-3]

He never mentioned local anesthesia/pain management....I am assuming that he's not planning on yanking out the teeth without anesthesia, but is there anything I should be concerned about in that respect/be on the lookout for/inquire about?

I was wondering about this too?

Does anyone know if there have been adequate studies of CS? And it seems that they need to be sure to use supplementary oxygen.

Also, does your dentist allow you to go back with them for CS? Mine allows you to be there for nitrous oxide but NOT CS.

[Denali]

Originally Posted by baby-makes-3

Also, does your dentist allow you to go back with them for CS? Mine allows you to be there for nitrous oxide but NOT CS.

Yes, he does.
If he didn't, I would switch dentists

[baby-makes-3]

Quote:
Originally Posted by baby-makes-3
Also, does your dentist allow you to go back with them for CS? Mine allows you to be there for nitrous oxide but NOT CS.

Yes, he does.
If he didn't, I would switch dentists

I agree, but living in a small town, I am limited to the number of pediatric dentists to choose from for a 3yo.

The only one that is close to us will only do GA at a hospital for this kind of procedure. And there are two in the next town over -- this is the one that got the best recommendation from the general dentist who did the laser dentistry but who won't do this work.

We're on our third dentist now.

[Denali]

I know exactly what you mean....there aren't any dentists where I live, I have to drive half an hour to the next bigger town, where until a few weeks ago, there was only one ped dentist who is absolutely HORRIBLE (tried him once, never again, and I know of many others who are feeling the same way). The next ped dentists are more than an hour away with really long waiting lists.

Luckily, a few weeks ago, another ped dentist opened up in the next town, so I could get in there. But if he hadn't worked out, I would have gone to the big city instead.

Life is difficult sometimes.....esp. if you try to do the right thing and try to be involved and informed.....those people who don't care/don't know better have it easier

[baby-makes-3]

those people who don't care/don't know better have it easier

I totally agree -- it truly is a pain to be a thinking person sometimes.

When she told me that I would not be able to come back for CS, I asked why and she said that sometimes they cry and are still hard to handle, it's just that they don't remember it afterwards -- and it would be hard for me to see. (Shouldn't it be my decision as to what's too difficult for me to handle?)I really didn't like that. If I end up going there, I really think I'm going to try for the nitrous oxide (which I can go back for) and do the extraction/spacer in the interest of time.

There don't seem to be any easy decisions with regard to this!

[Denali]

Originally Posted by baby-makes-3

There don't seem to be any easy decisions with regard to this!

Nope.....either take the bigger risk of GA or watch your child being "tortured" while under conscious sedation.....great choice

Our dentist didn't even offer nitrous, I'll have to call the office next week to ask if he at least has it as a back up.

Maybe you should try talking to your dentist again to make her change her mind about letting you go with your child? If you can convince her that you're not going to fall apart, maybe she'll make an exception, and that way you'd have all the options

[Otto]

Originally Posted by baby-makes-3

When she told me that I would not be able to come back for CS, I asked why and she said that sometimes they cry and are still hard to handle, it's just that they don't remember it afterwards -- and it would be hard for me to see.

This jibes with what I've read on the subject, with the qualification that the crying often co-occurs with the onset of sedation as "age-appropriate behavior" (that is, more a drug effect than a "coherent" stimulus response). At least one study that I've seen suggested that allowing 45 minutes rather than the usual 20-30 for the stuff to fully kick in noticeably reduced such behavior.

As long as it's understood for what it is (and is what it's understood to be), I don't see why some sort of blanket exclusion would be required.

[Denali]

Originally Posted by Otto

At least one study that I've seen suggested that allowing 45 minutes rather than the usual 20-30 for the stuff to fully kick in noticeably reduced such behavior.

But wouldn't that also noticeably reduce the window of time for the treatment itself?

How long is that sedation stuff effective anyway?

Our dentist said the work would take about 1 hour...if we waited longer to begin, would there still be enough time left?

[mb05]

I'd love to open this discussion again!

We're in a similar situation with our 26 month old dd... She needs work done on 11 of her teeth. Yikes! I'm at my wits end just trying to learn all the different options available.... And, I'm trying to do so before the year's over for insurance purposes. Ugh!!

Is there any legal reason we couldn't go back with her while she's having the work done with oral sedation on her if she's having a hard time? Has anyone had experience with IV sedatives? Any experiences would be *greatly* appreciated.

