Dental surgury options for a toddler?
September 8, 2011 7:32 PM   Subscribe

Our 2-year old has an injured tooth that is wearing away. Dentist would like to go in, and do baby-tooth root canal, or possible extraction if the tooth cannot be saved. Hospital wants outrageous sums of money, health insurance says it will not cover it. Are there any good options?

Our son MB is just under 2 1/2. He apparently injured his tooth about a year ago, and combined with his night-nursing, led to tooth decay. We took him to the dentist early this year, and he has been monitoring the tooth. We were waiting for MB's the roots of teeth to finish growing.

MB's injured tooth (his "D" tooth according to the dental universal numbering system, one to the right of his top-front-right) is about half the visible length of his uninjured tooth on the other side, and is dark with visible decay. Fortunately, he has not (yet) had any pain from the injured tooth.

The dentist wants about $3000 for the surgery, where he will go in and either do the root canal, or if he finds the tooth too injured, extract it. However, as he is so young, this procedure would be done under general anesthesia [a whole other set of worries] in the local hospital. Today, my wife called our insurance company (health, we do not have dental insurance), and they said "No, we only cover if it was a bony tooth intrusion"). We asked the hospital for a ballpark figure, and they said it would be $10,000+ between the operating room, the recovery room, anesthesia, etc. This has us in a bit of sticker-shock. They did say we may be able to negotiate the fee down a bit, if it would not be covered by our insurance.

Still, we want to do what is best for our son. If our best option is to take the financial hit (the hospital does offer an 18-month payment plan), then we will do it. I do have medical flex spending (FSA), but only a few hundred dollars left for this year. I suppose we could try and gamble that MB would be ok until January, and load up the FSA for next year although I do not know what the max amount we could put into it.

Right now, we feel like dopes for not finding this our sooner. I guess we were just thinking insurance=hospital visit coverage. Can the hive-mind help us decide what to do, or what other options we have?
posted by fings to Health & Fitness (19 answers total) 1 user marked this as a favorite
Best answer: Well my four year old had an abscessed baby tooth removed under laughing gas, with reasonable dental fees charged. I would get another opinion.
posted by tamitang at 7:38 PM on September 8, 2011 [1 favorite]

I am not a dentist, but I thought in general, you just pulled baby teeth if there was a problem. It's going to come out in its own anyway in about 6-8 years. That seems like a lot of money what is ultimately a temporary fix. At a minimum I'd get a 2nd opinion and ask what the risks are to just pulling it.

Disclaimer - I grew up in the military, and it seemed like "pull it" is the answer to just about every question when you are a military dentist.
posted by COD at 7:38 PM on September 8, 2011 [2 favorites]

Why would you do a root canal on a baby tooth? It's just going to fall out eventually.

Ask the dentist what about just setting up to do the extraction under sedation rather than general anesthesia. I'm not a dentist, but I'm a doctor and I do more painful procedures than tooth extractions on toddlers using ketamine sedation routinely. I would think with a combination of ketamine and a local nerve block you could get it done for a lot cheaper.
posted by treehorn+bunny at 7:39 PM on September 8, 2011 [2 favorites]

I am not a dentist or an expert by any means, but at least two of my friends have had children who injured baby teeth, and the baby teeth were simply extracted, and the kids had gaps until the permanent tooth came in. In your shoes, I'd ask this dentist why this expensive procedure is a better choice, in his opinion, and then I'd seek a second opinion, including saying, "Dentist #1 says it's best to do it this way because..." and see what Dentist #2 has to say about the reasoning used.
posted by not that girl at 7:47 PM on September 8, 2011

My niece had some baby teeth pulled at age 3. Get a 2nd opinion.
posted by k8t at 7:49 PM on September 8, 2011

Our eldest son had a lot of tooth decay at age three, mostly because of a gap in his tooth enamel. The dentist recommended fixing the teeth under general anesthetic. We didn't have dental insurance, and Canadian health insurance did not cover it either.

Anyway, we went through it. Tooth decay in baby teeth needs to be addressed, as decayed teeth will cause adult teeth to come in crooked.

You need to get a second opinion, though for the root canal, as well as the anesthetic. Our youngest son (2) recently cut himself on his eyelid (don't ask) and it required stitches. Instead of putting him under anesthetic, the emerg doctor used ketamine to tranquilize him.

It worked really well, and the drug lasted for about 3 hours. Ketamine is basically a hallucinagen, so our son never lost consciousness; it should be cheaper.
posted by KokuRyu at 7:51 PM on September 8, 2011

Best answer: Why would you do a root canal on a baby tooth? It's just going to fall out eventually.

I'm not a dentist, I will never be a dentist.

Baby teeth do a lot for you. They're placeholders, preventing crowding of the other teeth and helping the adult teeth come into their proper places.

They're useful for chewing.

They're important for speech.

Keeping them as long as possible is ideal.

