Toddler dentistry questions...fillings, papoose board, etc. - Mothering Forums

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Old 11-06-2009, 03:18 AM - Thread Starter
 
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Today DS visited our new dentist. He has preemie caries on his top four front teeth and we knew that eventually we would have to take some drastic action- either fillings, or the teeth would have to come out, or something....

DS was great during the x-rays and exam. The dentist saw him for all of two minutes before telling us that he thought he could save his four front teeth, but wanted to perform three root canals and a filling right away (like, he was ready to do it that very second).

I asked him how he would do that and he said, "I'll give him some Novocaine and strap him down."

(It might be worth noting that I have never had a single cavity, so I really have no idea what a root canal is. But from what I've heard, it's not fun.)

When I saw that he was adamant about doing that, I refused, then picked up DS and left. It just didn't FEEL right. The office was empty, he was really eager to do the work, and he did not offer any additional advice or prevention information.

So here's what I would like to know:
1) Is this typical treatment for a two year old who needs this kind of dental work?

2) This dentistry practice is a large, chain-like, corporate practice and it is the only one who accepts my insurance (I used to have a great pediatric dentist, but my insurance company changed their coverage). If I go anywhere else, I will have to pay out-of-pocket. That being said, should I be seeking a second opinion? If so, what kind of dentist/techniques should I be looking for?

3) The dentist did not give me ANY tips on how I could prevent further decay. DS just learned how to spit and can do it quite well. DO any of you use fluoride toothpaste with your toddlers? Is that even advisable?

Thanks so much for reading! This whole realm of dental care for toddlers is all new to me, and I'm not sure what I should be doing.

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Old 11-06-2009, 11:28 AM
 
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That's not the type of dental practice I would want to take my kids to. Both of my kids have needed cavities filled unfortunately. I've never had to deal with root canals with them so I don't know what's typical for that.

My dd had 4 cavities filled in her molars when she was 2 or 3. We went the laughing gas route. My dd has always been very compliant and stoic so she sat in the chair all by herself. I was in the room the whole time. She was such a trooper. She didn't flinch at all but I'm sure the gas had a big part in that.

DS had an enamel defect that led to a cavity needing to be filled when he was only around 15 months old. That didn't go as well, but he's always been much more dramatic. The dentist used a small amount of laughing gas on him and he was in my lap the whole time. He did scream, but he screamed before she even touched him.

I personally wouldn't let anyone strap my kids down and I would make sure they let you stay in the room. I also think the laughing gas makes a big difference personally.
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Old 11-06-2009, 12:46 PM
 
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I'd look for another dentist even if you have to pay out of pocket. Using a papoose board in that manner is a good way to start a huge fear of dentists in children.


I refuse to use one but I can see that there may be a need for one for certain children but the child would need to be properly sedated first, not just using novocaine and going for it. Look for other dentists, see what they are willing to do. I'm assuming that he is 2 maybe? It is going to be difficult to find someone that will fill those cavities without using general anesthesia or a papoose board. IMO dentists who do conscious sedation/nitrous oxide usually want the child to be a little older. Honestly with 4 teeth very affected, GA might be your best option even though it sounds so scary. He wouldn't remember anything and everything would be taken care of at once. Root canals are quite involved, though easier in children, I'm just throwing out maybe 30 minutes for the work you mentioned. COuld be less or more.


Can you travel to another town and find someone who takes your insurance? We traveled to get DD1's first round of dental work done. She had 4 cavities at age 3, we were barely able to do conscious sedation/nitrous in an office setting. For the next round she had 5 cavities including a root canal, and I almost did GA with her but she was older then (5) and we decided to try one just doing novocaine and she was able to sit by then and we ended up doing them that way. DD2 is 3 and goes in next month for obvious decay as well.

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Old 11-06-2009, 03:30 PM
 
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I am firmly against papoose boards. I was restrained in one at 4 yrs of age and still remember being terrified and screaming my head off.

My insurance has a special caveat that if thet do not have the specialist you need "in network" they have to pay for the out of network specialist. I would try calling your insurance and getting your ped to write a letter that you need a pediatric dentist for that work.

I would not get multiple root canals without something more than novocaine, so I would not expect my child to.

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Old 11-06-2009, 03:36 PM
 
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I have HMO dental so I also have to use a "chain dentist". When ds needed 4 crowns at age 4 I had my dentist request a pediatric referral. Because of his age and work needed the insurance gave me the referral to the pediatric dentist.

