6 year old needs to have his tooth extracted. Any advice?

April 11, 2008 6:59 AM

My 6 year old needs to have a tooth extracted for medical reasons tommorrow. Any tips/advice that my wife and I can use to ease the anxiety pre-pull?

We have already told him as gently as possible, and he understandably was not thrilled, in fact his initial response was "I'm not going." Neither my wife nor I ever had to go through this procedure at such an early age, any thoughts appreciated . . .

posted by jeremias to health & fitness (27 answers total)

How about a HUGE bribe?

Something on the level of a new video game. Or a cool pair of trainers. Or tickets to see something really awesome.
posted by By The Grace of God at 7:02 AM on April 11, 2008

Poor little guy. I used to get stressed out about many things as a wee thing, and one helpful thing my parents used to do was let me pick out a coveted toy (or they would buy one in advance that they knew I wanted), let me see it and hold it (he could hold it during the procedure) but not open it until the stressful situation was over. The anticipation of having the toy used to keep my mind at least a little bit occupied. Good luck to you and your little dude tomorrow!
posted by meerkatty at 7:03 AM on April 11, 2008

I think it might help to go over the steps of the day, most importantly including the steps after the tooth is pulled so it doesn't seem like such a full-stop event.

Like:
First Mom is going to wake you up, then we are going to have breakfast, then you'll get dressed, then we'll drive to the dentist, then we'll sit in the waiting room and read magazines, then we'll all go in together and we'll each hold one of your hands while the dentist numbs your mouth and pulls your tooth, then we'll get back into the car and go home, then we'll watch cartoons, then we'll go to the park, then we'll have X for dinner, then....

I think it helps kids feel in control to have a whole plan laid out that they are aware of and can follow along with. It was definitely reassuring to me as a kid!
posted by rmless at 7:08 AM on April 11, 2008

I got a few teeth pulled as a pretty young kid (9-10) when I got braces and it was pesky and annoying and I was stressed and unhappy about it. If I were you, I'd focus on the fact that it's (usually) a short procedure and it will be over by later tomorrow. Also deputize your kid to let the dentist/doctor know if he's having pain or if he feels something bad. Pediatric dentists are supposed to be good at this, pain management, but I think some of them just aren't anyhow. So, a few tips

1. tell your kid this isn't supposed to hurt much and if the dentist is doing something that hurts a lot then your kid should tell him so.
2. tell him when the whole procedure will be over. my mom taught me the count to ten process. That anything that was really hurting in a dental procedure shouldn't last longer than a slow count to ten. Granted, that wasn't always true but as a rule of thumb, esp for novocaine shots, it was a good guideline and got me thinking about something other than "wow this feels terrible"
3. ice cream, or something, have plans for it afterwards as something to look forward to.
4. if you guys have a tooth fairy meme at home this is a good time to let your kid know the tooth fairy pays extra for pulled teeth.
5. you and your wife need to be calm. Kids can sense fear and anxiety and if you approach it like it will be quick, as painless as it can be and then OVER your kid will pick up on that
6. more specifically, no soda or caffeine or sugar beforehand that will key the kid up. I don't know if this is going to be a sedated procedure (in which case the no food thing is a pain) or not but pay attention to what your kid will be eating beforehand
7. bring fun stuff for the waiting room in case you'll be waiting, favorite toys books or games, so you can sit around hanging out and then basically say "okay see you in 45 minutes" or whatever
8. you or your wife should be able to be with your son or be nearby, talk to the dentist about this
9. depending on how your kid is, let the kid wear whatever they want to the dentist. The dentist doesn't care generally speaking and sometimes it can be fun to go to the dentist in your pajamas

Good luck, let us know how it goes.
posted by jessamyn at 7:09 AM on April 11, 2008 [1 favorite]

Tell him he will get to take the tooth to school for show and tell, and that the more bloody and gory it is, the more fun it will be to gross out the teacher. Maybe he could ask the dentist to leave some blood on it for that extra squick factor.

He will also be able to display the big gaping hole in his gumline to friends.

Also, my daughter's dentist had a "Treasure Box" that kids could pick a small toy (like from a Happy Meal) out of after their cleaning or procedure. Maybe your dentist has one too? Most of the fun was rooting around in it and having a choice - the toys were cheapy things that broke in the car on the way home.
posted by SuperSquirrel at 7:19 AM on April 11, 2008

The first time I was to undergo a dental procedure involving local anesthesia when I was a kid, I was told that they would "give you a shot in your gums" that would make the rest of the procedure painless.

