General Anesthesia for kids dentistry?- UPDATE

[ktlm]

Unfortunately, DD(5) has teeth crowding issues which have caused her to get several cavities. The pediatric dentist wants to put her under a general anesthesia to fill all of these cavities at one time- he is also talking about a possible root canal or cap on one of the back teeth depending on what he finds. He has a good reputation; however, this whole thing makes me very nervous. We are going to get an opinion from another pediatric dentist; however, DH saw the X-rays and does believe that this guy is probably legitimate in regard to the cavities existing. I was just wondering if any of the Disers, have had any experience with this. Did you do the general anesthesia? How did it go? Really any information you can give me would be appreciated.

 

[Shelly F - Ohio]

I would not have this done in his office. Two months ago a girl in our town died while having teeth extracted. I would highly recommend doing it in a hospital setting where they will be better equiped to handle an emergency

 

[DopeyDame]

If you have any concerns at all, get a second opinion. You can always go back to the original dentist if it all checks out as reasonable, but there's no harm at all in getting another professional to help you sort out your options. Good luck!

 

[scrapquitler]

Unfortunately, DD(5) has teeth crowding issues which have caused her to get several cavities. The pediatric dentist wants to put her under a general anesthesia to fill all of these cavities at one time- he is also talking about a possible root canal or cap on one of the back teeth depending on what he finds. He has a good reputation; however, this whole thing makes me very nervous. We are going to get an opinion from another pediatric dentist; however, DH saw the X-rays and does believe that this guy is probably legitimate in regard to the cavities existing. I was just wondering if any of the Disers, have had any experience with this. Did you do the general anesthesia? How did it go? Really any information you can give me would be appreciated.

Two years ago my then 6 year old needed to have a lot of dental work done (two crowns, three fillings, and an extraction). Dentist recommended general anesthesia. Second opinion doctor agreed. We went to Yale to have it done and it all went well, no problems.

The big thing is the EXPENSE. We had to pay our hospitalization copay for outpatient surgery ($1500), and we had to pay for the dentist to walk into the OR and do the work...that cost us about $3000 on top of the copay But my son would NEVER have let them do that work on his mouth. He hates the dentist and doesn't cooperate (even now), and it takes 2 hygenists and the dentist to clean his teeth because he is so difficult.

 

[amy-momofthree]

My dd6 had to have two teeth pulled last year due to crowding issues. When they told me that, I got a second opinion from an orthodontist. He agreed. We went back to our original dentist and they did it while she was "awake" but she remembers nothing. We went first thing in the morning, they weighed her, took her blood pressure, etc. Then gave her a drink with 3 medicines; one for pain, one to make her not remember anything, and one to relax her. They then gave her novacaine and nitrous. She had a really good experience (as far as those things go) and remembers nothing. I also made sure the hygentist that we regularly see did NOT leave her side.

I also want to add that I was very skeptical of this and wondered if if would help with her crowding issues. BEST decision EVER! DD's teeth are PERFECT in just 3 months! Having the teeth pulled allowed for the others to shift to where they needed to be. I did not believe that would happen but it did.

Good luck!

 

[Fyrefly]

I don't really think it's necessary for a dental operation, personally. But I had oral surgery when I was younger to cut baby teeth off from my jawbone where they had fused so they couldn't fall out. I wasn't put under for that. I also wasn't put under when I had my wisdom teeth out.

I think they used a combo of local anesthesia, gas to get me really happy, and apparently there is an IV inserted maybe after the gas but I honestly can't remember because I was so zonked. Basically all I remember about my wisdom teeth is listening to my pulse slowing down on the heart rate monitor and thinking it was so cool, like I was on House or something (drugged me thinks odd things) and then feeling like I was going to throw up after the procedure was done. I had a bad reaction to the anesthesia and I imagine if they had put me under fully I would have been sick even longer than I was.

Sure for a root canal for a 5 year old gassing might be worth it (I think I got a cavity filled at 6 or 7 just being numbed but I've always been tolerant with dentists - honestly I always knew as a kid misbehaving for a doctor or dentist or anybody wasn't an option), but I'm in the camp of don't risk being put totally under unless its something major.

 

[Hannathy]

My DS when he was 2 1/2 had to have major work done, several of his teeth came in without enamel. he needed his whole upper front teeth crowned and several other side teeth needed root canals and capped. The Pediatric dentist said it COULD be done in the office HOWEVER he wouldn't recommend it because it would take several appointments and after the first a 2 1/2 yr old would have to be restrained and it would be very hard on him and the staff and hard to get the work done well. We went the general anesthesia route and I am very very glad we did. He had it done outpatient at a hospital and in the OR with a separate Anesthesiologist- who was extremely nice to him and us. He personally carried him back to the OR and let me walk with them to the door and then say bye and he carried him being very comforting to the OR. They didn't start the IV until he was out.

