Should my seven-year-old son's dentist knock him out?
January 3, 2012 7:08 PM   Subscribe

Just got home from a dentist appointment with my seven-year-old son. Five of his baby teeth are crowding the rest of his teeth and need to be extracted very soon. But he's extremely anxious at the dentist, and after today's ordeal, they're recommending putting him completely under using IV sedation with an on-site MD. I had IV sedation for my wisdom teeth, and it was amazing, but I'm flat-out terrified to knock out my little boy. He's never had anesthesia of any kind. Is it worth doing? Are there any risks or caveats I should know? Would it be better to stick with oral anasthetic? Help!
posted by waxpancake to Health & Fitness (26 answers total)
Best answer: It's up to you to determine if the risks of anesthesia are worth it for your son, but I can tell you that if I'd been "knocked out" at the dentist as a child, I'd be a lot more apt to go to the dentist without fear now, as an adult. Fear/anxiety about the dentist caused a lot of my absenteeism from twice-yearly checkups well into my late 20's. If it were my kid, I'd be much more apt to put him under sedation and have him wake up his normal happy self than cause or exacerbate a lifelong fear/distrust of dentistry.
posted by juniperesque at 7:21 PM on January 3, 2012 [2 favorites]

Best answer: So I'm your kid, 20 years later. I always got really, really nervous at the dentist. (In fact I still do.) Way too many teeth in too small a space. I was seven. They put me out entirely, and I woke up with 7 fewer teeth and everything was fine and I made a freaking mint from the Tooth Fairy.

The thing to keep in mind is that if he's really anxious at the dentist, imagine how anxious - and by anxious I mean freaking out and terrified - he's going to be if his mouth is pried open by a metal contraption and people are moving all around him, keeping him still, moving scary stuff in and out of his mouth. I'll tell you right now, speaking as someone who had it done, the idea of going through that other than totally unaware freaks me out hardcore, and I'm a big smart adult who does his own laundry and everything.
posted by Tomorrowful at 7:21 PM on January 3, 2012 [6 favorites]

There are always dangers when it comes to general anesthetic, but considering your son's honest anxiety about the procedure, if it were my son, I'd opt for general. Be sure your dentist knows your son's accurate weight before he puts him under so he can accurately guess the proper dosage (and I'd keep a video camera for the car ride home).
posted by crunchland at 7:23 PM on January 3, 2012 [1 favorite]

Best answer: I got five teeth extracted as a kid a little older than your son, while awake, and it was really not that great. Lots of blood and gauze and tugging and concern that it might start hurting even though it didn't. Also the big mouth needle. My mom was dentally anxious and so I went in expecting the worst and even though baby tooth extraction is less of a big deal than adult teeth, there's still a lot of pulling going on. I would try to talk to him about likely side effects of anesthesia [he might wake up feeling headachey or sick to his stomach, that is normal and you and/or mom will be RIGHT THERE] but I think it's worth strongly considering it. Also, I assume you're on this but different dentists can really make a huge difference in terms of kids' stress levels for this sort of thing, make sure your kid is clicking with his dentist.
posted by jessamyn at 7:24 PM on January 3, 2012 [1 favorite]

I dearly, dearly wish we'd gone that way for my stepson during his period of tough dental procedures. It was a nightmare for EVERYONE to try to do it with him awake. I need GA just thinking about it. :(
posted by rosa at 7:27 PM on January 3, 2012 [2 favorites]

If your son is going under general anesthesia this will most definitely be provided by an anesthesiologist (as you mentioned). So if you still have concerns, talk to him/her before you make your decision. They will most certainly be able to allay your fears.
posted by yawper at 7:30 PM on January 3, 2012

Note: my dad is an anesthesiologist. Often people don't realize just how much information is available to them re: anesthesia. There are many different drugs that the MDs have at their discretion and your doctor can explain the different options and side effects.
posted by yawper at 7:33 PM on January 3, 2012 [1 favorite]

I agree with others suggesting the GA approach. I don't think getting shots in the gums makes anyone have a more favorable opinion about dentists.
posted by oceano at 7:36 PM on January 3, 2012

Best answer: Definitely have a conversation beforehand and get answers to these questions (caveat: I'm someone who feels better knowing every last detail - some people do not):

- How many times have you done this procedure? On children?
- What complications/side effects have you seen?
- What happens if there are complications?
- What are the different drug options for sedation? For pain management?
- What monitoring do you do during sedation? Heart and brain?
- What is the transport plan in case of an emergency?
posted by judith at 7:39 PM on January 3, 2012 [2 favorites]

Reinforcing what Jessamyn mentioned, it might be worthwhile to get some recs for another dentist if your son's been anxious with this one. Our son's dentist was amazing; and it started the second we walked in the door and everyone treated him exactly how he needed to be treated to feel respected and comfortable. It was like I didn't need to be there which is not how he normally behaves! He (also 7) had no idea what was going on during his check-up and also his two subsequent visits for cavity fillings, including a bad one that needed a crown. The dentist told us they have patients who grow up and go off to adult dentists and it's a huge shock.

