Hospitalization/General Anesthesia - Page 6

[houseofboyz]

smillemomma, please read...

My 20month ds has decay on two front teeth
(one of which hasn't even come in all the way)
and 4 cavities on molars. The dentist wants
to try to cap the front and fill the molars. Is this
a good idea? Also he suggested ga, or we
could try morphine ( a shot in the gums) Ds
also screamed in terror when dr. examined his
mouth. Can I ask what anyone else would
do in this situation?

[gilnikche]

chevy974,

How is your little one?

[chevy974]

Thanks for asking she is about the same no worse. the temper tantrums and the sitting in the corner is still there and she does still flap of the hands. I think this is something we are just gonna have to learn to deal with. she will still just sit with head down like she is sad. It breaks my heart.

[gilnikche]

I can think of no words that are appropriate... My heart aches just to think of it. Have you posted any of this to the Health & Healing or Parenting Issues Forums? It sounds so much like symptoms in the Autistic spectrum. I remember reading posts from Stacie about her dealing with it.

[chevy974]

We are using homeopathy whcih i think has helped her some. YOu know what the worst of it all is My instinct told ME NOT TO DO IT!!!!!!!!!! and i went against that I thought maybe i was just being over anxious I tend to be paranoid about medical issues.
So now on top of a already difficult child she is kinda a high need kid now this. ARGGGGGHHHHHH

[Naomi]

Gen anaesthesia -- or none at all? 21 mo old.

*sigh*. A few months ago I noticed a brown spot on my toddler's teeth that I couldn't brush away (my first thought was that it was just a little bit of food that was stuck, but no such luck). We've brushed her teeth every night since before her first birthday, but we didn't start using toothpaste until recently -- she doesn't understand how to rinse and spit, and since I have fluorosis on my own teeth, I'm paranoid about it. We nurse at night, of course.

We finally saw the pediatric dentist today. We had to see a regular dentist first and get a referral; I liked the regular dentist a lot (when I talked about how she starts out the night in her own bed, but wakes up at some point and comes in with me and dh, the dentist said, "sounds like my kid") but I liked the pediatric dentist rather less. Still, it was a non-traumatic appointment for dd. The dentist was low-key and friendly and made her laugh, and she opened her mouth for him and didn't mind the funny foam thing he used to keep her mouth open while he looked at her teeth.

He says she has three or four cavities, including the one I spotted, all in her front teeth. And, we have two options for treatment:

1. Drill and fill, no anaesthesia. He said that novacaine injection is traumatic enough for a child this age that she'd probably throw a fit and not let him work on her teeth. He said that he probably would not be able to get ALL the decay but that he'd be able to get enough of it to stop it from getting worse. He would then fill the cavities with fluoride fillings -- I've been reading through the archives for the last two hours, and I can't find ANYTHING about fluoride amalgam. Does anyone have any idea what he was talking about here?

2. General anaesthesia. If he put her under completely, he would also be able to do x-rays, and to seal all her teeth. She has four molars in right now. We wouldn't be able to schedule this until September at the earliest, so she might even have her two-year molars by then.

I have to say, I am totally freaked out by both options. I have actually had a cavity drilled without novacaine, but it was a teeny-tiny cavity and I really felt no pain at all. Dh, on the other hand, had a cavity drilled WITH novacaine and insists from this experience that "novacaine doesn't do anything," as he felt an awful lot of pain anyway. Since I've also had a tooth drilled with novacaine -- as well as a whole bunch of routine extractions done as a kid with novacaine (they were supposed to help my teeth come in straighter) -- I told dh that they must just not have given him enough.

But at any rate, I really don't want dd to be hurt. I asked the dentist how they know when they've drilled far enough that they really have to stop because it's going to hurt the kid too much to continue, and basically it sounds like they stop when the kid shrieks in obvious agony.

I read some of Smilemama's posts where she talks about working on small kids without anaesthetic, and she says they do really well. How do you know when you're about to hit a nerve? Seriously. My dd is generally a pretty easy-going child and does NOT scream loudly unless she's really in pain, so I have no doubt that it will be clear that her hysteria is due to "time to stop drilling" and not just "okay, I've had enough of this." (Her usually "I've had enough of this" protest is to say, "all done! all done!")

On the other hand, I also really don't like the idea of putting her under GA. Reading the story from the mother whose child came out of it severely traumatized didn't make me feel any better about the idea, and I already know there are risks (like, kids can die just from the GA....though I know so few people who have gotten through life without having to go under GA at least once, it seems like if you are someone who will die from GA, you're probably doomed anyway!)

I forgot to ask about nitrous oxide and I didn't know anything about chloral hydrate until I started reading this thread. I can see the virtue of NOT numbing up a kid this young, though, because of the "chewing on their numb cheek" issue. My very first routine extraction, I was old enough to understand the instruction not to chew on my lip, but it was such a weird sensation I did it anyway. I regretted it later and didn't do it again.

Anyway. Can anyone give me some advice about this? I went through the archives but it seemed that most people were told their child would HAVE to go under GA because the work needed was so extensive, or else it wasn't presented as an option. Lots of kids were also given IV sedation -- which wasn't presented to me as an option.