After he stayed in recovery till he was awake and had a drink. then they took the IV out and we went home.

He is now 12 and has had no problems with those teeth, I think when they are out they can really do what they need to and take their time. In fact the last crowned tooth just fell out.
I would do it again if needed and I'm glad for a general and a small child we went to a hospital.

 

[Hannathy]

do they want to do full general anesthesia or sedation? Sedation I would be ok with doing in the office but full general I would want in a hospital.

Also wanted to add my DD had the same problem with her enamel but not as extensive so she only needed 2 teeth done. She needed root canals and crowns on those 2 and they were able to do her without sedation. She was also a very mature and ahead of herself 2 1/2 yr old! Her and the Dentist discussed the show ER! They had a very good relationship. The only thing my DD didn't like was the thing they put in your mouth to keep it open. so her and the dentist agreed if she would keep her mouth open she wouldn't use it. and my DD did thru 6 appointments. The Dentist said she almost always had to use them even with the much older kids and was so surprised my DD kept her word she gave her a T shirt!.

So it really depends on the child, how much work needs done and the severity of the work.

 

[ktlm]

do they want to do full general anesthesia or sedation? Sedation I would be ok with doing in the office but full general I would want in a hospital..

They found 9 cavities, 7 of which they believe need to be filled (the other 2 are not that bad and are on teeth which she should lose in the next 1-2 years). Of those 7, one may need a root canal or cap once they get in and see how bad the cavity is.

Because there are so many and they may have to do extensive work on one tooth, they want full general anesthesia.

They have an anesthesiaologist that comes to their office for these procedures. They do not do the anesthesa themselves. They put the child in your lap, and start with a mask. Once the child is woozy and doesn't really know what is going on, you leave the room and they do the iv. When they are done with the dental work, they come get you and put the child back in your lap so that the child wakes up with you holding them.

 

[kchughes]

That sounds like MAC sedation (monitored anesthesia care). General Anesthesia would require the insertion of a breathing tube to protect her airway. I would get a second opinion, but as long as she is monitored by an anesthesologist or nurse anesthesis, I would be ok with it. BTW, I am an RN who used to be in a position to sedate people for procedures. I refused to sedate kids, because I felt I was risking my license in the environment I was placed in and would not let any one but a board certified anesthesiologist/nurse anesthesis sedate my child. Just my opinion.

 

[brenalexacamp]

pediatric dental hygienist here!
If your child is unable to sit and have the work done- extensive work- it is better to go to the hospital and do under general anesthesia.

you want your child to have a dental home where they feel comfortable(cleanings)- when they get older and need one or two teeth filled- not a problem- they will be older and more able to cope.

Nitrous oxide helps relax-not make the child unable to move- the kiddo has to go into the appointment with the understanding they are going to get their tooth fixed and be a good listener and cooperate. sometimes they do fall asleep a bit.
The point of the baby root canals and crowns(they would bethe stainless steel crowns) are to sve the teeth because they hold the space for the adult teeth. If you take out a baby molar- the premolars that will come in their place, don't come in until around age 12.

If the decay is through the enamel into the dentin -you can fill it. If the decay is close to the pulp chambe it is a toothache waiting to happen. By the time all the decay is cleaned out- you'd be at the pulp-nerve of the tooth- the only way is to do the pulpotomy(baby root canal)
Now you have a shell of a tooth- a regular filling won't stay- you need full coverage-a stainless steel crown. It will fall out when that baby tooth falls out.
Hope this helps you- we have many families that come in- most accept treatment- others think it is too much. eventually the decay gets deeper and the kid winds up with an abcess- then there are antibiotics involved and the tooth needs to be taken out. then you are looking at space maintainers to hold the space for the adult tooth.
You have to trust your dentist. you have to do what's less tramatizing for your child so they will enjoy going to the dentist- we use friendly terms- help the tooth see the tooth fairy, mr. bumpy,silly nose, silly air, sleepy juice,paint a white star on your tooth. Never use needle- hurt- pull

I have a kiddo with special needs- needed 8 teeth pulled to make room for adult teeth- so crowded- broke my heart to put him to sleep- his oral surgeon let me be there while they put the mask on and said it was ok to cry- he was my baby- don't worry- he would take extra special care of him. Somehow I knew that before we got to the hospital. I trusted him. My poopsie did great- cried out of anesthesia-they all do. Eating and drinking just fine- i'm the one who needed a nap!