I don't have direct experience with GA but thinking back to my extraction it does sound like the best course of action in his situation and will be nicer for everyone involved. Talking him through the procedure as an intelligent human being (which I'm sure you do) is probably one huge trick of my dentist's office success with kids not being anxious.
posted by girlhacker at 7:41 PM on January 3, 2012

At the risk of being obtuse: by IV sedation, do you mean an unconscious twilight, or actual GA? For example, I went into a twilight for my wisdom teeth extraction, but it technically wasn't GA.

Either way, I've been under real GA as well, and both are fine. Modern medicine is pretty awesome sometimes. Sure, there are risks with GA, but there are also risks with driving a car to the dentist.
posted by Sticherbeast at 8:02 PM on January 3, 2012

Apparently, my dentist wanted to put me under to do some work when I was around that age. I was freaked out by the needles, etc. I'm told I struggled enough that the dentist was no longer willing to go forward without general anesthesia. My parents found another dentist who was much more subtle with the needles and such and there was no trouble at all. I couldn't even tell when the needles were being inserted. I remember even around age ten carefully observing to figure out when he was doing the injecting, without any success. So if you can, ask around for a dentist who works well with kids and give them a try. I'm a person who didn't react well to anesthesia later in life, so I am glad my parents found a better dentist.

That's my anecdote.
posted by ssg at 8:11 PM on January 3, 2012 [1 favorite]

Well, here's the thing. I like my dentist and he's really good and I don't have the fear a lot of people have of them, but when he's poking around inside my mouth and doing something serious to my teeth, it feels really freaky and weird. If I was that anxious, I'd be terrified, especially with all the blood and gauze and tugging and giant needles and whatnot.
posted by Ghostride The Whip at 8:11 PM on January 3, 2012

This past spring I had to have my son sedated to get some dental work done, as there was no way he would've sat through the procedure (he has anxiety and other issues). The dentist not only did the filling and the crown, but also was able to get his teeth really clean and put on sealants.

It was upsetting for me, of course, and he was loopy the rest of the day, but if he has to get another filling we'll probably do it the same way again. I would definitely do it for five extractions. Hell, if I had to have five extractions I'd want to be as out of it as possible.
posted by The corpse in the library at 8:13 PM on January 3, 2012

I'm not really sure why so many people are bringing up risks of general anesthesia, since that's not what we're talking about here. OP, it sounds like you realize that since you specifically said, "IV sedation." Patients under general anesthesia are intubated, which would make dental procedures...challenging.

Anyways, this is really one of those conversations you need to have with your child's medical providers. What about a conversation with his pediatrician?
posted by pecanpies at 8:14 PM on January 3, 2012

I had just one baby tooth pulled around your son's age with only the oral anesthetic. I felt like I was being stabbed in the gum with a dagger. I don't actually know if that pain was the Novocaine injection or if that was the pain of the tooth being removed. While the tooth was being pulled out, it hurt so bad and for some reason everything in my field of vision looked green during the worst of it when I opened my eyes a tiny bit. Needless to say, it was awful. For years I thought of that as the worst physical pain I'd ever felt. And I didn't go into it with any dentist-anxiety issues.

When I was older, I ended up getting my wisdom teeth pulled without getting knocked out (I had the twilight stuff but was awake and aware during the procedure), I think mainly because I had a fear of being knocked out because I never had been before. I was worried I'd never wake up. It wasn't until a few years after that, when I had surgery that required that I be knocked out, that I realized it can actually be pretty great. Take all thus as you will.
posted by wondermouse at 8:16 PM on January 3, 2012

There are different gradations of general anesthesia (general = unconscious and not able to follow commands.) Ask the dentist about the feasibility of using an LMA (laryngeal mask), not sure whether that will work for an oral procedure but if he could use a combination of LMA, IV and local, the "hangover" effect will be less severe. Also be sure that the dentist is using a board-certified anesthesiologist!
posted by tatiana wishbone at 8:24 PM on January 3, 2012

More anecdata: I was *not* a nervous kid, but I guess for the convenience of the dentist (I was having a bunch of teeth removed) when I was 8 I was put under IV sedation. I found it really fun.
posted by anildash at 9:04 PM on January 3, 2012

I had 5 teeth removed at around 8 or 9, without sedation, and it was horrifying. My face was numbed from about the eyeballs down, but I was really scared and kept telling the dentist I could feel it. He kept saying that wasn't possible, and gave me I don't know how many shots of novocain. when I think about it now, what I realize is that I could feel--and hear!--the tugging and tearing, the pressure of it, but not the actual pain. The dental hygienist let me grip her index finger through the whole ordeal, and I remember the little half-moon marks from where my nails dug into her. I was not a kid who was afraid of the dentist, and am not afraid now, but it was still pretty harrowing.