They gave him medication orally prior to the procedure that relaxed him, gave him laughing gas during the procedure, and novicaine to numb the site. He did very well.
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Old 11-06-2009, 03:40 PM
 
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I saw an investigative journalism report on one of those chain dentistry places that used the techniques you are talking about and also did some other horrible things, including not letting parents stay w/the children and Medicaid fraud. The show talked about the numerous complaints they had received around the country and also that they were sometimes the only place that would take Medicaid (or whatever other state insurance is called in every state). It was horrible.

My friend took her child to the same place as in the news show (before I saw the show) and was bullied into leaving her 3 yr old w/the dentist (she was strapped to the chair) for a teeth cleaning. She felt sick during and after and wished she would have done what you did.

You trusted your gut instinct and you did the right thing. Call around to see if there are ANY other places that take your insurance. In our town there is another kid focused place that is completely opposite of the bad one and they are really good. They also take Medicaid here.

Good luck finding an alternative and kudos to you again for protecting your little one.

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Old 11-06-2009, 03:54 PM - Thread Starter
 
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Thanks for your replies!

I have scheduled an appointment with a pediatric practice and will pay out-of-pocket for the consult and second opinion. I am hoping they will perhaps be able to stop the decay with less invasive treatments. If he does need the root canals, I plan on taking him to the regional university hospital and having his work done there under GA. I will have to pay out-of-pocket, but I think it's better than the board.

I looked up the covered benefits under my insurance, and oral sedation and nitrous are both covered. So if worse comes to worse and I can't get him into the university hospital (their children's dental clinic is booked solid until January) and have no choice but to use the board, then I will request sedation.

Does anyone have any insight on using a fluoride-based toothpaste at this point to help prevent further decay? DS is 2 1/2 and is able to spit (and does quite freely ).

"In the depth of winter, I finally learned that within me there lay an invincible summer"
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Old 11-06-2009, 04:08 PM
 
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I would do xylitol gum- we did ga with our 2.5 yr old. Way to pay attention to your mommy intuition!
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Old 11-06-2009, 04:18 PM
 
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I'ved used floride toothpaste (regular crest) on all my kids once they could spit. We've had some swallow incidents. I try not to worry.

Twin boys (2/05) and little sister (10/07)
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Old 11-06-2009, 10:10 PM
 
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I think this should have been over in dental, you have gotten a lot more info about alternatives to the treatment you described, you could still go over there and post, too!

My dd has had ECC since her first tooth came in, but with xylitol, MI paste and OZONE we have halted the deay and she can hopefully wait until these teeth fall out.
We have also drastically changed her diet to consist of mostly meat and green veg., protein and fat with CLO as a supplement and lots of KEFIR.

Good luck sorting this all out!
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Old 11-07-2009, 12:19 PM
 
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Many dentists do not believe in doing major work on front baby teeth. Our (not alternative in any way) ped dentist only does pulpotomies (baby root canals) on molars, and is very conservative in her treatment - you can "wait and see" what happens, most especially on front teeth, as long as you understand the signs of uncontained infection and the child is in no pain.

Most important, get thee straight to the sticky at the top of Dental - cavities are typically caused by nutritional deficiencies, especially in the fat-soluble vitamins and the minerals they enable us to utilize, and can be stopped or slowed long enough till the teeth are replaced by permanent teeth.

I've used the papoose board before, but only on a child who absolutely would not be still, even with me & a hygienist trying to hold him still, and he screamed no more with that than without it. I wouldn't use it as a first resort, and I absolutely wouldn't use it (or allow any medical/dental procedures whatsoever) without me being right there, comforting, soothing, and holding his hand. Sedation in a dental office is risky, btw, definitely look it up, and it doesn't always work to calm the child.

I'd run fast from that dentist - he's way too aggressive. I'm coming to the conclusion that I may have to drive up to an hour to get a good dentist - but it's worth it twice a year.
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Old 11-08-2009, 12:28 PM - Thread Starter
 
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I don't know when this was moved, but THANKS!

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Old 11-11-2009, 08:53 AM
 
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you can "wait and see" what happens, most especially on front teeth, as long as you understand the signs of uncontained infection and the child is in no pain.
Could I just hijack this for a minute?

What are the "signs of uncontained infection" in cases like this?

I also have a 2.5 year old with severe tooth decay as well, and I have been "waiting and seeing" since he was less than a year old (the first and only visit to the only ped dentist in this area did NOT go well, so I have just been waiting and treating with xylitol, nutritional changes, etc. since then).

