How to decide? Could you share your experiences with "bad" cavities in children?

[midnightwriter]

All of a sudden DD (8) has 8 cavities, all between her teeth, two of them "bad", and I can see them, but the rest are "small and maybes" according to the X-rays.

So the family dentist won't do her teeth, and referred her to a pedi dentist. Another family dentist we talked to, who allows parents in the room, won't take her either.

The pedi dentist who uses laughing gas / chair sedation does not allow parents in the room, under any circumstances, no exceptions etc.

I'm not comfortable with this policy, and the way it is stated, and I can't trust a dentist who does not allow a parent to check on the child even if the child cries.

I'm also not comfortable with them being alarmists and wanting to fix all of the teeth right away, as I believe that some teeth can remineralize, especially minor cavities. This has happened to me several times, when the dentist took a wait and see approach.

I'm not comfortable with their suggestion not to let the child know that she is going to the dentist until the very last moment--they suggested to let her know on the drive there. While I tend not to let her know about unpleasant events long in advance, I feel I need to prepare her for the experience. Otherwise it is entrapment, and I'm not comfortable with this.

We found a holistic dentist 4 hours away. They are eager to take us, even without looking at the x-rays, while a local family practice refused to take her based on her x-rays (they wouldn't treat her with needle only).

The situation is compounded by the fact that DD is VERY sensitive to pain. She also tends to be anxious. She does NOT like to be separated from parents (routed in a childhood trauma when I was hit by a car and she was forcefully separated from me at the age of 2.5) But she is cooperative and calm during procedures, especially if treated gently and with respect. She's eager to get her teeth fixed.

The bottom line is, she NEEDS to have at least two teeth fixed urgently.

So her choices are:

1. Chair sedation, no parent allowed under any circumstances. Faster dental work, less visits, less pain from the needle.

2. Needle anesthetic, parent allowed if wanted / needed, more visits, longer travel to dentist, uncomfortable sensation of frozen mouth.

I'm not sure which one she will choose. It is very hard for me to do the option 1--not because of the fact that the parent won't be there, but because of their general rigid, inhumane policies. I can trust them.

I would like to hear more experiences and suggestions on this situation. I feel very frustrated and conflicted.

[eclipse]

Well, my son had some work done when he was 5 - two deep cavities (one leading to an excraction of a molar) and smaller cavities in every molar. My son was/is a very anxious kid who has been known to freak out at doctors. He has sensory issues, etc. They couldn't even get him to sit for xrays, he was panicking so much - but from looking in his mouth, the two major cavities were obvious. His dentist had a no parents in the room policy for major work. There's no way I could have gone in anyway, because I had my two younger kids with me, alone (at the time dd was 3 and ds2 was an infant) because it was an emergency (he was in a lot of pain) and I had no time to arrange child care for them. Anyhow, we went with conscious sedation with the understanding that if he freaked too much, we'd postpone and do general anesthesia. He freaked in the begining (spit the Gatorade with the sedative in the dentist's face. That was, uh, fun.), but then they let him play video games for an hour while the sedative kicked in (and his sibs and I were with him during this time). By the time he was ready to go back, he was totally compliant and mellow. I walked with him to the door of the room and saw him climb up in the chair, which he had refused to even sit in during the first exam. Then I sat on the otherside of the wall from the room and never heard a peep from him (and believe me, I would have heard him!). They did ask me to sign something to allow them to use the papoose board if he freaked out, but I refused and told them that if it came to that, we would do general instead. After it was all over, he remembered very little of it - mostly the prick from the needle when they gave him novicaine and that it hurt a bit when the tooth getting extracted came out - but he said it didn't hurt much, and he's a kid who is very sensitive to pain.

