General Anesthesia for DD3 cavities?

[linzjane88]

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.

Honestly she is the most adventerous eating kid I know! LOL. She just gets very hysterical when it comes to dentists or doctors visits. I can't blame her too much because I want to react in about the same way at the dentist office I guess. One of her big things with letting me brush her teeth is the toothpaste. She hates it and we have tried every brand a flavor under the sun.

 

[mom2rtk]

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.

I really hope you find someone who can work with her. I like the previous suggestions of finding someone who works with kids with special needs.

I will say that you should definitely keep looking. You should trust your instincts when it feels wrong. Her teeth aren't going to fall out while you're evaluating options and setting up other appointments.

Our first dental office laid a huge guilt trip on me and scared my kids. We left and never returned. I took some time after that to find a better practice.

 

[Lisa loves Pooh]

I agree no to general.

As far as the cavities, don't beat yourself up. Even with very cooperative and meticulous teeth brushing, some people are just predisposed to having cavities. I have one child that almost always has a cavity.

 

[Feralpeg]

She's three. If the cavities are not bothering her, why not wait? She will lose the teeth eventually. If they start to bother her, then she will need to have something done, but small cavities many not cause her any issues.

 

[Kitty 34]

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

That's why the winked smile emoji.

 

[littleblackegg]

Since you know that we give sedation and anesthesia based on protocols, perhaps you could research the various sedation protocols for pediatric dentistry. I think if you know exactly what meds they are using and the researched protocols for this care, you will likely be more comfortable. Remember that general anesthesia requires total ventilatory and cardiovascular support. If they do not require all the monitoring and support equipment, they are likely using a deep sedation with something like propofol. Review the definitions of the various levels of anesthesia on the ASA website. As an RN, you know that there are no black-and-whites. Nothing is ever all terrible or all good. Your background and experience can be your guide. I think this will be 100% OK.

 

[lvillotta1]

We have an amazing pediatric dentist. If my child needed extensive dental work it would be under general anesthesia at a hospital. He does surgeries twice a week at one of our smaller hospitals. General anesthesia is very safe and I have no concerns that my child would do great. When my DD was 3 she adenoids and sinus roto rooted under gen and she did fine. The nice thing is that she will never remember. I am also an RN too.

 

[littleblackegg]

This is an excellent article from the Washington Post, about a mom's experience with exactly the same thinghttps://www.washingtonpost.com/national/health-science/my-baby-has-cavities-in-her-baby-teeth-does-that-make-me-a-bad-mother/2015/05/11/6245cc6e-da2f-11e4-8103-fa84725dbf9d_story.html.

 

[CaoilinnsMom]

She's three. If the cavities are not bothering her, why not wait? She will lose the teeth eventually. If they start to bother her, then she will need to have something done, but small cavities many not cause her any issues.

By the time they start to bother she might need a root canal or worse she could lose the tooth, I would not wait. You may not think it is a big deal but if a really infected tooth is in contact with another tooth it can cause that one to become infected too. If children loose their teeth at a young age, they lose their "place holders" for the adult teeth. It is is a bigger deal than you implied in your post, it could even cause a children to have braces because all the teeth shift into the open spaces left by the lost teeth and when the adult ones come in there is no space.

 

[anniemae]

I'm wondering if it would be better to try one at a time with laughing gas. Maybe it would be enough to calm her down. Filling the cavity is very quick, what takes so long for pediatric dentists is calming the child, talking to the child, explaining everything etc. which a pediatric dentist should be used to. My kids dentist takes time to explain what she is doing and lets them watch a video.

I agree that I would rather have them all done at once, but maybe one at a time is the way to go. I would try that first. Then if the first one gets done and DD is okay, she can continue filling, or stop and come back to do another one.

 

[The Mystery Machine]

No way in hell. Trust your gut mom.

 

[linzjane88]

I'm wondering if it would be better to try one at a time with laughing gas. Maybe it would be enough to calm her down. Filling the cavity is very quick, what takes so long for pediatric dentists is calming the child, talking to the child, explaining everything etc. which a pediatric dentist should be used to. My kids dentist takes time to explain what she is doing and lets them watch a video.

I agree that I would rather have them all done at once, but maybe one at a time is the way to go. I would try that first. Then if the first one gets done and DD is okay, she can continue filling, or stop and come back to do another one.

Yeah I think that is the route we want to try first. I am going to keep her appointment with the new place in June and if all goes well just have work done there. Hopefully we can get by with a little nitrous and be fine. I think the next exam will be the deciding factor. If she reverts back to 'not opening my mouth for the dentist' mode and melts down then we may have to go the general route. I am really hoping she turned the corner on the last visit and will do better in the future. She doesn't have enough of a track record for me to know which direction she will go, LOL.