This would have been fine, except that I interpreted "in your gums" to mean "in that really sensitive area under your tongue" and I pretty much flipped out about this every day until the procedure. In addition to the general unpleasantness of getting a shot in this area, I was convinced that I would be unable to hold my head still during the shot, which seemed like it would have devastating consequences for the integrity of my under-tongue area.

I'm not sure how common of a misconception this was, but if even ONE child doesn't think this is what's going to happen, then... :)
posted by Juffo-Wup at 7:23 AM on April 11, 2008

Berenstein Bears visit the Dentist. Visit your local library, check it out, and read it to him tonight.

Better yet, make it the middle of three books that you read to him. Don't make a big deal of it - don't let him know that you've specifically picked it out. Let him draw his own conclusions and internalize it himself.

And bribe him. He's six, they're pretty cheap to bribe. :)
posted by unixrat at 7:46 AM on April 11, 2008

I was intensely needle-phobic as a child. Luckily, when I had to have my first filling, my aunt was the dental hygienist. And instead of telling my I would be getting a shot to numb me, she said that I would "feel a pinch", and they would pour the medicine in. She told me to keep my eyes closed, and I never realized that I was getting an injection. Sometimes little lies make things much easier.
posted by kimdog at 8:00 AM on April 11, 2008

I like bribes too, I still use them on 18 and 22 year olds (although more expensive.)

Just a general rule, never say, It won't hurt. Say, you'll fee a little pinch on the pink part under your tooth, and then it will take a little while but it will get tingly and then feel numb, which is sort of like you can touch it and not feel yourself touching it. That's so the dentist can do what he has to do -- quick -- and you won't really feel it. You might not like him working inside your mouth, it might be uncomfortable and kind of noisy and unfamiliar, you might have to hold still for longer than you want to. But it will be fast, and I'll be right there with you, and then, oh boy -- you get lots of hugs and kisses, and you get to go to the toy store and you can eat ice cream for the rest of the day!

Good luck, I remember those days well.
posted by thinkpiece at 8:06 AM on April 11, 2008

Here is what worked for my kids. Give them only the information they ask for. If you have anxiety about it, they will have anxiety about it. Yea, and the lie that it is mosquito bites, not shots (that part came from the dentist). Really they know it isn't mosquito bites, but it just makes it easier.

For us the key to any situation that could be considered traumatic is to only answer the questions THEY have, not the questions you would have. Trying to fill in all the blanks may cause them to worry about something that might not have occurred to them otherwise and may not even happen. Approach it like it another every day event. For my kids, telling them as gently as possible would have made them think it was something to be afraid of, where as just saying, "hey, we have to come back in a couple weeks to take out a tooth" makes it seems like a minor deal. Which really in the grand scheme of things it is.
posted by domino at 8:19 AM on April 11, 2008

If the tooth is bothering him now, you might emphasize how much better he'll feel when the tooth is gone. I had a festering tooth pulled a few months ago and the extraction process actually felt great. I was surprised and relieved.
posted by PatoPata at 8:23 AM on April 11, 2008

Depending on his cooperation level, anxiety level, tears, flailing etc., the dentist may not be successful with the extraction. You may be referred to pedodontist, you may be prescribed a sedative for the next visit.

One tactic some dentists use with uncooperative children is to not allow the parent in the room when the child acts up. The dentist is the power figure in the room and the parent is in the room with his permission. I've seen this work most times.

Some dentist's use nitrous oxide prior to the injection. It's temporary, no lasting effects after removal of the nose cone. Your child may get to choose his air scent.

Is this his regular dentist? He has had regular check-ups before? Does he already have dental anxiety? If he is pretty good usually, I wouldn't worry too much, if you like and trust your family dentist, this isn't a situation that is new to him.

One thing I've seen that doesn't help... giving the child too much information. I would not tell him he's getting a shot. Most dentists are so good with placing a nice flavored topical gel on the gums, asking the child to close his eyes and asking them to raise their left hand when they feel "just a leeeeeetle mosquito bite"... most kids I see don't even bother to raise their hand they are so faked out and if they do raise their hand, I say "Thank you so much for letting me know, you can put their hand down now" And they do, it was very rare that a child who did not come in the door already crying started to during the procedure.