Anyhow, if you really think your dd could handle it with you there, I'd probably go with the needle and you present. If you suspect that she will freak out anyway, it might be better to try the sedation route first to see how it goes. I would find a dentist you trust, though, even if they have a no parents policy. I can sort of see the point of not having parents in the room during major work - I know the room they used for my son was very small and with the dentist and two assistants, I probably would have been in the way, and I really don't think my son would have even known I was there - he was that out of it by the time they did the work. He was practically asleep for the bulk of the time he was in there. But if you really don't trust the practice, and they aren't willing to work with you like mine was (agreeing to my declining the papoose, agreeing to stop if he had an anxiety attack, etc), you need a new practice, regardless of which method you try.

[sapphire_chan]

If she's wanting to cooperate with the dental treatment and will be opening her mouth as requested, ask the dentist who does the needle anesthetic if s/he knows about wiggling a finger right at the injection point. Normally, the injections are the worst part of dental work, and my last dentist visit the dentist did the finger wiggling thing and I didn't even feel a pinch as the needle went in.

[CherryBomb]

Dd1 (also 8) has had to have two teeth pulled due to decay. We've done it both way. I'll never do the sedation again. She has no recollection of what happened, but I could hear her screaming from out in the waiting room. The IV was a hundred times better. I got to sit there with her until she drifted off, then I went out into the waiting room while they pulled it, and came back as she was coming out. She was scared and disoriented at first, but I still much preferred it over gassing her.

That said, I don't think there's anything sinister in the dentist not wanting parents to be there during the chair sedation, or running back when the kid cries, because most of the kids scream and cry and it's probably not something you want to watch (hearing it was bad enough). If mom is in there freaking out it's going to take twice as long to get it done, ykwim?

[eclipse]

Originally Posted by CherryBomb

Dd1 (also 8) has had to have two teeth pulled due to decay. We've done it both way. I'll never do the sedation again. She has no recollection of what happened, but I could hear her screaming from out in the waiting room. The IV was a hundred times better. I got to sit there with her until she drifted off, then I went out into the waiting room while they pulled it, and came back as she was coming out. She was scared and disoriented at first, but I still much preferred it over gassing her.

Was the first time just gas and novacaine, or did they give her a sedative ahead of time? I know my son couldn't have handled just gas - i couldn't have even got him in the chair. But the oral sedative really did wonders for him.

OP, I didn't comment on it because you didn't ask, but the Pp mentioned it so I will too. My youngest son had major dental work at two yo and had to be put out completely. That was the easiest experience we could have had, though I was a wreck about it before hand. They gave him a sedative shot - and that was the scariest part. He screamed when they gave that to him (in the leg - and the dentist told me ahead of time that he would really scream. Apparently that particular shot is very painful.) but then came to a full stop, and his eyes glazed over. I started to hand him to the dental assistant, but he whined, so I held him for a few minutes more. When I handed him over, he didn't even stir. I could have gone back while they put the IV anesthetic in, but he was so completely out already that I didn't bother. I was able to send his favorite blanket back with him, and they covered him with it so he could wake up with it. They came and got me before he even woke up, and I was there as he came around. Other than being groggy and not able to walk well (sort of a drunk, weak walk), he was fine from the moment he woke up. It was a very easy experience for us.

[midnightwriter]

Originally Posted by sapphire_chan

If she's wanting to cooperate with the dental treatment and will be opening her mouth as requested, ask the dentist who does the needle anesthetic if s/he knows about wiggling a finger right at the injection point. Normally, the injections are the worst part of dental work, and my last dentist visit the dentist did the finger wiggling thing and I didn't even feel a pinch as the needle went in.

Could you elaborate??
How do you do this?

