General Anesthesia for DD3 cavities?

[linzjane88]

Heres the situation:

DD3 acts like any form of dental work/toothbrushing is barbaric torture. She has always gone with DD8 to cleanings and but refused to let anyone near her mouth. She finally (after an hour of bribery and soul selling on our part) let the dentist look in her mouth on the checkup this week and he found four cavities. (And the worst mother of the year award goes to.....) They gave the option of filling them one at a time (they are on different areas of her teeth) or giving her a general and doing it all at once. He was semi-pushing for that option because of her dentist-related hysteria. I mean the kid only started letting me use toothpaste within the last month--if it involves anyone coming near her mouth....no dice!

Initially the RN in me was ok with the general idea and we scheduled the 'surgery for this Friday. Knock her out and take care of what needs done. These are pediatric dental professionals here. Then the RN in me started freaking out a little. They said their normal process is to give an inhalant type anesthetic, then intubate with a nasotracheal tube, then start her IV. In my line of work (L&D) we would never consider anesthesia before having IV access established. I get not wanting the little one to feel a poke but that's just so far out of my comfort zone. They said the recovery period is just a few minutes and then we take her home as they tend to get wild when coming out of anesthesia. I get that but, again, where I work when we have someone coming out of anesthesia we are monitoring constantly during that time. Granted, cavity fillings are not the same as a C-Section but general anesthesia is general anesthesia.

I started thinking about all the other what if's (cough...malignant hyperthermia) and I am getting worked up an anxious--wondering if this is even necessary? What about just waiting a few months or longer and seeing if she is more agreeable to dental work as she ages a bit? I think having that last visit where she let them do a cleaning and an exam was a game changer- she saw there was nothing to be afraid of and did okay once they started.

Should I get a second opinion? It isn't a money thing but JUST the anesthesia is $900 for this procedure. I also talked with a friend who said one of her acquaintances stopped working for this dentist because of the unnecessary procedures they pushed on people to bring in the $$$, specifically pushing for the surgery route. Maybe I should just get it done and stop working myself up about it.

I don't know if I need advice, to vent, or a hug. My baby is too little for anesthesia and I feel like its my fault we are in this boat

 

[sonnyjane]

Normally I wouldn't be paranoid but there have been a few fairly high profile deaths/medical emergencies related to young kids being put under for dental procedures as of late which would make me take at least enough pause to get another opinion.

 

[lifesavacation]

As someone with a family history of malignant hyperthermia, I am so extremely cautious when it comes to general anesthesia for myself and my kids.

I wouldn't rush this decision and would get a second opinion.

 

[Shanti]

Heres the situation:

DD3 acts like any form of dental work/toothbrushing is barbaric torture. She has always gone with DD8 to cleanings and but refused to let anyone near her mouth. She finally (after an hour of bribery and soul selling on our part) let the dentist look in her mouth on the checkup this week and he found four cavities. (And the worst mother of the year award goes to.....) They gave the option of filling them one at a time (they are on different areas of her teeth) or giving her a general and doing it all at once. He was semi-pushing for that option because of her dentist-related hysteria. I mean the kid only started letting me use toothpaste within the last month--if it involves anyone coming near her mouth....no dice!

Initially the RN in me was ok with the general idea and we scheduled the 'surgery for this Friday. Knock her out and take care of what needs done. These are pediatric dental professionals here. Then the RN in me started freaking out a little. They said their normal process is to give an inhalant type anesthetic, then intubate with a nasotracheal tube, then start her IV. In my line of work (L&D) we would never consider anesthesia before having IV access established. I get not wanting the little one to feel a poke but that's just so far out of my comfort zone. They said the recovery period is just a few minutes and then we take her home as they tend to get wild when coming out of anesthesia. I get that but, again, where I work when we have someone coming out of anesthesia we are monitoring constantly during that time. Granted, cavity fillings are not the same as a C-Section but general anesthesia is general anesthesia.

I started thinking about all the other what if's (cough...malignant hyperthermia) and I am getting worked up an anxious--wondering if this is even necessary? What about just waiting a few months or longer and seeing if she is more agreeable to dental work as she ages a bit? I think having that last visit where she let them do a cleaning and an exam was a game changer- she saw there was nothing to be afraid of and did okay once they started.

Should I get a second opinion? It isn't a money thing but JUST the anesthesia is $900 for this procedure. I also talked with a friend who said one of her acquaintances stopped working for this dentist because of the unnecessary procedures they pushed on people to bring in the $$$, specifically pushing for the surgery route. Maybe I should just get it done and stop working myself up about it.