I guess what I'm saying is: A little information with a big imagination=anxiety prior to appointment. As for the bribing, make it small. You don't want to set up a situation where you have to buy a $59.99 Wii game just so your child will act the way he should be. The bigger deal it is made to be, the larger his fear/anticipation will be.
posted by Jazz Hands at 8:57 AM on April 11, 2008 [3 favorites]

Can I offer a practical tip? Ibuprofen 8 hours before you leave (so maybe tonight before bed), then right before the dentist. I would do this before getting my braces tightened, and it helped immensely. Getting the anti-inflammatory action working ahead of time works very well.
posted by peep at 9:10 AM on April 11, 2008

I had to have a half-dozen molars yanked once when I was a youngin. Afterwards, my folks took me to Meijer and bought me Mario Paint, which was the game I wanted more than anything on the planet.

To this day, I still have a weird little Pavlovian pleasure-response to painful dental work.

i might get mario paint!
posted by Baby_Balrog at 9:14 AM on April 11, 2008 [2 favorites]

Definitely appeal to his 6-year-old masculine pride--tell him how brave and strong he is.
posted by mpls2 at 9:25 AM on April 11, 2008

My then seven year old had to have a tooth pulled (and had to have an $800 "temporary" cap put in for spacing --but that's another story more related to my bank account). Feeling anxiety is totally natural of course. Our pediatric was great. Gave her some "gas" to relax her and the rest was pretty easy. Also the dentist allowed Mom to be there so that also helped our daughter's nerves.

Let us know how it turns out.
posted by Taken Outtacontext at 9:38 AM on April 11, 2008

I lost two of my baby teeth naturally, and all of the others were pulled (at least I have the coolest collection of baby teeth because of the roots). The first appointment where I got two teeth pulled, my parents did the calming, explaining thing, and that got past the first tooth. Then the screaming bloody murder started. To get the appointment finished, my parents promised me a ~$30 toy that I'd been lusting for (this is around the early 80's, so that's probably the equivalent of at least a $60 game), and that calmed me enough to open my mouth again.

For all of the following dentist appointments, there were intense bargaining sessions between my parents and I regarding just how big the payoff would be for each appointment. Typically a gift in the $20-30 range for 2 teeth, and $60+ for the four tooth appointments ...

Since it's just one tooth, you can probably get away with just being calm, and explaining it as something simple. Failing that, bribery should definitely work.

It might be worth considering a dentist who will do it by putting the kid down with gas; I didn't see a dentist from age 20 to about 26 from built up fear from all of the pullings, as well as the fact that my sadist of a dentist ould never numb a tooth he was going to drill until *after* I started jerking in pain. He'd always start with "This is just a shallow cavity, you won't feel a thing." ... and then he'd start drilling, and there wouldn't be pain for 5-10 seconds. And then ...

I finally went to a dentist at age 26 because one of my teeth shattered while I was eating a Smartie (M&M to the US'ers). I was amazed to be getting a dreaded root canal, and while it was unpleasant, it didn't hurt. Well, it didn't until after the numbing drugs wore off; but there wasn't any sharp blinding intense pain.

Ms. nobeagle is afraid of dentists, so we go to the dentist for chickens (seriously, his business cards has a big chicken on it). I think it's $20 per 15 minutes of gas (never had n2o other than from whippets myself), but I'm unsure how reasonable it is for children. But if you want your kid to not fear dentists, it might be worth the extra $$ to find dentists specializing in cowards and children.
posted by nobeagle at 9:43 AM on April 11, 2008

The best thing I've overheard a kid say in the dentist's office is, "Will it hurt? It's okay if it does, I just want to know." That's pretty much what I thought as a kid, but just couldn't put into words. Yes, a lot of kids are NOT okay with pain - but still.
posted by Xere at 9:51 AM on April 11, 2008

I had four baby teeth pulled when I was just a smidge older than your son is now. I basically agree with everything Jessamyn said. I also strongly concur with the sentiments of not saying that it isn't going to hurt or be uncomfortable at all (so that he won't feel lied to) and avoid the words "shot in the gums;" say prick or pinch instead if he's at all weird with needles. That was the part, then and now, that I hated the most about dental procedures, but there's no point in stressing out about it before hand because of the horror of that phrase.