But of course I worry, too....especially about infections. So if you could expand on the above a little, I'd be grateful
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Old 11-12-2009, 04:13 PM
 
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Pain, swelling, & redness are simple signs of infection. They can go away quickly with megadosing vitamin C (or other natural immune boosting methods), a return to an unprocessed/low-grain&sugar diet, and/or antibiotics. (The first two being means to aid the body in fighting the particular infection, the last being a means of obliterating nearly all bacteria in the body.)

An abscess is a sign of an infection that the body has decided needs to be contained, b/c it isn't succeeding in kicking it out. It is just a wall the body builds around the infection to contain it, and a hole in the gum is a sign that it is draining properly.

If the pain doesn't fade on its own, or abscess properly (a good abscess should no longer hurt), it should be watched carefully. Rapidly increasing pain, or (rapidly or not) spreading redness/swelling (such as to the cheeks), are signs of spreading infection. According to the author of Cure Tooth Decay (who is on this board sometimes!), his daughter had swollen cheeks and still they were able to stop the infection. At what point you quit using natural means to fight it and go for the antibiotic shot is up to your comfort level. My son had two abscesses that stayed painless for 2.5 years till they fell out, the one exception being on Thanksgiving once he had pain, but the pain was gone by time we found anyone open. His adult teeth came in strong & healthy, and the gums which once looked all bent from the yucky teeth now are beautiful.

Most dentists assume parents will take no responsibility for infection and so they say that as soon as infection appears, it must be rooted out. And even a cautious dentist who lets you wait-and-see will typically say that at the *first* sign of pain (in a tooth already abscessed), you should run to the pediatrician for an antibiotic shot, b/c the worst-case-scenario is an infection left unchecked until it reaches the brain. I think I'm closer to that in my personal comfort level than I am to treating even a swollen face naturally, but there are many places to be, and the key is being an informed parent who is watching, as well as listening to your gut feelings.

So the progression seems to be cavity -> pain/swelling/redness -> abscess -> pain -> spreading pain/swelling/redness, and the progression can usually be stopped or slowed at any point by returning to nourishing foods (that especially includes mama if she's breastfeeding, esp. if bf'ing a lot) & other means of boosting the immune system naturally, or it can be stopped by antibiotics/extraction/rootcanal.

I'd definitely check with your dentist to get his/her ideas and also read up to verify what I've said, lol. I'm not a dentist and I don't play one on TV and I didn't stay at a Holiday Inn last night.
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Old 11-13-2009, 03:51 AM
 
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Thank you so much for the detailed answer, that really helped.

I am surprised that it's actually possible to halt/push back an infection that already started.....up to now, I had always thought that I'd just "wait and see" until there were any obvious signs of infection/abscess or pain, and then rush to the dentist and have the rotten teeth removed.

My main concern was actually for him to get a little older before maybe having to have GA to remove the teeth.....when I first went to the dentist, he was only 11 months old, definitely much too young for something like that if it can be helped.

I have no idea what I'm going to do when there will develop an acute problem, whether to try to fight the infection or go for broke and have the teeth removed.....I guess I'll decide then....but for now, your posting was extremely helpful.

I actually do have the Cure tooth decay book, but haven't managed to read all of it yet.....I guess I should try to finish the second half as well, but my DS doesn't leave me much spare time for reading

Thanks again,

Charlie
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Old 11-13-2009, 12:42 PM
 
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I skipped right to the chapter on children's teeth, then went back and read some of the others, especially regarding my child's specific issues.

WRT infections, think of infections in any other part of the body. If you get an infected eyelid (I used to when I was bad about good contact lens hygiene), do you go straight for antibiotics? My eye doctor recommended washing thoroughly with a certain soap & water routine and getting strict on the lens hygiene, and it worked every time, until I learned how to prevent the whole issue. I've treated UTIs & mastitis with vitamin C megadosing (and it takes vigilance, you want to get it all, but always cleared up faster than antibiotics and now I've learned how to prevent both in the first place), and killed many colds & other upper respiratory infections w/i 24hrs w/ garlic & C. (And, with all infections, avoiding sugar.)

My son had a sore (bug bite?) on his leg (I didn't know till too late since it was under his pants on his thigh) that got infected & I took him to the ped since it looked bad. She said if it started to swell even more or pus (abscess), to give him the antibx she prescribed. It did, on the way home! I started pumping the vit C, and by time we got the Rx filled, etc., the swelling, pus, & pain were done.

Long story short, infections are neither unpreventable, nor untreatable. Antibiotics are the surefire, no-brainer way to kill 'em (well, when they work), so that's the route doctors take, but most will acknowledge, if pressed, that it's possible to take more natural means - after all, who hasn't had an infection somewhere before? Do we believe that all our ancestors died of the first infection they got?