 

[blessedby3]

Our dd3 went for her first check up and they determined that she didnt have enamel on 4 of her teeth. We were given the option of having them taken care of in the hospital or letting the Dr. try in the office with nitrous. We opted to try and have them taken care of in the office. Dr. said that only 2 had decay right now and that we should just fix those and keep a close eye on the others. We took her for the first appt to do one and she did fairly well. She was a little nervous and the nitrous didnt take the full effect, but we came through it and went a week or so later to have the other taken care of.
I used to work for this pediactric dentist 21 years ago (until I had my first child) and he used to sedate kids before bringing them into the office with a prescription drug. I asked about this and he said they dont do it anymore because of some reported deaths from it. They also used to restrain the kids who had this premed, but they dont use the restraints anymore either. I am thankful we were able to take care of my dd's in the office. I know she is going to need more fillings or root canals in the future for those bad teeth, but we are hoping she will be much older and we can talk things out with her better about it.
Good luck to you...its a HUGE decision!

 

[shaylyn]

My 5 yo had to have many cavities filled in February. The Pediatric dentist wanted to use anesthesia to put him to sleep and do all of the work at once.

IMO, it's just to make it easier on the dentist!

I told him, "No, we can do it in a few visits." so we set up 4 visits to complete all work.

He wanted to give him Nitrous (not covered by insurance, an extra $75 each visit). Again I told him, "No, lets try without it and see how he does."

He did GREAT!!! No pain during, no pain after, and went back for each treatment with a smile on his face

Don't let a dentist, or any other doctor for that matter, push you into making a decision you are not comfortable with.

 

[Leajess99]

They found 9 cavities, 7 of which they believe need to be filled (the other 2 are not that bad and are on teeth which she should lose in the next 1-2 years). Of those 7, one may need a root canal or cap once they get in and see how bad the cavity is.

Because there are so many and they may have to do extensive work on one tooth, they want full general anesthesia.

They have an anesthesiaologist that comes to their office for these procedures. They do not do the anesthesa themselves. They put the child in your lap, and start with a mask. Once the child is woozy and doesn't really know what is going on, you leave the room and they do the iv. When they are done with the dental work, they come get you and put the child back in your lap so that the child wakes up with you holding them.

Honestly, I would NOT let them do it in their office. The surgical center where my youngest had her adnoids out is where the local dentists do the work on kids under anesthia.

My daughter's experience with anesthia resulted in an asthma attack and they had a hard time getting her to breathe. I could not imagine if she were in a dentist's office without the oxygen or support staff.

There were many kids having dental work the day my daughter was there.

 

[lunalibre]

Years ago when my son was a toddler, he had to major dental work done. Considering the kid screamed bloody murder anytime someone tried to touch his mouth, that work was absolutely going to have to be done while he was sedated. He was put under very light anesthesia by an anesthesiologist who came to the dentist's office. DS came out of it just fine.

The worst part, honestly, was getting the anesthesia paid for! Even though it was preapproved through both the medical and dental insurance, neither side would pay for it afterwards and each blamed the other. We finally had to invole HR where DH worked (it was his insurance), and it took nearly a year to get the bill paid.

I have never heard of going to a separate surgical center. Maybe that would have made it easier to get all the bills paid. At the time, we also didn't fully grasp the possible dangers of the anesthesia, or else I might have insisted on a surgical center given that DS was barely 2.

Now, for a 5 year old, I would take into account how she behaves at the dentist. If she's terrified of the dentist, go for sedation! If you're going to a really good pediatric dentist, she might be able to tolerate the multi-appointment approach. I can see where, if the kid needs a root canal, sedation might be the way to go.

Get a second opinion, talk to both your dental insurance company and your medical insurance company to see what the costs are, and think about how much work your DD can take while she's awake.

Good luck with whatever you decide.

 

[disfan07]

My 5 yo had to have many cavities filled in February. The Pediatric dentist wanted to use anesthesia to put him to sleep and do all of the work at once.

IMO, it's just to make it easier on the dentist!

I told him, "No, we can do it in a few visits." so we set up 4 visits to complete all work.

He wanted to give him Nitrous (not covered by insurance, an extra $75 each visit). Again I told him, "No, lets try without it and see how he does."

He did GREAT!!! No pain during, no pain after, and went back for each treatment with a smile on his face

Don't let a dentist, or any other doctor for that matter, push you into making a decision you are not comfortable with.