That said, I think you should always get a second opinion with big ticket medical interventions. General for a root canal is...not unheard of for small children, but not universal. If you have any doubts about your dentist, I'm a big fan of moving on, because this is someone you want need to trust. Especially with your kids.
posted by bilabial at 7:55 PM on September 8, 2011

Best answer: There are a host of very good reasons it is important to save baby teeth in all but the cases where exfoliation of the tooth is within a year--proper development of the palate, jaw, and adult teeth relies on healthy primary teeth. It is an extremely old school pediatric view to dismiss primary teeth as expendable--research learns more all the time about their importance.

You have obviously already been briefed about the importance of following through on some level of care for the tooth (for proper development, abcess prevention, and protecting the brain), but your widely differing consultations and estimates suggests that you haven't found the right clinical fit. Is the hospital a Children's hospital? Right now, there is a big push in Children's hospitals to provide evidence based pediatric dental care to all families, including those who would confront financial hardship. What's more, pediatric dentistry approaches these issues with long term views of dental health while keeping invasiveness down a's much as possible. A Children's hospital will often assist you in working with insurance, as well.

I am finishing my pediatric NP residency at a big R1 school in a city with a Children's hospital. The college of pediatric dentistry and the Children's dentist service are working really hard with all aspects of clinical and resident education to get this message out there, and I, personally, have observed how correct pediatric dental care makes an incredible difference. Good luck--I know isn't easy wading through everything.
posted by rumposinc at 8:00 PM on September 8, 2011 [1 favorite]

Hmm... are you seeing a dentist who specializes in pediatrics? If not, might be worth finding one and getting a 2nd opinion.

Kid#2 had caps put on her upper front teeth at 18 mo because of serious decay. She had it done in the dentist's office under light sedation. It wasn't tons of fun and she had to be restrained, which I'm guessing is why the dentist you're with right now wants to do general anesthetic. But she did well, it was much less invasive than an OR visit, and they were very professional, kind and quick. Of course you'll want what's best for your child, and that may very well mean a big hospital bill. But if there's an in-between option it's worth seeking out.

My best friend's 5yo had a tooth pulled in the same general location - she has indeed had speech problems as a result, and that stretch from 2-7 includes a LOT of language and personal development that can be difficult to catch up later. Given her experience, I personally would not go the extraction-and-wait-it-out route for my kids.
posted by hms71 at 8:18 PM on September 8, 2011

Response by poster: Various answers:
Yes this is a pediatric specialist. We first went to one family practice dentist, who referred us to this dentist, who specializes in pediatric dentistry and oral surgery.

We do trust this dentist; I don't think he's trying to huckster us. The nurse my wife talked with at the hospital has a good opinion of him as well. He did say if MB was older (like 4), we would do this under local anesthetic, but at MB current age, he thinks (and we agree) that this would be too difficult/traumatic for our son. We were already prepared to for his services, and some percentage of the hospital, but were thinking it would be about $5k total, not a possibly $15k bill.

We would like MB to keep his baby teeth for as much of their normal lifetime as possible.
posted by fings at 8:57 PM on September 8, 2011

Response by poster: We have talked about getting a second opinion, though we will have to do it fast, as right now MB is scheduled for this surgery September 29th. My wife has also spent hours with "Dr. Google", and the general consensus of the Internets seems to be for tooth decay of his sort at his age, the options are general anesthesia and get it over with in one go, or restraints and multiple visits if it is a root canal (which sounds terrifying for the child).
posted by fings at 9:08 PM on September 8, 2011

I am quite surprised he is not speaking about concious sedation for the procedure which would help a little with the costs.
posted by Wilder at 3:52 AM on September 9, 2011

No matter how much you and the hospital like the doc, I strongly recommend a second opinion when:

a) your child will be under a general anesthetic in a somewhat serious procedure
b) you are spending a considerable amount of money.

Make an appointment today.
posted by arnicae at 5:38 AM on September 9, 2011

My daughter has had dental work done under general anesthesia twice (she had several cavities). The first time was when she was around 2 years old. We had a combination of generally bad enamel and night-nursing (please don't lecture, we've been through all the guilt and lectures, though our dentist was not shaming at all!). Our dentist told us that it is not uncommon for young children to actually be strapped to the chair for dental work(!). He did not recommend this. We were lucky because our insurance covered it--and the dentist office also dealt with them to help this process along. I can't speak to the issue of Ketamine, but for us it was extremely important that our child have an properly trained anesthesiologist working with her to mitigate breathing complications. By the way, we were terrified of the GA, but it turned out fine. Because of my daughter's fears about dentists, we did not hesitate to go through the same process when she had cavities later (around age 5). Again, she had no complications.
posted by bluespark25 at 6:30 AM on September 9, 2011 [1 favorite]