It takes education and awareness, and the humility to know when you've done your best and need to get out the big guns, that's all.
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Old 11-13-2009, 06:31 PM
 
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It takes education and awareness, and the humility to know when you've done your best and need to get out the big guns, that's all.
That IS actually my problem....for a reason:
Until last February, I had a lot more confidence in my intuition. Then DS got what we (and the doctor) thought was a stomach bug.......a few days later, the doctor didn't like how he looked (I still thought it was harmless) and ordered blood tests....a couple of hours later, we were in the Ped ICU, he'd had an E.coli infection which had developed into a very rare syndrome (google HUS = hemolytic uremic syndrome...it's scary).

He's fine again now, but now I'm afraid to trust my instincts and tend to be overly cautious
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Old 11-14-2009, 12:44 PM
 
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s: In support of your intuition, you did take him back to the doctor, for whatever reason, whose expertise led him to give the test. You got him there, and he got the care he needed. There have been many times I've felt fairly certain something my kids had was within the realm of normal, but called the ped & talked briefly to a nurse to verify I didn't need to bring them in.

I'm sure that was quite scary to go through.
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Old 11-15-2009, 02:41 AM
 
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I'm sure that was quite scary to go through.
Yes, it was
Thank you for your support

And I guess now I'd better go and finish the cure tooth decay book
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Old 11-21-2009, 07:08 PM
 
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Thanks for this post! I am in the "wait and see" approach w/my 30mth old DD, she has severe ECC on her 4 top front teeth and her to way back top molars. I found the post on what to watch for very informative, thanks SOOO much! How do you get your 2 yr old to take Vit C? Is there a chewable form of good vit C or is it liquid? Thanks so much!!

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Old 11-22-2009, 01:48 PM
 
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I think they say chewable vit C is bad for tooth enamel; I haven't tried it so don't know much about it. I use Emergen-C sometimes (almost any grocery store, health store, & general store, like Wal-Mart or drug stores, carry it now; vitacost.com is a super affordable source) and SAP for acute infections.

Em-C has 1000mg C per packet, but also has some sweetener, so isn't my favorite way, but is very easy to get down most kids if you find a flavor they like. Mine love Super Orange, Tangerine, Pink Lemonade, & Lemon-Lime the best, and hate the berry flavors. They like it as a drink and they like to stir it into their unsweetened whole yogurt.

SAP is just a powder, and you should take it with bioflavonoids. I buy it from Bronson, and also their bioflavonoids tablets - you take one tablet with every 5000mg of SAP (which is a buffered vitamin C). For little ones, I crush the tablet in a mortar & pestle (simple & inexpensive, really pretty marble decor for the counter!), then mix the SAP w/ the powder & mix it all into a little OJ or cran & OJ, maybe watered down a bit. I think I've also mixed it into the yogurt with a packet of Em-C (Em-C has the biofl. already mixed in).

This is a very distilled version of things you can do with vit C, lol; there is a sodium ascorbate mega-thread somewhere on MDC that is FULL of info!

Megadosing means taking it until you get loose bowels (b/c it's water-soluble, you just excrete any excess). I give a little one 2-3gm (2000-3000mg) the first hour, then 2-3gm more every 2-3hrs until we reach "bubbly tummy" stage, then hold steady or slightly back off the amount for the next dose.
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Old 11-30-2009, 02:44 AM
 
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Thanks for this post! I am in the "wait and see" approach w/my 30mth old DD, she has severe ECC on her 4 top front teeth and her to way back top molars. I found the post on what to watch for very informative, thanks SOOO much! How do you get your 2 yr old to take Vit C? Is there a chewable form of good vit C or is it liquid? Thanks so much!!
what is ECC?

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Old 12-01-2009, 04:06 PM
 
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I didn't get a chance to read through all of the replies so I hope I am not repeating too much, I just wanted to share a few thoughts since my I had a similar experience.

I think it is pretty crazy that dentists act so casual about strapping down a kid for dental work. There is so much that the 2 yo will be freaked out by because they don't understand. When I asked about the office sedation offered at my dentist office they explained that the child somehow won't remember even though they will likely scream and struggle throughout the procedure. My dentist that I finally settled on actually said that she thought it was unethical to perform in office procedures on kids 3 and under because the risk of complication from the sedation, injury from the child's struggle, and poor quality/incomplete work is too high. I would totally seek out a second opinion. I had a similar situation where the dentists covered under our insurance plan were part of a chain, but that meant that we had several offices within an hour or so from home that we could choose from and each office housed different dentists. You can still run into blanket protocol issues I suppose, but we actually ended up finding a good fit for us just by trying out the different offices.