[midnightwriter]

Originally Posted by eclipse

Well, my son had some work done when he was 5 - two deep cavities (one leading to an excraction of a molar) and smaller cavities in every molar. My son was/is a very anxious kid who has been known to freak out at doctors. He has sensory issues, etc. They couldn't even get him to sit for xrays, he was panicking so much - but from looking in his mouth, the two major cavities were obvious. His dentist had a no parents in the room policy for major work. There's no way I could have gone in anyway, because I had my two younger kids with me, alone (at the time dd was 3 and ds2 was an infant) because it was an emergency (he was in a lot of pain) and I had no time to arrange child care for them. Anyhow, we went with conscious sedation with the understanding that if he freaked too much, we'd postpone and do general anesthesia. He freaked in the begining (spit the Gatorade with the sedative in the dentist's face. That was, uh, fun.), but then they let him play video games for an hour while the sedative kicked in (and his sibs and I were with him during this time). By the time he was ready to go back, he was totally compliant and mellow. I walked with him to the door of the room and saw him climb up in the chair, which he had refused to even sit in during the first exam. Then I sat on the otherside of the wall from the room and never heard a peep from him (and believe me, I would have heard him!). They did ask me to sign something to allow them to use the papoose board if he freaked out, but I refused and told them that if it came to that, we would do general instead. After it was all over, he remembered very little of it - mostly the prick from the needle when they gave him novicaine and that it hurt a bit when the tooth getting extracted came out - but he said it didn't hurt much, and he's a kid who is very sensitive to pain.

Anyhow, if you really think your dd could handle it with you there, I'd probably go with the needle and you present. If you suspect that she will freak out anyway, it might be better to try the sedation route first to see how it goes. I would find a dentist you trust, though, even if they have a no parents policy. I can sort of see the point of not having parents in the room during major work - I know the room they used for my son was very small and with the dentist and two assistants, I probably would have been in the way, and I really don't think my son would have even known I was there - he was that out of it by the time they did the work. He was practically asleep for the bulk of the time he was in there. But if you really don't trust the practice, and they aren't willing to work with you like mine was (agreeing to my declining the papoose, agreeing to stop if he had an anxiety attack, etc), you need a new practice, regardless of which method you try.

Thank you so much for sharing. Very helpful!

[midnightwriter]

Thank you for ll the replies. We are not getting that many sedation options, it seems.

Why do kids scream with laughing gas? Is there still pain?

[midnightwriter]

Originally Posted by CherryBomb

Dd1 (also 8) has had to have two teeth pulled due to decay. We've done it both way. I'll never do the sedation again. She has no recollection of what happened, but I could hear her screaming from out in the waiting room. The IV was a hundred times better. I got to sit there with her until she drifted off, then I went out into the waiting room while they pulled it, and came back as she was coming out. She was scared and disoriented at first, but I still much preferred it over gassing her.

That said, I don't think there's anything sinister in the dentist not wanting parents to be there during the chair sedation, or running back when the kid cries, because most of the kids scream and cry and it's probably not something you want to watch (hearing it was bad enough). If mom is in there freaking out it's going to take twice as long to get it done, ykwim?

Thanks.
The IV is the full sedation? I think it is available here only at the children's hospital, and involves restraints.

[midnightwriter]

Originally Posted by eclipse

Was the first time just gas and novacaine, or did they give her a sedative ahead of time? I know my son couldn't have handled just gas - i couldn't have even got him in the chair. But the oral sedative really did wonders for him.

OP, I didn't comment on it because you didn't ask, but the Pp mentioned it so I will too. My youngest son had major dental work at two yo and had to be put out completely. That was the easiest experience we could have had, though I was a wreck about it before hand. They gave him a sedative shot - and that was the scariest part. He screamed when they gave that to him (in the leg - and the dentist told me ahead of time that he would really scream. Apparently that particular shot is very painful.) but then came to a full stop, and his eyes glazed over. I started to hand him to the dental assistant, but he whined, so I held him for a few minutes more. When I handed him over, he didn't even stir. I could have gone back while they put the IV anesthetic in, but he was so completely out already that I didn't bother. I was able to send his favorite blanket back with him, and they covered him with it so he could wake up with it. They came and got me before he even woke up, and I was there as he came around. Other than being groggy and not able to walk well (sort of a drunk, weak walk), he was fine from the moment he woke up. It was a very easy experience for us.