I would start working on your health insurance to get them to cover some of it. Don't always take their "no" as a final answer. Does your company have an advocate that will work with them? If not, you may be on your own but I have found that fighting with ours will result in better coverage. I think you have a case with the child's age, the importance of doing something now, future possibility of issues related to his health and speech might make them reconsider.
posted by maxg94 at 6:58 AM on September 9, 2011 [1 favorite]

Best answer: I work in a pediatric hospital where we do dental procedures on children on a daily basis. I do not know what we charge patients, but the prices you quote seem pretty high; I suspect you may be falling into the trap that a lot of "self-pay" patients do; you are being quoted the full price for the procedure, whereas insurance companies have negotiated their reimbursement down to a fraction of that number. Here is a 60 Minutes story on the practice. You can work with the hospital to charge you the same price they do insured patients as well as work with your insurer to cover the procedure; the hospital should have social workers/financial counselors who can help you explore your options. In our hospital a lot of dental patients are covered by state Medicaid or other government programs. Even if they don't cover the entire cost of the procedure you still get to take advantage of the discounted rate they negotiate. You may have to delay the surgery some due to the qualifying period for these programs, but not by much. In our OR rescheduling a procedure this far in advance is done all the time as is delaying surgery to wait for insurance to get straightened out. I can't address the dental consequences of delaying the surgery but it is pretty common to wait for these things until all the financial glitches have been worked out.

Although you only addressed them tangentially, a couple of other concerns you mentioned are worth talking about. First, since it is only one tooth, MB is in pretty good shape. We had a patient the other day who needed a filling or extraction on every single one of his 20 baby teeth. That is an extreme case, but multiple fillings, extractions, and crowns are par for the course here. Second, if your dentist for whatever reason is reluctant to do this in his office under sedation, he is showing an appropriate level of concern for your child's safety. Since it wasn't the main question I won't get into details, but in general your child is safer under general anesthesia being watched by a trained anesthetist than they would be under deep sedation in an office setting. There are a number of AskMe's about children and anesthesia if you want to learn a little more.

Good luck, I hope everything gets straightened out.
posted by TedW at 8:10 AM on September 9, 2011 [2 favorites]

Baby teeth do a lot for you. They're placeholders, preventing crowding of the other teeth and helping the adult teeth come into their proper places.

Yep. I had a (I think the same one as your little dude's) deciduous tooth pulled because of damage when I was maybe four or five. The surrounding teeth crowded and when my permanent canine tooth came in on that side--it was the last to come in--there wasn't sufficient room and so it erupted higher up, above the other teeth (fang!). Braces fixed it.

I understand that primary teeth are important, but it seems like you've lost this one already. You could spend thousands to salvage it and keep it as an expensive placeholder.

I say get it pulled for a few hundred bucks and then buy a braces policy now on the cheap just in case little dude's teeth come in funky later on. If they don't, woo-hoo!
posted by resurrexit at 8:45 AM on September 9, 2011

Our now 3.5 year old irreparably damaged a front tooth via a fall on concrete at just past 2. He wasn't talking a lot at the time, probably due to ear infection related hearing problems. He has no perceptible speech problems now and has completely caught up in the speech department.

I was totally, 100% prepared to try to save the tooth or to get pediatric dentures or something. However, absolutely no one that we spoke to thought it was worth doing anything but pulling the tooth. I was very upset at the time about years with a missing front tooth and would have gone with any alternate opinion. He went to a highly recommended oral surgeon, was put completely under for the procedure, had no complications, and it cost about $400 total to have the tooth extracted.

FWIW, braces are an inevitability for our kids due to parental genetics. Personal opinion, though, I can't imagine spending more on a single primary tooth repair than a full set of braces would cost.
posted by pekala at 11:07 AM on September 9, 2011

Response by poster: Update: we took the little guy for a 2nd opinion, and the other dentist said she did not think the tooth needed a root canal. She was willing to try to remove the decay and cap it under just nitrous oxide. We did our best to prepare him, telling him stories, showing him videos of other kids on youtube, etc.

However, when the day came, he flipped out, and the nitrous was not working for him, first with mommy holding him and then with him strapped to a papoose board. At that point, she was willing to still proceed without any anesthetic, but we were not. Not with no painkiller and with him terrified, crying and begging us to let him "get down" from being strapped in. It felt like it would have been torture.

So we went ahead with the in-hospital day surgery with the first pediatric specialist. All went well, MB was very well behaved right up until the anesthetic, and was upset when he woke up afterwards. The procedure itself went well, the tooth did not need the root canal, and was able to be cleaned and capped, and three other teeth had cavities removed and filled. The dentist will be giving us a partial refund on the payment we gave, since the procedure went easier than expected.

The hospital took our insurance info, we will see what they say now once they get the bill. We have had a friend who helps people write insurance appeals offer to help us as well. If that fails, we will be negotiating with the hospital to try to get the rate that the insurance company would have paid.

Thanks all.
posted by fings at 8:53 PM on October 10, 2011

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