Generous bribing is key. My parents used the "tooth fairy gives $10 per tooth the dentist takes out" method.

Also, find out if the dentist will let him listen to music through a cd player or iPod. Once I was gassed and numbed, I couldn't feel anything, but I remember the sounds being barbaric and scary. It was a pretty traumatic thing to hear my tooth cracking out of my jaw, so I highly recommend tunes as a calming distraction.
posted by mostlymartha at 10:09 AM on April 11, 2008

next time, don't tell him. that's what my parents always did....
posted by misanthropicsarah at 10:32 AM on April 11, 2008

I had to take my niece to get some errant baby teeth extracted. I discovered the following:

* the dentist and dental assistant know exactly how to distract kids
* the needle wasn't an issue
* I was more anxious for my niece than she was for herself
* they used nitrous oxide for a relaxing experience for my niece (and me!)

Oh yeah, I also bribed her by telling her that she couldn't eat anything solid for a day or so while her mouth healed, which meant that she could eat ice cream for breakfast the next day.

I think that building up to it ("We'll hold your hand and everything will be okay and you'll be a big boy, and you'll get a present! afterwards!") will only cause more anxiety.
posted by parilous at 12:07 PM on April 11, 2008

Bribery. Plain and simple. Toy, game, whatever.
posted by radioamy at 12:13 PM on April 11, 2008

Also, that novocaine needle? It's HUGE and even bigger in a kid's eyes. If someone had told me, "there's a big needle but it realy makes a smallish pinch" it would have saved me about 30 seconds of abject "they are going to murder me with that thing if they stick it all the way in my mouth" terror that could have been avoided. I've never understood why dentistry as a profession doesn't do something about the looks of that giant metal needle.
posted by jessamyn at 12:18 PM on April 11, 2008

I hear ya jessamyn, but the thing is, it has to be held and controlled from outside the mouth and also has to sink in a certain distance to reach the nerve canal. The doctor has to be able to see exactly where the point is going in, so the needle can't be shorter and the handle longer, it'd block the view. What has been improved on over the years is much, much sharper and smaller gauge needles. 30 gauge compared to 25 gauge 20 years ago means much less discomfort with the injection.

I've worked on kids thousands of times and 95% of them aren't even aware of having received the injection. We ask them to close their eyes, their head is tilted back slightly, our hands are over the chest, not in view of the patient. They never see the syringe, it isn't sitting out in view on my tray.
posted by Jazz Hands at 12:41 PM on April 11, 2008

I had to have 9 baby teeth extracted before I got braces. It sucked. It's especially going to suck for the kid if this is a situation where they pack gauze in a hole for a week (so freaking gross).

I was 13 when this was happening so I was fully aware that it was likely going to suck. And it did - but it wasn't near as bad as I thought it would be.

Be honest with the kid but not brutally honest. It's not going to be pleasant but it's also not going to be the worst thing ever. And tell him he can have ice cream after. (And possibly offer to take him to a movie or buy him a book or whatever he wants within reason.)
posted by fluffy battle kitten at 11:42 PM on April 11, 2008

As a parent of a kid who still stresses too much in advance of any type of medical procedure, I am gonna go with misanthropicsarah on this one. Don't say much of anything at all. Obviously, he already knows what is going to happen, but up to the very moment that you have to go the dentist, distract and redirect. Bribe when bribes are necessary, and don't lie when the time comes.
When my son was a small child, he was never told that he was going to the doctor ahead of time, and only found out when we pulled into the parking lot at the doctor's office. Now that he is older, and can actually make some decisions of his own, he still prefers that I do not inform him in advance, so as to minimize the amount of time he has to stress and let his gigantic imagination get the better of him.
posted by msali at 7:28 PM on April 12, 2008

Reporting back: It was a fairly straightforward procedure. There was a small bribe involved when he was still anxious the night before (apparently "Crazybones" are all the rage these days). But we followed Jazz Hands advice and didn't go nuts with the size of the bribe and also didn't volunteer information unless asked.

We also created an amalgamation of the tooth fairy me and bringing the tooth to school. He got his regular tooth fairy gift but we put a note with it asking if we could hold onto it for two days in order to show his classmates. Then on Monday night he will get to put it under the pillow and get another small gift.

Thanks all for the advice . . .
posted by jeremias at 7:46 AM on April 13, 2008