I would make it a point to ask the dentist what kind of timeline you are under because you may be able to delay the work being done with some home treatments or it may be accelerated decay in which case you could be saving your child from having extractions by doing simple fillings sooner. In our situation waiting was not beneficial beyond us finding the dentist we liked. My son went from having minor decay on the front four and some in the back to having serious decay within a matter of six months. I think it is good to be choosy but aggressive in dental treatments with toddlers.
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Old 12-02-2009, 08:07 AM
 
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I think it is pretty crazy that dentists act so casual about strapping down a kid for dental work. There is so much that the 2 yo will be freaked out by because they don't understand. When I asked about the office sedation offered at my dentist office they explained that the child somehow won't remember even though they will likely scream and struggle throughout the procedure.
My dentist said pretty much the same thing today. They usually let the parents help hold the kid down, but he said "we also have a board to help if necessary" (which I told him I didn't like )
He also said that due to the drugs he uses for "conscious sedation", the kids won't remember at all afterwards. But it's hard for me to believe that struggling for an hour won't traumatize them in some way

He said he'd still prefer in office sedation to general anesthesia in the hospital since there are fewer risks involved.....and I don't know what to think or to decide
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Old 12-02-2009, 11:30 AM
 
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He said he'd still prefer in office sedation to general anesthesia in the hospital since there are fewer risks involved.....and I don't know what to think or to decide
This is SO hard. With our situation my son needed pretty extensive work to be done, four extractions, four pulpectomies with crowns, etc. and he fights SO hard that we couldn't even get really complete x-rays in the office so we ended up going with general. Hardest decision/experience of my life without a doubt. I totally sympathize with your struggle s
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Old 12-02-2009, 09:55 PM
 
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we couldn't even get really complete x-rays in the office so we ended up going with general. Hardest decision/experience of my life without a doubt. I totally sympathize with your struggle s
We couldn't get xrays either...but then, they were ok with that....they said, they didn't really expect a kid his age to cooperate with xrays

The dentist feels completely confident that he'll be able to get the work done by using conscious sedation......but I still don't know what to do

I really don't like the idea of restraining him, especially for that long, but on the other hand, shouldn't I choose that method just because it has a slightly lower risk of complications....?

I know what you mean about hard decisions
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Old 01-13-2010, 04:36 PM
 
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we have a similar situation here. the dentist is recommending GA rather than sedation and strapping down for my 2.5 year old, he has 8 cavities, one in each molar. the dentist doesn't think she can do it in office as my son wasn't cooperative today when she just tried to do an exam. any advice?

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Old 01-23-2010, 05:25 AM
 
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No REAL advice, just an update to my thoughts from before Christmas:

I have done some more research and found out that there are not so little risks involved with in-office conscious sedation as well, especially when a combination of drugs is used. Also, since our son has to have quite some work done, I don't even know if the sedation would last long enough. And my Ds is not very cooperative either.

So I'm almost to the point where I think that having GA in a hospital setting is safer than conscious sedation in an office setting, due to the monitoring and emergency response possibilities, even if GA in general has bigger risks than sedation.

I would like to talk to the dentist again to get a few last questions answered, and - even though this is not really the deciding factor - I would like to get an estimate for the costs for doing the GA in a hospital. We don't have dental insurance, and the estimate for the in-office treatment is 3000$. I read somewhere on here that somene else was quoted 20,000 $ for the GA procedure in a hospital and sincerely hope that that's untrue

But all in all, it looks like we will be going the GA route.
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Old 01-23-2010, 07:03 PM
 
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We had our medical insurance cover all of the hospital costs and worked seperately for the dental for what the dentist did specifically. In other words, the room, GA, nurses, recovery was medical but the fillings, crowns, etc came under dental. Without dental coverage it was $4000 for us.
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Old 01-26-2010, 05:22 AM
 
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$4000 isn't too bad, that would only be $1000 more than the in-office sedation. Thanks for letting me know...I checked our insurance policy, and they do cover the general anaesthesia costs (same as with you, not dental fees, just the hospital stuff), but only IF the patient is under 7 (which he is) AND if he "can't be treated effectively and safely" in the dentist's office.

Since the dentist recommended the in-office sedation, the latter might be difficult to prove...I guess I'll really have to talk to him again
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