General Anesthesia for DD3 cavities?

[linzjane88]

This. Do they have enough dantrolene
Or rayondex in the event of MH.
Like pp have said I would not do general anesthesia in a dentists office.

To answer one of your questions yes that is typical that they give a little inhalant before starting an iv-so they child doesn't have to suffer through the stick. I have yet to see this go badly (knock on wood).
To put it in perspective DS received inhalant at the dentist and never got an iv.

LOL, every time I see you post on the Dis it always confuses me for a second because we have similar avatar pictures. 'I don't remember saying that' always goes through my head before I realize.

I am researching more dentists outside of our town right now and I am confident we can find a happy medium in getting her teeth fixed without the need for general. If that was neccessary they perform their general procedures at the pediatric hospitals in the area. I am sure the original dentists have few complications that arise from their procedures but from what I saw in the office it didn't feel like a setting I would be comfortable with. Reading other dentists websites it seems they are willing to use medications to calm them before we get to the appointment. I would much rather try that first!

Interesting to see it can be common to place the IV after sedation is initiated. I get the reasoning, it is just so opposite of what I am used to that it feels scary. In my world no patient would go near the OR without IV access. Then again things are done a little differently when your patient has another patient shoved inside them (pregnant mommas) .

 

[linzjane88]

It's a tough call and I agree absolutely with a 2nd opinion.

DD did have hers done when she was 3/4 yrs old and I didn't really question it too much. We had gone to our regular dentist for xrays and she flipped about the XRays. They couldn't manage to do it and advised us to go to a pediatric dentist. At the pediatric dentist, they were able to do xrays of 3 sections of her mouth, but despite THREE people working with her, she flipped and they absolutely could not get the 4th xray. The dentist found NINE cavities and recommended general anesthesia. He said to do it the normal way would require 4 separate visits and it would be too traumatic for her.

We went with it - everything other than some co-pays were covered by insurance. We didn't question where or how (thinking back, we should have lol) but it was done at the local hospital (thankfully!). I hated the thought of putting her under, but the NINE cavities scared us. Everything went smoothly and all her cavities were filled (they were mostly in between her teeth). They also got that 4th xray LOL. The dentists then said that she would likely always have horrible teeth. She is now 14, doesn't need braces as yet, and has had no more than your usual 1 or two cavities here and there.

We are now with a new dentist who doesn't like excessive dental work and is very good about discussing costs and options. We came here because our previous dentist recommend my son get braces. We decided to get a 2nd opinion and this dentist said it was unnecessary and he works with his teeth in less invasive ways instead.

Anyway - I'm still dubious about the positive effect of all this excessive dental work on toddlers and their baby teeth. It just seems a little crazy but I admit I know very little nor have I done much research into it.

I do feel like unneccessary dental work is pushed in general. I also find it odd that dental offices oftentimes are decked out with the newest gadgets and inventions. It just feels like alot of money is thrown around and it's hard to prove whether or not these procedures are necessary (in general, not necessarily with DD3). My view of dentists is similar to a mechanic. You have to have full trust that what they recommend is really needed.

 

[Turn the Page]

I do feel like unneccessary dental work is pushed in general. I also find it odd that dental offices oftentimes are decked out with the newest gadgets and inventions. It just feels like alot of money is thrown around and it's hard to prove whether or not these procedures are necessary (in general, not necessarily with DD3). My view of dentists is similar to a mechanic. You have to have full trust that what they recommend is really needed.

I agree that some dentists recommend dental work that isn't really necessary. A lot of medical professionals can be that way. However, in the case of cavities, you want to get them fixed sooner rather than later. If one of them gets to the point that it goes all the way through the enamel and dentin to the pulp you're looking at a much bigger problem than a simple cavity. I have had an abscess before and it is no fun. At that point you're looking at a course of antibiotics and a root canal at a minimum. Abscessed teeth can actually be fatal.

Whether to get them fixed or not may also depend on how far away that tooth is to coming out. If the xrays show it should come out in the next 6 months and the cavity is in early stages then sure, there may be no need to fix it. But if not, don't wait. These things do not get better on their own.

 

[mefordis]

I would never ever ever put my kids through general for dental work. Never in a million years. So many complications and risks for even adults, for kids it is just so dangerous. I would run from any health professional who even recommended it.

 

[mom2grace]

We had a slightly different situation when DD was about that age. She was very small for her age and the dentist didn't even want to use nitrous without an airway.