On the other hand, I had my tonsils out under GA at 5, and that was pretty scary, too. The before and after, of course, since I had no memory of the surgery itself.

There are definite risks to sedation of any kind. You should be talking to the dentist and the MD who will be doing the work and ask them a million questions. I had surgery last year, and the surgeon totally downplayed the risks of GA, but when I pressed him, he gave me all the details. I have an 8 year old and I honestly can't say what I would do in your place. I'd need a lot more fact-finding to make myself feel good about a decision either way.
posted by looli at 9:05 PM on January 3, 2012

We did a GA to extract five or six rotten teeth from my daughter when she was about ten, because she didn't speak much English at that time and was already iffy about medical people. The risk of the GA weighed lower than the excruciating pain she suffered from her teeth to us.

However - she woke up early from the anesthesia, in an OR with a mouthful of blood. I heard her screaming in fear and ended up grabbing her from the gurney and carrying her back to her room, yelling at the nurses and doctors. It was horrible.

Still, for her, even with the unexpected early wake-up (she and her siblings are ridiculously quick on medication, and often need higher doses), the GA extraction was the best choice. She doesn't remember any of it immediately after she woke up properly, and is normal-nervous fine with the dentist for cleaning and the very occasional filling.

Talk to the doctor about the exact method of anesthesia, how long it will last and what the percentage of risks are in healthy children (it's a whole other ballgame if you have underlying respiratory issues.)
posted by viggorlijah at 9:34 PM on January 3, 2012

Personal experience:

I had trouble with my baby teeth in that they refused to fall out, and I ended up having to have the majority of them pulled out by the dentist in order to make room for my adult teeth.

I hated it. They would put a cotton swab in my mouth with this purple, horrible-tasting numbing jelly. I spat out it out the first couple times, it tasted so bad. But even worse was the serious numbing medicine they used was administered through what appeared to be a long needle that, as a panicked child, I was sure had to be at least six inches long and went clean through my jaw. (Anxiety always makes needles seem longer.)

This is my recollection of my worst experience at a dentist:

I remember them trying to pull a tooth and realizing that they couldn't because it was fused to the bone. I was sent to the oral surgery department (same building), whom I was told would be able to address the problem. When I arrived, they saw how upset I was and asked if I wanted laughing gas. I accepted.

My panicked, early middle school-understanding of what happened was that I did not get the laughing gas because they simply forgot to give it to me, and that they removed the tooth by essentially drilling away at it (not sure that this is entirely accurate, but that's what I understood at the time). When I got home that day, I found a small, white piece of something on my shirt. Then I realized that it was a shard of my tooth that had been drilled to pieces. I was upset and hated the dentist for a very long time after that.

I don't know whether general amnesia is right for your kid, but I sure wish I had had it.
posted by hypotheticole at 9:49 PM on January 3, 2012

Yes, put your child under for this. My 8 year old daughter is terrified of the dentist (bonus points: she has cognitive delays which make reasoning near impossible), but had no problem with general anesthesia and recovered very quickly.
posted by plinth at 2:37 AM on January 4, 2012

Best answer: I had two babyteeth pulled without anesthesia. My complete panic attack in response to the tugging, cracking, blood, etc of the first one had my mother so upset that she went out to the waiting room for the second one, leaving 7 year old me alone to deal with the second. Not fun, not cool.

The next four, a year later, I was under for (using an IV). 100% better. Everyone went home happy. Do it. Just do it. Don't even think twice about it.
posted by olinerd at 5:24 AM on January 4, 2012

After rereading, I'm curious as to whether or not the child is actually anxious about the dentist, or if he's just reciprocating the emotional state his mother is creating.

Children don't really know what to expect, so they're blank slates. If the parent is showing fear, or anxiety, or humor or whatever, then the child will simply reflect that, giving parent evidence that the child is feeling the same way they are.

See also: confirmation bias.

First things first: Stop worrying. Then get your son the medical/dental treatment that's been recommended by a medical/dental professional. If you don't think he needs it, then get a second opinion. Otherwise, you're just creating more anxiety/fear/whatever for your child to reciprocate.
posted by Blue_Villain at 6:28 AM on January 4, 2012

Response by poster: Blue_Villain: Funny that you assumed my wife was the problem! She's actually very laid-back about it; I'm the one that gets most anxious about it. But both of us try to keep things light and fun, and his dentist has been amazingly sweet, but he just doesn't like people messing with his mouth. Gets very scared.

Thank you for the advice, everyone. Sounds like the clear consensus is IV sedation, after we've talked over risks with the anesthesiologist.
posted by waxpancake at 10:44 AM on January 4, 2012

Definitely talk to the anesthesiologist. You may think of GA as being this ordeal, with long slow wake-up recovery, but it's not all like that. Most dental sedation only lasts as long as they're pushing the drug; once it's discontinued you're up (if fairly stoopid) within a couple of minutes.
posted by Lyn Never at 9:32 PM on January 4, 2012

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