I think I mentioned that if we go the GA route, it won't be done until September, so I'll have months and months to worry about it. If we go the no-anaesthesia route, he could treat her in as little as two weeks. Ughhhhh. I'm so bummed about this whole thing. I had NO cavities as a kid -- despite nursing at night as a toddler -- and only three cavities as an adult.

[simonee]

Look further.

I have pretty bad teeth, and my dentist didn't believe in novocaine for "little cavities." As a result, I'm still dealing with dentist phobias. Beyond very very tiny, it hurts like hell on me, and novocaine definitely helps. Mostly, I feel nothing at all (I just had all my amalgams replaced with composites, and that's a lot of work in my mouth )

My dd (almost 3) just had one cavity on a front tooth filled, with Versed (an oral sedative, which "takes the edge off" the experience. My dd is feisty, and I get the impression it would take more edge off for your dd than for mine). She also got novocaine, and thanks to the Versed that shot hardly bothered her at all. Check my thread on the story, "how Audrey got her tooth back."

GA sounds maybe a bit big for your case, especially since she sounds cooperative. If you can think they can do the procedure in half an hour, I'd probably not go for that. I would insist on novocaine, though. Some people have more sensitive teeth than others, and you don't know till you find out (that sounds like a Yogi Berra-ism )

Do her teeth hurt her? If so, the cavities are likely pretty deep. And if not, I'd still go with novocain (but can you see that I'm a wimp?)

Does your dentist offer oral sedatives or nitrous? I feel that without the sedative, my dd's experience would definitely have been more traumatic. Hope this helps ~ good luck!

[simonee]

BTW: Why, if you like the regular dentist more than the ped dentist, not stay with him/her? I've heard that even smilemomma is a regular dentist!

[simonee]

My dd (almost 3) had one front tooth filled and capped, with novocaine and Versed (oral sedative). It was doable, but she definitely didn't like the experience.

For 6 teeth, including 4 in the back, I'd go GA despite all my worries about her being under. It seems like a lot of work, and a long sit. And I wouldn't really want to give a 20-month old a taste of morphine, either

[Tamarack]

Milesmom, thanks for your feedback. After my husband and I discussed this, we decided to go for a second opinion. Another pediatric dentist examined my son today and has a somewhat different treatment plan. This dentist noted that the back of a second incisor is also decayed, and thinks the two decayed incisors that look chipped are actually the result of defective enamel. This dentist noted defective enamel on all four molars as well, but doesn't feel that the small amount of decay there requires treatment, since the defective enamel is on the cheek side of the smooth part of the molars, not on the chewing surface, and can be brushed well.

However, he definitely thinks the two incisors and a small cavity in the chewing surface of one molar need to be filled. He uses chloryl hydrate in his office, administered by himself, while the other dentist is proposing iv sedation administered by an anesthesiologist. I'm off to read through the archives for information on chloryl hydrate, and I've got a call in to my pediatrician for his opinion on the different anesthesia, but I would love any input from Smilemomma or anyone else with experience with the different methods!

OT, but as the nurse was giving me instructions on how to prepare for the procedure if we end up deciding to use this dentist, she mentioned no food or drink after midnight. I asked about nursing. Her response? He's too old to nurse anyway, I should have weaned him at one! Grrrrrr.....

[rachael_barlow]

Firstly, I'm so sorry for the anxiety you are feeling. It's just awful having to decide stuff like this. My first child had her 4 front teeth removed at 18 months of age. Because she has many allergies, we were afraid to do anesthesia of either sort. Instead we used novacaine. I held her down while they worked in her mouth for the longest 9 minutes of my life and hers while I prayed out loud. With my second child, we found tooth decay at 14 months. I decided to attack the decay right off. We drilled and filled the teeth again while I held her down for 2 minutes - that's all it took! Again she has allergies, even worse than her sister. Then since 14 months of age, we pay to see the dentist every 4 weeks. Several times we have coated her teeth with fluoride, as much as I hate to do that. Again, that takes about 60 seconds and I just hold her down. Every time I have had to hold my children for a procedure, this is how it works. I sit with my knees touching the dentist's knees. I hug my child. Then I bend at my waist, placing the child's head on the dentist's lap upside down. Then I move my head out of the dentist's way but my hands still hold my child's hands. I tell the child everything that is happening and actively empathize with them. "This is scary. There's going to be a sound - it's called a drill. It will scrape the nasty bugs off your teeth. That hurts but it's almost done. Your teeth are clean! ..." Then I nurse the child as soon as possible. I hope that helps.
A couple of other thoughts:
- often a 2nd opinion can be obtained for free or for a small fee.
- does your child have allergies? especially allergies to meds?
- if you chose general, then you will be separated from your child. In most hospitals, you are separated until your child is conscious and CALM! How long would that be for a 20 month old in an unfamiliar place with a sore mouth!
- if you chose general, they will not be permitted to have anything by mouth for some period of time before the surgery. That could make for a rough night if they night nurse. (And no amount of "but breastmilk is a clear liquid, look at these studies..." would convince the MD's in Boston otherwise.)
- if you chose to have anesthesia in the dentist's office, then look up the dentist in the web. See if you can find complaints against them. I saw some scary show on TV about dentists doing anesthesia when really only anesthesiologists should do it.

