GA for 2YO dental work?

[MunchiesMom]

My two YO had three "small cavities" on his teeth. The first dentist we saw sold us a great story about nitrous oxide and it's calming affect in toddlers. He was only able to work on one tooth and it was a horrific experience for my son - something he'll remember forever and we don't want to repeat.

So, to work on his additional cavities we have no other option but going under general anesthesia. This scares me a lot (seems kind of drastic for a few little fillings). I worry about how traumatic it will be for him when he wakes up, I've hears horror stories about uncontrolable crying and fear. I also can't get the surgery center to allow me in the room BEFORE he wakes. As a co-sleeper, APer I've never not been there for him upon waking. I think me not being in the room when he first wakes will amplify his fear.

I've read all the archives on GA and wonder why some parents are allowed in the recovery room as their LOs wake and some are not? The head anasthesiologist told me I could not be in room before he wakes. Any suggestions on how I can get them to budge?

Thanks!

[MunchiesMom]

Maybe I need to rephrase the question...

What are my other options for a 2 year-old's cavities besides going under general anesthesia? As I stated before, the surgery center will not allow me to be in the recover room until he is fully awake. This won't work for me and I know he'll be traumatized waking up somewhere without mommy. So I guess if we don't go under GA, are there any easy, untraumatic ways to care for my DS's teeth? With only two cavities, GA seems to extreme to me.

Anyone?

[mom0810]

I'm facing the same possibility with my ds. He's two, also. I'm terrified.

I will tell you that my older ds had surgery for a hernia/hydrocele at 3 years old. He woke up without us in the room and was just fine. No issues. We also co-sleep and he had never been away from us upon waking. He handled it just fine. They don't remember that part at all. They are still really foggy.

I have had GA twice and don't remember waking up at all. Nothing. So I think as far as that goes, he'll be fine. The bigger concern to me would be GA in general, not the waking up without you part. And if he's going to be in hospital I would think that is ideal. I would not worry about that at all. He'll have good people around him. My dentist wants to do GA in the office... that scares me a bit.

[MunchiesMom]

Thanks for your reply! At least I know I'm not alone here!

I have been doing extensive research on this and would not use GA or other sedation techinques (beyong nitrious oxide/laughing gas) in a dentist's office. I understand they are required to be certified in sedation and I would assume that would mean they should have all the necessary equipment in their office (like if something God forbid happened and a child coded). But I am not comfortable with it unless I'm in a surgery center or hospital.

Do you mind sharing what kind of work your 2YO needs done? If my son needed several cavities filled (like 8) I would think GA would be the only way to go. But with just two cavities (one of which might end up being a pulpotomy which is deeper and more complex) I'm just torn. On which way to go - or if I should even address them now at this young age. I'm back and forth every day... do we use just laughing gas in the dentist's office, GA in a surgery center, or get him extra flouride treatements and see if we can wait a year.

If we end up going under GA, I need to find a facility that will allow me in the room before he wakes. I've been told they areout of it still for a while, but I just feel like he would know! Plus, maybe a little of that is for my need. And I hear toddlers can wake up vomitting. This would be his first time throwing up, and I need to be there for him because he'll be so scared.

So where are at in your decision progress? I need an ear to listen because my husband is of no help with this. He just nods and agrees.

[mom0810]

My little guy has a couple of cavities. That's it. And I just don't feel safe with the GA in the dentist's office, either. I don't know how to even find a dentist who works with a hospital.

I guess where I am is, I am waiting to see how the MI paste works, we have been applying that at night (no more night nursing), using a flouridated toothpaste twice a day, and brushing after ever meal. I am hoping that will STOP any decay that is in place, and that the MI paste will also remineralize the areas on his teeth that are decaying or are about to start.

I would be very wary of pediatric dentists because they make a fortune filling stuff that doesn't need to be filled. Also, often their work falls out before the kids' teeth do. They are notoriously bad dentists. Our former ped. dentist told me my 4 year old had 3 cavities that NEEDED to be filled. I took him to a family dentist, who was very highly recommended, and was told the spots on his teeth are congenital, that they are not decay, and that they did not need to be fixed. I was very upset with the ped. dentist, but glad that I listened to my gut.