[Denali]

Originally Posted by mb05

Is there any legal reason we couldn't go back with her while she's having the work done with oral sedation on her if she's having a hard time?

No "experiences" yet, still researching, but as far as I know, there's no legal reason, it just depends on the office policy of the individual dentist.

[Otto]

Originally Posted by Denali

But wouldn't that also noticeably reduce the window of time for the treatment itself?

How long is that sedation stuff effective anyway?

Our dentist said the work would take about 1 hour...if we waited longer to begin, would there still be enough time left?

I think there are two parts to the answer, which are (1) it depends on the sedatives, the skill of the dentist, and the cooperativeness of the child; and (2) I'm out of my depth. Oral midazolam alone (0.5-0.6 mg/kg) seems to have a duration of 30 to 45 minutes once it kicks in. I don't know whether concomitant hydroxyzine might give it some breathing room.

Unfortunately, PubMed is something of a hornets' nest on the subject, even with reasonable full-text access. I think one thing that is generally acknowledged as desirable is not traumatizing the experience, which seems to be able to psychically "stick" for a long time. Perhaps you could prearrange to leave open the possibility of splitting up the work if the sedation starts to fade too soon and there's no supplementary option.

[baby-makes-3]

We're in a similar situation with our 26 month old dd... She needs work done on 11 of her teeth. Yikes! I'm at my wits end just trying to learn all the different options available.... And, I'm trying to do so before the year's over for insurance purposes. Ugh!!

Hi, we had a similar circumstance. DD started out with 10 teeth that needed work. And we wanted to avoid GA if at all possible. We found a dentist to do laser work on 8 of them. The only reason he couldn't do these last a2 is that 1) they are too deep for laser dentistry and 2) after several visits, DD got sick of even that.

But it worked great at first -- it only takes a matter of MINUTES to fix a surface cavity. And there is no numbing needed. She had just turned 3 at the time, and since it goes so quickly, we were pleased with how it turned out.

Sorry it's late now and i'm braindead, but I did want to add that in case you want to research it.

[WuWei]

Curing Cavities with Nutrition

Please see the yahoogroup VeryYoungKidsTeeth. http://health.groups.yahoo.com/group...oungkidsteeth/ It is AP and extended nursing friendly. Read the Files section regarding Sedation. This is a very difficult situation, I understand. You can post there and ask for other's personal experience regarding sedation. Or on Alternative Kids Teeth yahoogroup.

The concern, imo, is less the choice of sedation as the degree of medical management of conscious or unconscious sedation.

There is a medical article in the "Files" section of Very Young Kids Teeth about in sedation risks called "CONSCIOUS SEDATION.doc ". The degree of responsiveness of the patient is the defining variable. In hospital/out-patient, it is required that (1-2) licensed anesthesiologist along with multiple personnel certified in ACLS (Advanced Cardiac Life Support) are present and available during general anesthesia.

I was a critical care nurse, so understood the measures required for conscious sedation in hospital. Oxygen saturation, oxygen supplementation, IV access, emergency drugs for respiratory compromised incidents are available in an outpatient setting.

The dangers of Chloral Hydrate are covered in that article. Chloral Hydrate is highly associated with children's deaths. Plain and simple, no way would I give this to my child when he is not under constant medical observation with oxygen saturation measurement. But, the respiratory depression effects can be lethal. This drug is even contra-indicated for sedation dentistry for children due to its risks.

I investigated the clinical research related to sedation dentistry for our son. Here are some of the studies. The studies evaluate various sedation alternatives, in a controlled and monitored setting.

Adverse Sedation Events in Pediatrics: Analysis of Medications Used for Sedation:
http://www.ncbi.nlm.nih.gov/pubmed/11015502
http://www.ncbi.nlm.nih.gov/pubmed/11015502

Sedation of anxious children undergoing dental treatment.pdf is in the Files of VYKT.

Sedation disasters in pediatrics and concerns for office based practice also in the Files of VYKT.

CONCIOUS SEDATION.doc

The ability to proscribe and measure the dose accurately is critical due to the different liver metabolism of children by age. The half-life and peak effects are different than in adults. Multiple children have died after taking oral sedation before dental treatments due to the respiratory depression effect.


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[radish]

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