Again, I'm so sorry you have to travel this road too.

Rachael

[rachael_barlow]

oops -newbie mistake. you got a second opinion already.

Also, with just fillings, why do any sedation? Why not just work on one tooth at a time? Laura at 20months now actually likes the dentist. We see him so often she sees him and smiles saying "toothies". Katherine at this age was terrified but her experience of tooth extraction was much worse. Just a filling is not so bad. I would suggest that you ask the dentist how many minutes the procedure will take. Then decide what risk you really want to take for that amount of time. I'm sure that in your gut, you will know what to do.

Also, read the latest Motherine - awesome article on caries. For fish oil, try Coromega. My children love the supplement - beg for it!

Rachael

[Smilemomma]

Yep, I'm a "regular dentist" alright, except that I won't berate you for nursing! . You should go with whoever you are comfortable with, and whoever your daughter is comfortable with. That's going to count for a lot!

Simonee, you need a job? Wanna be my "cyber dental assistant"? The pay sucks but the appreciation is big!

Good luck to you, I hope this helped a little!

[lillacoix]

Chevy974 - read this

Chevy,
I am wondering how your little one is doing now. I read your post and I get the feeling that she might have had a strong reaction to one or a combination of dental materials that they used in her mouth. Little children are even more susceptible than adults when it comes to toxins. Have you ever heard of kinesiology or "bodyscan 2010" to figure out where your little angel's problem is coming from? Depending on where you live, I could try to put you in touch with a practitioner who could do some muscle testing on your daughter using you as a surrogate. This way, you could rule out if the problem is psychological or physical or both. Let me know if you want/need info. I'd be glad to help.

[simonee]

Originally posted by Smilemomma


Simonee, you need a job? Wanna be my "cyber dental assistant"? The pay sucks but the appreciation is big!

Uh... I have hardly enough time as it is... But I always like reading the stuff here, and try to reply whenever I feel I have something to say. I know how mysterious dental stuff is for ordinary people like me and most mothering mamas, and I've read so much here that I can sometimes point parents into the right (?) direction and offer support, of course. My own experience, and of course my recent experiences with dd's teeth, put me right there as a mama "who knows waaaay more about dental care than she ever wanted to"

Thanks though. I always look forward to reading your stuff!

[chevy974]

sorry it took so long to get back to you. yes i am interested I as well think it might be a reaction to maybe the stainless crown UGGHH that i argued i didnt want and was bad for her but of course they didnt want to hear. I called every where form here to colorado looking for a dentist to do an alternative and every one said NOPE. so any info you can send would be great you can email me direct [e-mail]

[Naomi]

Smilemomma, thanks a lot for your advice. (And thank you, too, simonee.) I still don't know what I'm going to do As far as I can tell, the tooth doesn't hurt her (yet). I don't want to take her back to the 'regular' dentist just because, well, she's a VERY young child and I don't want someone who's not used to working with young toddlers trying to drill her teeth.

[lillacoix]

Hi chevy,
I will have time this Sunday to respond and share the health stuff with you so you can help your dear little daughter. I will email you at the address you gave me. Until then, peace.

[simonee]

Good luck. But how do you know this regular dentist is not used to working with toddlers? S/he at least has a kid, and seems to treat that kid right. That's two positive things right there.

But ouch what a terrible situation to be in. Again, lotsaluck.

[Greaseball]

Bad reaction to IV anesthesia...scary experience...vent.

I went to get 3 teeth pulled today, 2 wisdom teeth and a molar. They don't use nitrous, which I prefer, so I agreed to have general anesthesia. They said they would use Demerol, Valium and sodium pentothal.

Anyway, as soon as I went under I apparently had some kind of horrible nightmare. I don't remember much but they said I was swearing at them and telling them all to go to Hell. I remember screaming my head off because I thought one of them hit me. I also thought I was tied to the chair. I was thrashing around a lot.

They swear that no one hit me, and I don't think I was tied down. It was probably all part of the dream. I don't know what could have brought this on. I've never had any kind of general anesthetic before, but I thought that stuff was supposed to make you relax. They said they gave me all they could, and that any more would have to be given in a hospital. They said they would not give me any more IV medications and that I'd either have to make arrangements to have it done in the hospital or just have it done in the office with a local.

So I used the local, which was excruciating. They didn't give me enough and I kept screaming "It hurts! I need another shot!" And all they could say was "You have plenty of Novocaine. It shouldn't hurt." And I tried to say "But I know it hurts because I feel it! You think I'm making it all up? Why would I do that?" But I had gauze and this rubber thing in my mouth, so they couldn't understand me. Thankfully it was all over in 15 minutes.

It scared me a lot and I hope I never have to do it again. They said only 2 wisdom teeth needed to come out, so I hope the others are fine being left in. I still don't understand what happened. Has anyone else ever had a bad reaction to an anesthetic like that before?