So... with my 2 year old I guess I am waiting. At least until we come back from vacation next month. Then I will decide what to do. Feel free to chat with me about it, because I am basically not sure what to do.

[deditus]

Can you try another dentist, get a second opinion? Are they visible to you, are they causing pain? If they are small, I would try to remineralize first. My dd had enamel defects in all of her top teeth due to malabsorption from food intolerances. Some healed as we figured out all of her intolerances and some didn't. Well, all improved but in some the decay was too bad. She has had to have several fillings, our dentist used just nitrous and was SO quick and gentle. He had 2 assistants in with him to help get it done faster. I personally would not do GA unless basically a life or death issue, and if I had to I would only do it at the children's hospital, which is where our ped dentist does it if needed.

[vewainwright]

I am having the same kind of issues, and have a post separate from this... but there is one other thing you may want to look into. There is a book called "How to cure tooth decay". It is based on the research of Weston A Price. I have found a lot of the info online, and it is pretty convincing. I am still looking into it, though. Just a thought. . .

There is in fact a link to some of this info at the top of the page for this forum... curing cavities with nutrition. cool.

[MunchiesMom]

I can see my DS's cavities. In fact, he's had them since October, we were just waiting to get him on our dental insurance and praying they went away.

We've seen 4 dentists in town and they all have the same song and dance. I would call all the dentists near you and ask if they are affiliated with a surgery center or hospital for sedation or GA procedures. I don't think I would do more than laughing gas in a dentist's office.

The update on my is that I've called the major hospitals' "Childrens Sedation" department and got a very nice, helpful lady that helped me research this. She's found that no hospitals or facilities in town allow parents in the room before the child wakes due to HIPPA. Apparently different cities have different HIPPA rules (just kidding, it irks me some moms can be there before waking but some can't). She said they say no BM 4 hours before surgery, but the head anesthesiologist at the actual surgical center said nothing after midnight.

I'm still no okay with this. I also think GA should be used for life or death situations. Not todown play dental work, but a cavity? I hope the dentist returns my call so I can ask her about the following:

- How bad are the cavities, really? Do they need to be addressed ASAP or could she help me develop a plan to delay the treatment. I imagine MI Paste, which we used on and off, flouride treatments or even flouride fillings could be a part of this plan.

- What other sedation options are there besides full GA?

- If we opt for GA, are there meds to relax him before hand? He'll freak if they come at him with the mask. And can he get an anti neasua because I'm scared he'll be scared if he vomits while waking up.

- If we opt for GA, how can I be with him before he wakes????

- Finally, if we opt for GA, can I nurse 4 hours before the procedure? The surgery center said nothing after midnight. Good luck with that! Apparently they don't think BM is a clear liquid.

[my_baby_love]

My DS had a bunch of cavities (all his molars and across his upper front teeth) and we have a great ped dentist. Our ped dentist was willing to wait for 3-4 months and see if they got worse. If they looked to be holding stable or improving (I second the idea that you look into healing the cavities) then he was willing to let us keep doing what we were doing. If they got worse, the option was to fix them in the office using a sedative and nitrous oxide (which is what we ended up doing for all his molars - the front teeth have been completely stopped in progression and some have gone away!). Our denitst did mention that if we needed to do GA that he would take his dental team to the hospital, where they use the children's hospital staff to put the child under GA and monitor him. He did say that was a very extreme option, though, and shouldn't be necessary in most cases unless extensive work was needed.

I would suggest asking your dentist if you can just closely monitor the teeth and see if you can halt the decay on your own. Then, if he needs work, see if there is a sedative or something that can be given in the office. Basically, just work with the dentist to utilize every option except GA. It does seem a bit extreme.

Oh, and breastmilk is considered a "clear liquid" in medical terms and should be ok until 4 hours before the procedure.

[my_baby_love]

One more thing, our DS was able to have what our dentist called "band-aid fillings" for some of his teeth. They don't give any sedative or numbing and they just do it in the office. They just scrape off what decay they can and clean out the cavity and then patch it with some filling stuff. It kept us from doing more extensive work until DS was older and could handle a more extensive procedure better. Maybe that could be another option for you.