I don't know if I need advice, to vent, or a hug. My baby is too little for anesthesia and I feel like its my fault we are in this boat

I would definitely get a second opinion if they think general anesthesia is the best they can do in this case. My anxious, autistic son had to have a tooth pulled, and they started by giving him a sedative in the waiting room. That made him calm and wobbly (he walked like a drunk, but was fully conscious), then they took him (with me) to the dental work room to use laughing gas and (without him knowing) give him the Novocaine shot. They gave him movie glasses upon his arrival in the dental work room, so he watched a cartoon during all of this and thought the procedure hadn't even started when it was actually over.

Dentists are notorious for pushing excess treatments- even my own dentist (not my son's) has done this a bit lately, to where I'm looking for a replacement. I imagine that declining insurance reimbursements are triggering an increase in this problem.

Regardless, I would NEVER put my small child under general anesthesia for a dental procedure. It's too risky, and there are too many other options. Also, be sure to be in the room during any significant dental procedure (such as fillings, anything involving any kind of sedation, etc.) A dentist telling you that you must wait in the waiting room while that happens to your child is a dentist to be avoided. The incidents with children harmed by dentists during procedures all had rules against parents being in the dental work room, so the parents weren't privy to what was really going on.

 

[AK_Christina]

I would try it first with laughing gas. My daughter had some work done - albeit older than your DD - and the gas was enough to keep her calm. That said, the dentist turned it off before she was done and my DD definitely felt the difference and got really anxious again and crying. I do believe that if the gas was simply left on until they were done than she would have handled it like a champ. I may or may not have bribed her with a toy afterwards too.

 

[katie01]

Normally I wouldn't be paranoid but there have been a few fairly high profile deaths/medical emergencies related to young kids being put under for dental procedures as of late which would make me take at least enough pause to get another opinion.

This is exactly what I was thinking. At the very least, I would get that second opinion.

I don't know how big of an area you live in, but I'd also shop around for a pediatric dentist who specializes in treating anxious kids. When DS was little he was anxious and had a lot of sensory issues, so his first dental visit we took him to a pediatric dentist who advertised being able to work with kids with autism and special needs. Our DS doesn't have autism, but some of his sensory issues were similar to those of a child with autism. They were just so fabulous with him and out him right at ease. Eventually we switched over to a regular dentist as this office was kind if far, but they had just given him such a gentle and peaceful introduction to having his teeth cleaned, that he wasn't anxious about going to another dentist.

 

[DebbieB]

http://www.people.com/article/baby-...dure-expert?xid=socialflow_facebook_peoplemag

I would definitely get a second opinion plus be sure the dentist is qualified for anesthesia, does he have an anesthesiologist available? I had a colonoscopy with propofol yesterday, there was an anesthesiologist and a nurse anestecist present and that wasn't even general anesthesia.

 

[CaoilinnsMom]

I allowed my daughter to go under general at 4 to have a root canal and a crown. I had it done in a pediatric outpatient surgical center with a qualified anesthesiologist and a really good pediatric dentist. The reason I agreed to this was her age and her resistance to treatment. I would not have done it in the dentists office, because if there was an issue they would have to rush her to an emergency room. I was not willing to take that chance. The whole thing was billed at over 13,000 dollars, so be prepared for that. The in office option was much cheaper, but once again I was not willing to take the chance. Thank goodness I had good insurance. My daughter has since had several teeth pulled and tolerated it with local and gas. If you think you can do it, try and see if she will do it that way. I would not trust general in a dentist office.

 

[lpereira]

No. To any non necessary general anesthesia. Is thedentist and his staff PALS certified? Does he have actual registered nurses on duty? Will there be someone in the room certified with anesthesia whose ONLY job would be to monitor your 3 year olds vital signs? Crash cart on hand and stocked with nonexpired drugs? You get my drift.

 

[linzjane88]

Thanks for the replies. You all reinforced what my gut was telling me, that we might be able to find a better solution. The thing that made me more unformftable was that their dental office is in a strip mall type building with other businesses. The dental office is decked out. I mean they have put a TON of money into waiting room activities, toys, books, Ipads, etc fo the kids to use while they are there. Everything is top of the line. The office where the surgery is performed is in the same complex but a few offices down. It is furnished with what looks like old leftovers with a couple of old toys in the corner on the floor. I caught a glimpse of what I assume was a recovery/ pre procedure room and it had a super old hospital bed in a pretty empty room. Again, my nurse brain started wondering where the O2 was, if they have suction available, LOL. But really, a general is a big deal and you have to be prepared for anything. Its hard to explain the reasoning behind my uneasy feeling it but it was just a huge discrepency between the two places.