 

[linzjane88]

We have an amazing pediatric dentist. If my child needed extensive dental work it would be under general anesthesia at a hospital. He does surgeries twice a week at one of our smaller hospitals. General anesthesia is very safe and I have no concerns that my child would do great. When my DD was 3 she adenoids and sinus roto rooted under gen and she did fine. The nice thing is that she will never remember. I am also an RN too.

I would feel much more comfortable if the work done under general was at a hospital but nobody around here does that apparently. But more than anything I want to make sure that it's necessary in the first place.

I wish giving a little Valium to them pre-appointment could be a thing. Probably frowned upon for the little ones . When I got my wisdom teeth taken out as a teenager the denist gave me enough valium to take down a moose and that was one of the most fabulous dental appointments ever. I have a tiny handful of things I remember. Mostly everything in between me walking out of my front door to the appointment to waking up at home was gone though.

 

[linzjane88]

Since you know that we give sedation and anesthesia based on protocols, perhaps you could research the various sedation protocols for pediatric dentistry. I think if you know exactly what meds they are using and the researched protocols for this care, you will likely be more comfortable. Remember that general anesthesia requires total ventilatory and cardiovascular support. If they do not require all the monitoring and support equipment, they are likely using a deep sedation with something like propofol. Review the definitions of the various levels of anesthesia on the ASA website. As an RN, you know that there are no black-and-whites. Nothing is ever all terrible or all good. Your background and experience can be your guide. I think this will be 100% OK.

But this is my baby . My little snuggly, cuddly baby. I realize I am getting probably way more worked up than I need to about the whole thing and that these are professionals who do this every day. I think I may have just enough knowledge to be dangerous and annoying . I am doing exactly what I hate my patients/visitors doing. LOL.

 

[Tiggeroo]

I am an extreme dental phobe. There is probably no work I can't get done with either xanax or nitrous. Those relax me enough that I really don't mind any work being done. I don't know much about the safety of either of those on a young child but if they can be used I would definitely do it. The nitrous would not get her into the chair to cooperate though. So if a low dose of xanax can be combined with nitrous it would be fine. After a few visits she might get over her fear. In the long run you may need to get some help because by 3 she needs to be ok with brushing her teeth.

 

[Turn the Page]

Keep in mind nitrous does not have the same effect on everyone. Heck, I had to get a couple cavities filled and had nitrous once. It was wonderful, I took a nap. DD5 had nitrous and she still screamed through the whole thing. It just depends on the person.

 

[littleblackegg]

But this is my baby . My little snuggly, cuddly baby. I realize I am getting probably way more worked up than I need to about the whole thing and that these are professionals who do this every day. I think I may have just enough knowledge to be dangerous and annoying . I am doing exactly what I hate my patients/visitors doing. LOL.

You'll be just fine!! I am confident of it. You are allowed to be anxious about it, but if you ask a bunch of people other than actual professionals about it, you will only become more nervous. You already know this! You got this. I have faith in you.

 

[Lilacs4Me]

I didnt read through, so I'll just give my experience:

My younger two (DS15 is getting his very FIRST cavity ever filled next week) were born with very little enamel on their teeth. Their baby teeth were super fragile and chippped/wore away really easily. Cavities happened like crazy.

DS10 was 2 1/2 and we brought him to the hospital for dental surgery. They filled what they could and capped the bad teeth. It took about an hour under general anesthesia. He was fine after. No side effects and it was done all at once.

DD11 was about 4 when she needed basically the same thing done. She was totally fine, too.

As they have gotten older and have lost many of their baby teeth, their adult teeth have been fine. I am actually leaving to go pick both up in about 5 minutes for a cleaning - good timing! We shall see if there are any cavities this time. (fingers crossed!...)

 

[Kiren]

My step son has poor baby teeth and has recently started complaining about his teeth hurting. We took him and they wanted to pull teeth and put crowns on a bunch. This dentist is apparently notorious for wanting to do expensive procedures right away. All three of us are in agreement that while his teeth are bad he has not complained about them since. He was really good when he was younger going to the dentist but we think at one of his visits the dentist didn't do enough freezing and it hurt. Now he has to be bribed to go!

I just had my first root canal myself and would rather have the root canal done again then go through the core and crown work afterwords. 2 and half hours in the chair with the freezing coming out halfway through? No thanks!

 

[strat68]

My step son has poor baby teeth and has recently started complaining about his teeth hurting. We took him and they wanted to pull teeth and put crowns on a bunch. This dentist is apparently notorious for wanting to do expensive procedures right away. All three of us are in agreement that while his teeth are bad he has not complained about them since. He was really good when he was younger going to the dentist but we think at one of his visits the dentist didn't do enough freezing and it hurt. Now he has to be bribed to go!

I just had my first root canal myself and would rather have the root canal done again then go through the core and crown work afterwords. 2 and half hours in the chair with the freezing coming out halfway through? No thanks!

Crowns on baby teeth? Wow, just run away.