Thanks! sounds like a great option for a young child.

I don't think this option is available here, or at least they are not willing to discuss it.

[mommy2maya]

My son has had a lot of dental work done. None of the ped dentists in our area let parents in during work. He is also anxious about the dentist. If he gets gas, then followed with novacaine, he is totally compliant and fine with it all. One time he had to have a spacer adjusted and they didn't give him gas first and he freaked a bit. We left and came back for another appt and they gave him the gas first and he was fine. He has also had work done while he was under general anesthesia, and they used versed( an oral sedative) before the IV. It was done in a hospital, with an anesthesiologist. I would never do any sort of general NOT in hospital. It just seems way too risky.

[sapphire_chan]

Originally Posted by midnightwriter

Could you elaborate??
How do you do this?

Dr. Sullivan just used one hand to do the injection and a finger from the other hand to sort of press and jiggle as he did the injection. I actually thought he was trying to adjust my lip and gum to get a good place to do the injection and then he was like "do you feel anything?" and I realized I was numb. Because of where the injections go, it wasn't as effective for my lower wisdom tooth extraction but it was still far less painful than other dental injections.

When I mentioned my surprise at how painless it was, he said that he also did a very slow injection and this: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1586792/ suggests that that is the best practice solution.

You could also get your dd headphones and some music to listen to. That'd help with the sounds of the drill help her mouth be relaxed in the open position so the dentist has and easier time. Opening WIIIIIIDE is actually a nuisance for dental work because it makes your lips rigid and your mouth narrower.

[midnightwriter]

Originally Posted by sapphire_chan

Dr. Sullivan just used one hand to do the injection and a finger from the other hand to sort of press and jiggle as he did the injection. I actually thought he was trying to adjust my lip and gum to get a good place to do the injection and then he was like "do you feel anything?" and I realized I was numb. Because of where the injections go, it wasn't as effective for my lower wisdom tooth extraction but it was still far less painful than other dental injections.

When I mentioned my surprise at how painless it was, he said that he also did a very slow injection and this: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1586792/ suggests that that is the best practice solution.

You could also get your dd headphones and some music to listen to. That'd help with the sounds of the drill help her mouth be relaxed in the open position so the dentist has and easier time. Opening WIIIIIIDE is actually a nuisance for dental work because it makes your lips rigid and your mouth narrower.

Thank you!

Another question: Were your children restrained, and how?

The dentist here explained that children cry during dental procedures because they are restrained. What kind of a restraint would they use for an 8 year old?

[eclipse]

My kids were not restrained. I wouldn't use a dentist who insisted on restraining a child. Most of the time kids who are restrained during a procedure are on a papoose board - http://comps.fotosearch.com/comp/LIF..._~PED07003.jpg . My opinion was that if a child needed something like that, even with sedation, that they should go under general anesthesia. I would agree that probably most kids cry because of the restraint (because if they are properly anesthetized, they will feel very little) - but I don't think that's anything to discount. Kids who cry because of the restraint are crying because they are terrified. I can understand the use of something like the papoose in an emergency situation (like something causing a child to end up in the Emergency Room), but dental work doesn't usually fall into that catagory.

[sarahdavida]

Originally Posted by midnightwriter

Thank you for ll the replies. We are not getting that many sedation options, it seems.

Why do kids scream with laughing gas? Is there still pain?

I don´t have experience with this, but I would imagine it´s just scary to be alone, have a mask put on you, and start feeling weird, but still be awake and have all these things being done in your mouth (drilling, etc.) - I guess it just depends on the age and temperament of the kid.

DS is 3 and has a cavity horror show in his mouth (poorly formed enamel and extended night-nursing didn´t help). We were referred to a pediatric dentist who does this work in the hospital under general anesthesia - there is simply no other way. Unfortunately we had to postpone it for another month or so, first because he got sick and now because we have a big trip coming up and I didn´t think it was a good idea to do it so close...I am HOPING things don´t become so much worse in the meantime and that we haven´t made a huge mistake by putting it off - I wish we could have had it done before our trip.