The more I type the more I am convincing myself. Posting was a good idea.

 

[linzjane88]

No. To any non necessary general anesthesia. Is thedentist and his staff PALS certified? Does he have actual registered nurses on duty? Will there be someone in the room certified with anesthesia whose ONLY job would be to monitor your 3 year olds vital signs? Crash cart on hand and stocked with nonexpired drugs? You get my drift.

EXACTLY the nagging thoughts I have. I do know they have a dedicated anesthesiologist but they didn't discuss other staff. I assume no RN as I have never seen one and it wasnt brought up. The way the secretary made it sound was that they line their appointments up for certain days only (based on anesthesiologist availability) and do a couple of procedures then. The building where surgery is done has one secretary for arranging the appointments but is otherwise without staff unless they come over from the main building for a procedure. I should have asked these questions then but, honestly, I was focusing on both not being one of "those" people (ya know--in the medical field so they grill everyone about everything--sounds like you know the type ) and not crying (felt guilty). Now is when I am starting to think of all of this stuff.

 

[Christine]

Nope, I'd be using Xanax or something well before I got to that point.

 

[Kenny1113]

No. To any non necessary general anesthesia. Is thedentist and his staff PALS certified? Does he have actual registered nurses on duty? Will there be someone in the room certified with anesthesia whose ONLY job would be to monitor your 3 year olds vital signs? Crash cart on hand and stocked with nonexpired drugs? You get my drift.

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.

 

[Magpie]

In my neck of the woods (Ontario, Canada), if a young child needs to be anethetized for a dental procedure, it's done at the local hospital with proper equipment and procedures. I would never agree to have it done at a dental clinic. So I vote for a second opinion, too.

Btw, my son, due to having congenitally malformed enamel and baby teeth that were rotting before they even erupted through his gums, had to have porceleine caps put on his teeth when he was two. This was done at a pediatric hospital.

And don't ever worry about being one of "those" people. This is your child - you are absolutely justified in using every bit of your knowledge and experience to protect him.

 

[aaarcher86]

I'd definitely be figuring something out to get the cavities taken care of so they don't get any worse. BUT, general anesthetic would be my absolute last solution, even for a 30 year old. I just don't like it the idea, aside from all the possibilities.

 

[DopeyDame]

Another vote for no.
DS sounds just like your son when he was little. (He's 7 now) He had to have a bunch of work done when he was 3.5 and, as his dentist said, he was "not yet compliant" at the time.
She offered us general anesthesia or "twilight" sedation. She was definitely pushing the general anesthesia, but it would have been done in a surgical center (not a full-up hospital, but more than the regular dentist office)
We went with the twilight sedation instead. I'm really happy we did that. It sounds like the exact method that Shanti talked about above. They gave him some medicine to make him woozy/drunk/compliant and then used the laughing gas and local anesthesia. It worked really well and without the risk associated with being put under.

 

[mnrose]

I'd definitely be figuring something out to get the cavities taken care of so they don't get any worse. BUT, general anesthetic would be my absolute last solution, even for a 30 year old. I just don't like it the idea, aside from all the possibilities.

Completely agree. General just seems like overkill when something like a small dose of ativan and laughing gas will achieve the same affect with much less risk.

I won't do general myself unless absolutely necessary. I'll do spinal blocks etc before general all day and all night, even for major surgery. LOL.

 

[HM]

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.

 

[Turn the Page]

I will just throw this out there. DD5 has had to do it both ways. When she was 3 1/2 she had to be put under to have 11 cavities filled. 11. It was ridiculous. Apparently no one told DH or her biological mom that it isn't a good idea to give a 3 year old pop in a bottle all the time. But I digress. The dental problems continued and a year ago she complained of tooth pain. It turned out she had an abscessed tooth and a few more cavities and the pediatric dentist recommended caps on most of her molars in an attempt to keep them in her mouth until it was time for them to fall out.

We had to take her to four separate appointments for all that work and it was hell. At the third appointment she decided that was it, she wasn't doing it anymore, and she just screamed, and I mean SCREAMED, through the entire process. I nearly had to sit on her to keep her in the chair. It was at that point that I refused to take her to the lat one and made her mother take her.

If I had it to do over again we absolutely would have taken her to the hospital to have it all done at once again. That is really a decision each parent needs to make for themselves. Of course, you want to make sure they are following proper procedure and all safety/emergency protocols are in place and all that and if another solution presents itself then great but I wouldn't want to try and take my child there four separate times again. If they can do it all at once that is what I would go with.

 

[elaine amj]

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.