what kind of anesthesia for a pulpotomy in a four-year-old?

[Symbi]

My four-year-old has an enamel defect in his teeth and has ground them down quite severely, some down to the nerves. He has already lost one tooth naturally, and he has had one extracted due to an exposed nerve. He is going to need a pulpotomy on another tooth next week. The dentist said he would have only local anesthesia, no nitrous. I am ok with this--it is actually what I prefer (anesthesia in children worries me and my son did not do well with the after-effects of nitrous before--different dentist), but will a four-year-old really do ok with only local anesthesia and enduring at least one shot of novocaine and then enduring the entire procedure fully awake? Has anyone else here had this procedure done on a young child, and if so, what kind of anesthesia was used? I plan to talk with the dentist more before the procedure and get all my questions up to that point answered. We really do like this dentist and trust him, but I just worry. The dentist has a good rapport with my son and with us, and I am hoping that my son's comfort level with this dentist will be enough to get him through the procedure. Thanks so much for any thoughts on this.

[pokeyAC]

Bumping up for more attention. 

[Symbi]

Thanks for the bump. The procedure was done yesterday. My son did great with the novocaine. The dentist did an amazing job explaining to my son ahead of time all the instruments he was going to be using, what they looked and sounded like and what their function was, as well as preparing him for a little "mosquito bite" when the needle went in (he did not use the word needle though I don't think--just sleepy juice). Anyway, yes, after yesterday, I would go this route again, with just the local anesthesia. I was amazed at how well my son did with it all. When I asked him what he thought about his visit, he said that the air they sprayed in his mouth tasted awful and the water tasted wonderful. I asked what else he remembered and he said that was it. Later on he told my husband that the dentist gave his tooth sleepy juice and it fell asleep for two hours. :-)

[phathui5]

"my son did not do well with the after-effects of nitrous before--different dentist"

Can you share more about your son's experience? I passed up nitrous for my 7yo ds because I didn't feel comfortable with it even though the dentist insisted that she had never heard of anyone having adverse side effects.

[Symbi]

Apparently stomach pains/gas pains are common as well as constipation following nitrous. I did not know this before my son received the nitrous. For days after, my son experienced severe pains in his stomach and constipation as well as getting some of the most sick he has ever been within hours after the procedure (high fever, lethargy). He was definitely not himself directly following the procedure, even though the dentist said once the nitrous is turned off, it no longer effects the patient? The dentist denies the fever/lethargy could be related to the nitrous or the procedure, but I have my doubts. I find it interesting that the new dentist we go to does not even offer nitrous in his office.