So we had the work done with our dentist at a outpatient surgery center. It went very well. It was the best of both worlds and maybe a solution.

I would also lean toward something to relaxing instead of anesthesia.

 

[linzjane88]

My goodness- trying to find someone that does any form of oral sedation is a challenge! I have called about 5 places so far today. Almost all want to do in-office general anethesia. I found one that performs the procedure at the hospital at least but then noticed he has terrible reviews so that one is a no-go. If we did have to go general I would prefer it be done in a hospital setting (that's also the only way my medical insurance will cover the anesthesia).

 

[rwdavis2]

My wife, a nurse anesthetist would never allow of our family to get any kind of anesthesia in a dentist's office. In our town we had a very high profile death in a dentist's office even with an anesthesiologist present. Our kids wisdom teeth were pulled in the hospital's outpatient surgery center.
Even with a trained anesthesia provider it's dangerous as they may not have resuscitation equipment in the office. Your RN instincts served you well.

 

[rwdavis2]

My son was reluctant as a small child to let the dentist in his mouth and they had a hard time getting in. They gave him a prescription to take before the appointments that relaxed him. It really helped. And when he needed fillings, they only had to use some "laughing gas" beyond that. I would not have agreed to general anethesia if they'd wanted to do that.

"Laughing gas" is a general anesthetic in low doses to prevent full unconsciousness. Over do it and the patient stops breathing.

 

[Turn the Page]

My goodness- trying to find someone that does any form of oral sedation is a challenge! I have called about 5 places so far today. Almost all want to do in-office general anethesia. I found one that performs the procedure at the hospital at least but then noticed he has terrible reviews so that one is a no-go. If we did have to go general I would prefer it be done in a hospital setting (that's also the only way my medical insurance will cover the anesthesia).

Good lord, general anesthesia in the dentists office?!?!?! I must have misunderstood your OP. I thought the dentist wanted to do general anesthesia in the hospital. That is what we did with DD5. Actually, I guess I never heard for sure if she was put all the way under or just really heavily sedated but either way, it was done in the hospital. I think in an actual OR. I would not hesitate to do that again and wish we could have done it for this last round of work.

No way would I do that in a dentists office.

 

[linzjane88]

Good lord, general anesthesia in the dentists office?!?!?! I must have misunderstood your OP. I thought the dentist wanted to do general anesthesia in the hospital. That is what we did with DD5. Actually, I guess I never heard for sure if she was put all the way under or just really heavily sedated but either way, it was done in the hospital. I think in an actual OR. I would not hesitate to do that again and wish we could have done it for this last round of work.

No way would I do that in a dentists office.

Yep- everyone wants to do the general in their office. One place I called said they only do their procedures in hospital if the child is medically fragile. There is one promising dental office (good reviews, offers oral sedation) but they can't get her in until June. This is way more challenging than I anticipated.

 

[linzjane88]

"Laughing gas" is a general anesthetic in low doses to prevent full unconsciousness. Over do it and the patient stops breathing.

I think I am going to need some nitrous by the end of this process

 

[rwdavis2]

Yep- everyone wants to do the general in their office. One place I called said they only do their procedures in hospital if the child is medically fragile. There is one promising dental office (good reviews, offers oral sedation) but they can't get her in until June. This is way more challenging than I anticipated.

Anesthesia reimbursement pays very well. And if you don't have insurance you have to pay the full rate not the negotiated down rate for the insurance company. In some cases the anesthesia bill is higher than the dental one.

 

[linzjane88]

Anesthesia reimbursement pays very well. And if you don't have insurance you have to pay the full rate not the negotiated down rate for the insurance company. In some cases the anesthesia bill is higher than the dental one.

Our dental will cover nothing sedation wise-not even nitrous. They strictly will cover the cavities being filled. In Washington state the medical will cover the anesthesia portion and the facility cost of dental work in an approved location (I.E. in a hospital they contract with but not anesthesia in a dental office) as long as the child is under 7. Trying to find someone who fits that bill is like trying to find a unicorn.

The out of pocket anesthesia charges for the 'in dental office' general range from 675-900$. I don't even care about the money, my main concern is taking care of what needs done without going over board and without a traumatic experience. I think I am giving up on this search for the day. My brain is throbbing and I feel like I have accomplished nothing. Our medical insurance wouldn't even talk to me because I am not on the medical plan that my DH and our girls are on . Alright, I guess I will have DD3 call when she wakes up from her nap

 

[Kitty 34]

My youngest was deathly afraid of haircuts but we would never have knocked him out to get his cut......maybe cavities are a bit different!!