[MunchiesMom]

Ug, I think GA is going to be the only option. I talked to DS's dentist and she said the work is going to be pretty extensive. Imagining his being conscious for 45 minutes with all the drilling noise will be torture for him. One of the teeth will need a pulpotomy, which is like a mini-root cancal where the damage goes down to the nerve. Plus, there is another tooth that will need a filling and she'd like to put selants on his teeth to prevent any further damage. Thank goodness this dentist is not lecturing me for breastfeeding or night nursing. She blames the damage to DS's teeth mostly on genetics. I also asked her about waiting a few months and she's scare the one tooth might start causing pain or create further damage to the permanent tooth.

So, if GA is going to be our only solution, how am I going to do this??? For anyone who has been there, how bad is it when they go to sleep and when they wake up?

[~savah~]

I just wanted to reply to offer you a little support. We went through this recently with our 2 yo, except she had six cavities in her four front teeth. It was such a stressful decision, one we did not make easily and which I cried about more than once. We were able to do GA in the dentist office and I was able to be there with her when she woke up. So that did make it a little easier. However, I had stepped out of the room to use the restroom at the moment she woke up, but she woke up so slowly she did not notice that I wasn't there. (it was probably less than 15 sec.) Hopefully they will let you into the room the second your DS wakes up, before he has a chance to really notice that you are not there. In the end I am glad that we got them fixed, I spent five months stressing about it so when it was over it was such a relief.

[MunchiesMom]

Is it scary for them when they go down? DS's dentist said they can give me a med that makes him groggy and forget everything, then they put the mask on and they're out in like 25 seconds. This scares me... I worry how this will impact him emotionally.

I am so freaked out by this, it's basically taken over my life since being told the news and I'll continue to obsess about it until the procedure is over. We just got on the surgical center's calendar... June 2 at 7 am. Oh, how am I going to be able to live fully the next 6 weeks? I feel like I'm missing out on DS's toddlerhood because I've been obsessing over this.

A friend of mine helped me realize that I may be exhadurating this in my mind because of some type of Post Traumatic Stress from my mother dying recently. Like I watched her die in a hospital bed, now I'm opting to take my son for this risky procedure and lay him down in a hospital bed?

Can anyone tell me the risks involved with GA? I wonder how many toddlers have it done, successfully, each week?

[MunchiesMom]

SweetDaughter: I understand what you say about "wanting it over with." I feel like my life's been on hold ever since we discovered the cavities 6 months ago. Four dentists later, we finally have a solution but it still doesn't sit right with me. I'm trying to listen to my mothering instincts, and something just isn't right.

[~savah~]

I really don't think that DD remembers going down. She is very verbal for her age and still talks about her 2 year wbv which was a month before her dentist appt. They tried to give her some of the drink before they put the nitrous mask on, but she wouldn't drink it. When they got ready to put her under they showed her an episode of elmo's world, which she does not remember. I understand what a hard decision this can be. It just seems so counterintuitive as a mother to put our children under anesthesia for something like dental work.

I am sorry about your mother and I hope that this situation resolves itself a so that you feel like you can relax and enjoy your son.

[lmk1]

I second getting more opinions. My 2.5 year old just had one tooth filled, and the dentist used novacaine. Ds didn't love the shot nor the numbing feeling, but he watched cartoons while the dentist was doing the work and was not bothered at all by the drill or the scraping. We've gone to 8 different dentists with ds since he was 12 months, and I've heard opinions from "crowns under GA" to "wait and see". Ds also reacted very differently to all the different dentists, and he was absolutely fine with this last dentist. Whatever the dentist told him to do, he did...and I was fine with this dentist, because there was no talk of using a papoose board, and I held ds the entire time. I think it gets easier to fix kids' teeth as they get older as they're able to understand more of what's happening to them, so you may want to get more opinions from other pediatric dentists (and my experience shows me that me that ped dentists are MUCH better at dealing with kids, and I've had unnecessary work recommended by general dentists, too), and see how long you can "wait and see". In the meantime, they can put fluoride varnish on the teeth, and you can get much stricter about sweets, and any other dietary changes.

[MunchiesMom]

I wanted to follow up on my original post because I have some updates...

First, thank you for all of your kind words and personal stories! I've been stressing about this for so long. I've been praying, reseraching and talking with a lot of other people and have come to the conclusion GA is the only way to fix DS's teeth.

