Baby root canal vs. extraction on 14-month-old + sedation options

[IncompetentHousewife]

My 14-month-old daughter has decay on her top two front teeth. One has two cavities on it that we will have filled with composite material, but I’m torn about what to do with the worst tooth. Please help! The bottom half of this tooth has fallen off and soft brown pulp is visible.

I took my baby to two pediatric dentists. One refuses to have parents in the room while they do treatment, so I’m not going back (she also blamed breastfeeding and insinuated that if “the habit” continues I will ruin my daughter’s teeth if not her entire life). This dentist wanted to do a pulpotomy (baby root canal) and add a white crown.

The other pediatric dentist said that because my daughter fought the exam so much, he will attempt the pulpotomy, but will probably have a hard time doing this delicate procedure and will likely end up extracting the tooth. He doesn’t want to mess with any cosmetic dentistry at this point.

The questions I am having trouble finding answers about are:

•I’m not sure how much to push for trying to do the pulpotomy. This dentist seems like he’ll be responsive to my requests. I think that if I say I really want to try to save the tooth, he will try his best. But maybe extraction is better? How do I decide?
•If he does extract it, how might a missing tooth affect her speech? Her eating?
•Aesthetics are much less important to me than my daughter’s overall health, but I do worry a little about the stigma of a missing tooth until her adult tooth comes in. Anyone been through this?

I realize that whatever procedure we end up with will be traumatic no matter what, but I wonder about any ways to lessen this. Neither the dentist nor I feel general anesthesia is appropriate due to its risks, and I understand nitrous oxide may not be appropriate for her age. Are there any other safe ways to calm my daughter at least a bit? For example, my older daughter was given Versed before receiving some stitches on her lip.

Thanks for any information you can share! I’m a worried mommy in Michigan!

[OneAtHome]

I'm not sure if this will be of any help-but we just went through a very similar situation. We had to make the same descision for our three year old. It was awful, but we decided to just have the tooth taken out. She was given Ketamine (which I don't think I would do again) so that they could give her an IV medicine. We weren't allowed in (which made me sick, and I still don't feel right about), but she wasn't completely "out". This was good and bad-just horrendous to think about, but less risky? However, I am just writing to say that I m so so glad to be rid of the tooth, granted, it was a back one. Her health and well being have just made huge leaps forward. If nothing else, I just wanted to say I have been there, and that it is really hard, but that one or another, at some point it will be over! Jeanne

[AJP]

My first son had his 4 top front teeth pulled at the age of 4, he had no teeth there until he was 6 when the permanent ones began to come in. He had no trouble eating without them. He did have trouble forming certain sounds ("th" in particular) until the teeth came in, but he compensated pretty well. His speech patterns were more established by 4 than your child's would be now, but it sounds like yours can keep one of the teeth for sure, so that should make eating and speaking not much of an issue.

My son had his work done using the same kind of sedation that Jeanne desribed above - ketamine followed by an IV. He has no memory of the work now, remembers when it occurred and right before and after (came to afterwards in my arms and said "that was fast - where's my prize?"). At the time he remembered them asking him to open his mouth during the procedure, but he doesn't remember that now, and he never seemed to have any trauma from the experience. I put the anesthesia off as long as possible, and had the dentist first try doing the work with just nitrous and local anesthetic (he went ballistic at the drilling, even though he was totally numb, and the nitrous just made him more squirmy than usual), so we decided GA was the least traumatic route for him. I couldn't bring myself to allow it until he turned 4, though. (Looks like I'll have to make the decision again for son #2, hoping to preserve his problem teeth and put it off as long as possible.) It was really, really hard for me, but he bounced right back, he was playing normally just a few hours later, only had a little bit of soreness (he also had 1 molar extracted, 3 pulpotomies w/ caps and a few small fillings). Two of his front teeth could have been saved with pulpotomies and caps (the center ones), but the dentist said in her experience caps on young kids' front teeth have a lot of problems with falling off or getting damaged because kids can be rough on them. White (porcelain) caps especially are fragile there, she said, and I decided that no teeth was better in front, phychologically, than metal teeth. It wasn't much of an issue at all for him, really, having no teeth there for 2 years.

I also was not allowed in the room during the GA procedure, but I can understand the anesthesiologist's reason - he needs to concentrate only on the patient, and not have to worry about whether the parent is going to freak or faint or something at the sight of their anesthetized child (which can happen with even stable people, like people who go weak in the knees at the sight of blood). I held my son while they gave him the very quick ketamine shot, then when he was loopy they carried him into the next room for the rest of the procedure. I sat there and cried for a few minutes, but attended by a person the dentist's office assigns just to babysit parents while their kids have the work done (she also reported to me about every 15 minutes how things were progressing). I was comforted by the fact that there was a separate anesthesiologist to concentrate on only that, the sedation wasn't administered by the dental staff. It was at the dentist's office, but they have a separate room just for GA procedures (most non-sedated work is done in the open exam area, and parents are more than welcome there).