The process here is so complicated also. First you have to have blood and urine tests and permission from the pediatrician, then you have to schedule it in the hospital...that process alone take at least a week or 2 - and by that time, the kid is probably going to get sick again - very frustrating!

[midnightwriter]

Originally Posted by eclipse

My kids were not restrained. I wouldn't use a dentist who insisted on restraining a child. Most of the time kids who are restrained during a procedure are on a papoose board - http://comps.fotosearch.com/comp/LIF..._~PED07003.jpg . My opinion was that if a child needed something like that, even with sedation, that they should go under general anesthesia. I would agree that probably most kids cry because of the restraint (because if they are properly anesthetized, they will feel very little) - but I don't think that's anything to discount. Kids who cry because of the restraint are crying because they are terrified. I can understand the use of something like the papoose in an emergency situation (like something causing a child to end up in the Emergency Room), but dental work doesn't usually fall into that catagory.

There's no way in h**l my DD would agree to this. Even if I were okay with this, and I'm not. Like you say, for an emergency situation, yes, but not for dental work!

[sapphire_chan]

Originally Posted by midnightwriter

Thank you!

Another question: Were your children restrained, and how?

The dentist here explained that children cry during dental procedures because they are restrained. What kind of a restraint would they use for an 8 year old?

Oh! I'm very sorry. This was my experience having dental work done as an adult and something I thought would be possible for an 8 year old who was motivated to cooperate with treatment.

If it doesn't hurt, then no need for restraint, y'see? If she's told it'll feel like a really hard pinch, but then it doesn't even hurt that much, she'll have confidence for the rest of the procedure.

[LorenaAZ]

I used gas when I was younger and had a molar extracted. The gas in NOT a pain killer. It makes you feel like you don`t have a care in the world, and makes you extremely slow to react (like you are reaaaallllyyy heavy, your arms are heavy, etc). I was given an injection into my gum first as an anaesthetic, and then the gas, so all the pulling and jerking on my mollar wouldn`t freak me out. It worked out well.....but my parents are both doctors and I used to spend A LOT of time with my dad`s friend who was a dentist. He let me in his office when I was a little girl with his patients`permission...I clearly remember him asking me to move my head `cause he couldn`t see into his patients`mouths. It was a great learning experience for me, and I never feared the dentist.

Having said that, I would NEVER let my DD into a dentist`s office for treatment without me there. Especially if she has never seen what they do, how they do it, etc....it can be terrifying for a child. I don`t care what the reason is for the dentist to have this policy. And restraints? No way. If they felt restraints were necessary, then I would prefer having my DD go under general anaesthesia. We are not in the dark ages any more!

You need to find someone who respects your child as a person, and not as a little animal to be subdued by any means so the dr can make his money in a timely manner before lunch time. I have friends whose dentists set up appointments with the children just to talk, familiarize them with the equipment, the office, etc. and get the children to trust and like their dentists before any kind of treatment even begins. And yours is telling you not to tell your child until you are on the way there?? Insane!! There are humane dentists out there who care about their patients, even if they are little people. They deserve the same respect as any adult.

Have you seen the holistic dentist yet?

[CherryBomb]

Originally Posted by eclipse

Was the first time just gas and novacaine, or did they give her a sedative ahead of time? I know my son couldn't have handled just gas - i couldn't have even got him in the chair. But the oral sedative really did wonders for him.

They gave her the apple juice drink before they gassed her, but unfortunately it didn't really help :/ It made her drowsy and unable to get combative, but she still screamed and screamed. The nurse said her reaction was pretty typical, though.

[CherryBomb]

You know, I honestly can't remember if she was restrained or not. I *think* they might have restrained her arms after the IV, but I honestly can't remember. I think with the gas the nurses just held her down, but I'm not sure.