You're lucky that your child did so great but I don't believe that would be the best option for most children. I don't think that the OP is being pressured into anything. I am 21 and I had 9 cavities filled over 4 visits over the past 6 months (side effect from a couple of medications plus other issues). I would NEVER put my child through that. EVER. My dentist wanted to sedate me and do them all at once but we can't do it. My doctors won't approve it and he won't do it without doctor approval.

It is probably MAC (Monitored anesthesia Care) that they want to do. That is the same type of sedation I have had for a bronchoscopy, EP study, Endoscopy and colonoscopy. Regular general anestheisa requires a breathing tube to be placed.

OP, personally, I would not put a 5 year old through all of that without sedation of some sort. I would find out all of your options for sedation but I would definitely use some sort of sedation. It's much easier for teh child if it is all over with at once instead of having to go through it multiple times. If you decide to go with anesthesia, definitley have it done in a hospital setting though. Not in the dentist office.

 

[chellewashere]

I just had work done for my DD (5) yesterday. She needed a baby root canal to fix 2 cavity issues and a crown put in. She had nitrous with a banana scent and did just fine. The only time she whined a little was the first needle in her mouth but after that she was great to go. She was in no pain after it was done and she actually said it was fun..the kept getting her lip with the suction and told her it was buffalo kisses and she loved that.
Her going fully under would scare the crap out of me, but this was OK and it went great.

 

[lost*in*cyberspace]

They found 9 cavities, 7 of which they believe need to be filled

How does a 5 year old get nine cavities?!

I think it would be very difficult for a 5 year old to have such extensive procedures, especially a root canal, without being under general anesthesia.

 

[ktlm]

How does a 5 year old get nine cavities?!

That's my question too- especially since when the regular dentist sent her to the pediatric, he told us there were 2 cavities- however, he has never done X-rays with her. The regular dentist said because of her crowding issues, he thought she should move to a pediatric dentist for early intervention. He also felt because of the location of one back cavity, it would be better to have the 2 cavities filled with the pediatric dentist. We took her to the pediatric, who took X-rays, and suddenly it went from 2 to 9- with 7 needing to be filled. He told us that the problem causing the cavities is her crowding issues. He says there is just no way for the toothbrush to get between the teeth because they are packed so tight together. Unfortuately, I'm afraid it is genetic. I had to have baby teeth pulled when I was 5 and then later 4 permanent teeth pulled all because my mouth was too small for my teeth.

Thanks so much to everyone who has responded so far. I can't even tell you how much I appreciate my Disfriends. I would love to hear even more from you. For those of you with the medical background, I got a little more information today, so any more input you have would be really appreciated.

Spoke to the anesthesiologist briefly today. He is a board certified dental anesthesiologist (in other words, a dentist who had an additional 2 year education in anesthesiology and is board certified in both). They do put a breathing tube in their nose to regulate breathing during the procedure. He uses a little valium in the IV and then the sedation drug is Sevofluane. He has been doing this in pediatric dentistry 19 years, and has never had any child wind up hospitalized or with any major complication. He has only had one significant adverse reaction in all that time, and that was with a severely disabled child who for life had never been able to be on solid foods and that child had vomiting issues for several days after the anesthesia.

We also spoke to the other pediatric dentist's office where we are taking DD for a 2nd opinion next week. We wanted to know what they did as far as sedation. Again, they advised that it depends on the extent of what they are doing. Apparently, they do the came thing (said they do IV and general sedation depending on the issues) and they also do all procedures in-office; however, they have their own nurse anesthesists employed on staff who do the sedation. Supposedly this keeps the costs down to the patient. I could care less about it being cheaper. All I care about is safety. I don't know what drugs they use there as we were just talking to the desk staff. I'm still taking her there next week, to see if they agree about these supposed 9 cavities and what their recommendations would be.

 

[seashoreCM]

IMO, it's just to make it easier on the dentist!

Dentistry requires great precision. A squirming child means the chances are greater for a small error that leads to a filling falling out later or a tooth getting butchered unnecessarily and having to be extracted.

There is no good solution to this kind of problem. Regrettably I feel that some kind of general anesthesia is the least of the evils.

Isn't nitrous oxide a kind of general anesthesia?

Children need to be kept away from soft drinks and excessive sweets and in most cases need fluoridated water (can be mixed manually from concentrate).

Health hints: http://www.cockam.com/health.htm

Not sure whether they still do it but one of the exercises in dental school has been hand carving of a piece of blackboard chalk.