 

[wvjules]

My youngest was deathly afraid of haircuts but we would never have knocked him out to get his cut......maybe cavities are a bit different!!

You can't be serious. Of course cavities are a bit different.

 

[ravenclawtrekkie]

I was put under general anesthesia for dental work several times as a child because of severe anxiety. I even needed nitrous just for cleanings until I was in my early teens. I 'graduated' to just IV sedation as I got older, and now I can manage with just nitrous for most procedures. Sometimes I take a Valium beforehand.

As far as I can remember, the general was always done in a dentist's office, and the only time I ever had an IV put in for it while I was awake was for getting my wisdom teeth out when I was 15. (That was an ordeal all its own, though.)

 

[Kenny1113]

LOL, every time I see you post on the Dis it always confuses me for a second because we have similar avatar pictures. 'I don't remember saying that' always goes through my head before I realize.

Interesting to see it can be common to place the IV after sedation is initiated. I get the reasoning, it is just so opposite of what I am used to that it feels scary. In my world no patient would go near the OR without IV access. Then again things are done a little differently when your patient has another patient shoved inside them (pregnant mommas) .

LOL!



yes, it did take some getting used to the first couple of times. Like you said , it goes against everything your used to.

 

[DLgal]

OP, I think a bigger issue is your child's oral sensitivity and guarding behavior. Is she a picky eater? She may have a sensory disorder causing her to be orally defensive. Obviously oral hygeine is really important and if she has such a problem just letting you brush hed teeth, something might be up.

I have a child with autism with extreme oral oversensitivity. The dentist visits have been a long, slow process. I recommend you find a dentist with experience working with special needs children, as they are often much better at dealing with kids with oral defensiveness and have lots of techniques and tricks they use to make kids comfortable. My son was born with an extra tooth (a mesiodent) right in his front upper gums. Right when he lost the baby tooth, it started growing in. It is not a normal tooth, and his adult tooth was right above it. So, it had to be pulled. He was 5 years old at the time and had barely gotten to the point where he was able to tolerate X Rays. We weighed all the options, including a papoose board, general anesthesia, and nitrous. I ended up just choosing nitrous and hoping for the best. Because of how wonderful the dentist was, and how quickly she worked, it ended up being no big deal. I was sweating it out BIG time, but in the end, my son handled it way better than I expected. Bribe her HEAVILY (my son got a game boy out of his procedure).

I recommend finding a dentist used to working with difficult patients, then using nitrous and doing them all at once. I would only recommend nitrous if your child is really good at following directions, though, since they do have to take breaths in a certain way as directed.

 

[mom2rtk]

Yep- everyone wants to do the general in their office. One place I called said they only do their procedures in hospital if the child is medically fragile. There is one promising dental office (good reviews, offers oral sedation) but they can't get her in until June. This is way more challenging than I anticipated.

I understand the desire to get it behind you, but June really isn't that far away. I doubt it would hurt to wait.

I really feel for you. My kids had lots of work done when they were little. We used a pediatric dentist who used oral sedation and nitrous and it really helped a lot.

Just another thought. My daughter (15) had a cavity filled recently and they used a laser instead of Novocain. Would that help at all or will she just not let anyone in there at all?

Those early trips to the dentist are really a bad memory for me.

 

[linzjane88]

I understand the desire to get it behind you, but June really isn't that far away. I doubt it would hurt to wait.

I really feel for you. My kids had lots of work done when they were little. We used a pediatric dentist who used oral sedation and nitrous and it really helped a lot.

Just another thought. My daughter (15) had a cavity filled recently and they used a laser instead of Novocain. Would that help at all or will she just not let anyone in there at all?

Those early trips to the dentist are really a bad memory for me.

See, thats the thing. I am not sure how she will actually do because she had never let them examine her until this last visit. It took about an hour (DD8 was getting her exam done and we were watching while I tried talking her into it) to convince her and get her to calm down. Once she got in the chair though she was pretty compliant and agreeable to everything. I think we made huge progress getting that first exam/cleaning done so I think if she went another time or two (doing a simple exam) we might get away with them actually doing some work on her. Then again we could also revert back to the crying/screaming/refusing to get into the chair behavior. Kids are unpredictable.