*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.