I visited with his (wonderful ped dentist) again and understand the decay is worse than I thought. He has a cavity on the back of a front/upper tooth that will need filling. Plus, one of his 'eye teeth' are really decayed and chipped and it need a pulpotomy, or "mini-root canal". That will get a tooth-colored crown on it. She's going to fix the pulpotomy the other (bad) dentist did with just laughing gas to make it look better. Plus, she's going to put sealants on his molars and do a cleaning.

After thinking about all this, the only way all this work can get done is under GA. And I believe the work is necessary. The health of your baby teeth can affect permanent teeth and dental issues can cause other health problems.We tried laughing gas before and it was like he didn't even use it. (I've heard toddler breathe through their mouths when they're crying, so they don't inhale a lot of the gas anyway.) Traumatic dental experience stay with kiddos for so long, even now DS freaks when we enter a medical office.

So, $475 out-of-pocket and over $1,000 billed to our insurance, we're going to go under GA at the local surgery center in 4 weeks. Ug!

My concerns regarding GA have kind of shifted as the surgery date is getting closer. Now I'm freaking out about the UNKNOWN. What will happen and in what order? What will DS think, what will he say? Will he cry "no, no mama" or willhe remain calm if I can stay calm? What do I tell him before? How will it be as he goes down? As he wakes up?

A close friend of mine helped me recongize that I'm having a really hard time with putting DS (my LIFE and reason for living) through an ELECTIVE procedure because I lost my mother on ahospital bed to cancer 2 years ago. We were 8 weeks from DS's birth. So I can see that I'm a bit of a nut right now, but deep down inside I'm really really scared. Everyone tells me I need to remain calm and confident, because that's what he'll see on surgery day. But inside I'm dying. Any words of advice or calming vibes? What should I say to him on surgery day?

[crawdad]

thought i would pass along my short thread. my suggestion is that if you need your child put under is to find an office that will have an anesthesiologist come to the office to do the sedation while the dentist focuses on the dental work.

http://www.mothering.com/discussions...6#post15061516

also, google search on twilight sedation. ours also had to have mini-root canal among the many fillings and a cap. we waited while i researched until we were comfortable enough to do it.

[LDSmomma]

I've heard many of you say you'd rather have GA in a hospital/surgery setting, not in the dentist's chair. Can you elaborate on that? DH & I both, years ago, had our wisdom teeth removed in dentist's chairs. My mom was with me for mine, and was there when I woke up. The surgeon wouldn't allow me to stay with my husband, but he was an adult, and he didn't really care, so I didn't press it.

Originally Posted by vewainwright

I am having the same kind of issues, and have a post separate from this... but there is one other thing you may want to look into. There is a book called "How to cure tooth decay". It is based on the research of Weston A Price. I have found a lot of the info online, and it is pretty convincing. I am still looking into it, though. Just a thought. . .

There is in fact a link to some of this info at the top of the page for this forum... curing cavities with nutrition. cool.

I'm familiar with WAP, and the traditional foods movement, but it's a long-term fix, that will take a while to make any effects with your LO's teeth, as far as I know. I learned about it after DS was born, and we've followed it since he started eating solids, but his teeth are terrible. Enamel is gone on one, and what's left of that tooth (dentin, I Guess) is chipping away before my eyes tonight.

Originally Posted by MunchiesMom

. She said they say no BM 4 hours before surgery, but the head anesthesiologist at the actual surgical center said nothing after midnight.

- Finally, if we opt for GA, can I nurse 4 hours before the procedure? The surgery center said nothing after midnight. Good luck with that! Apparently they don't think BM is a clear liquid.

I keep thinking of when I was pregnant, and learning that most OB's don't allow women to eat during labor b/c of the chance they may have to do a c-section, and go under ga, and the minor chance they may asparate the food. But I remember my doula pointing out that many people have emergency surgeries with full stomachs with no problem. If I'm ever in your situation, I think I would nurse my son anyway. It's not just food in our home. It is the single tool in my parenting toolbox that fixes all sorts of problems, and I imagine I'd need that tool before such a big event like this.

[~savah~]

I was just thinking about you and your ds and was wondering if there was an update. Hopefully everything went well with the surgery.