Could Dental Anesthesia Possibly Kill My Daughter?

April 15, 2013 7:47 AM

My 9-year-old autistic daughter has 5 cavities, three in adult teeth. The dentist wants to put her under general anesthesia. While this would certainly be way more convenient for the dentist, and less hellish for her, I'm concerned about the dangers of anesthesia. I've read about hospital patients suffocating in anesthesia screwups. Is that a possible outcome in dental anesthesia, or is that a different procedure? Do I have a reasonable concern? Should we try to do it normally? Snowflake details: on the spectrum, she's definitely a bit more sensitive and rigid than neurotypical kids, but not drastically so. On a side note: how important is it to fill cavities in baby teeth she will probably lose in a year or two?
posted by musofire to Health & Fitness (21 answers total)

General anesthesia is a generally accepted as safe practice that's used safely many, many thousands of times every day. Don't believe fear mongering about it :)

I can't speak to the necessity of filling the cavities though, of course.
posted by wrok at 7:50 AM on April 15, 2013 [8 favorites]

Do you know another dentist who could give a second opinion?
posted by jquinby at 7:53 AM on April 15, 2013

There are often dentists who specialize in working with children/young adults with ASD and other special needs as part of their practice. Are you near an academic medical center or children's hospital? They would likely know of specialists in this area who could at minimum give you a second opinion about the need to fill the teeth and the need for anaesthesia to do so.
posted by goggie at 8:02 AM on April 15, 2013 [3 favorites]

**I am very much not a dentist.** Has she ever tried undergoing dental procedures with nitrous oxide? Does your dentist even use it? Of course it has risks too, but I would think they would be far less anxiety provoking for you than general anesthesia. Personally I would try to find an alternative if possible when you are just talking about a few cavities; what if she has appendicitis next month and needs an operation with anesthesia again? Many kids who tend to freak out at the dds get relaxed and really do well with nitrous. Some dentists don't use it any more, in part because there is some accumulated risk to them, I believe -- which is of course understandable -- but if this were my kid, I would find a dentist who uses nitrous and have him do the fillings in a couple of sessions. As for the baby teeth thing, my kids' dentist said deep ones needed to either be pulled or filled because of possible infection. Shallow ones he left and tracked.
posted by third rail at 8:02 AM on April 15, 2013

General anesthesia should be administered by an anesthesiologist. Some dentists are trained and licensed as anesthesiologists, and some have dental anesthesiologists on staff. I would ask about this, but as long as the answer is satisfactory, don't worry about it. Every single time she rides in a moving vehicle she's at far greater risk than going under anesthesia.
posted by amaire at 8:05 AM on April 15, 2013 [15 favorites]

Our eldest son had this done when he was 3 years old. We were worried, but he was fine. The whole thing was done in an operating room, though, and I suspect the same will (or should be) the case with your daughter.
posted by KokuRyu at 8:06 AM on April 15, 2013

Yes, general anesthesia carries risks, including an extremely small risk of death, and those need to be discussed with your medical professional in the context of the operation in question.

This article gives a clear overview of what exactly the risks are rather than giving you an overly simplistic "yes it's safe" or "no it's not safe".
posted by emilyw at 8:07 AM on April 15, 2013 [2 favorites]

General anesthesia is a generally accepted as safe practice that's used safely many, many thousands of times every day. Don't believe fear mongering about it :)

I disagree that it's "fear mongering". There are risks associated with putting children (as opposed to adults) under general anaesthetic, and it's something that no parent can ever relax about. However, as someone else noted, there also are other risks we take with our children every day, such as driving around with them in an automobile.
posted by KokuRyu at 8:09 AM on April 15, 2013 [1 favorite]

Having had a very traumatic dental experience at about the same age -- which has affected my ability as an adult to see the dentist when necessary and take proper care of my teeth -- I would say that minimizing trauma to her should be your utmost priority.

I would definitely get a second opinion on fillings in baby teeth, though.
posted by fiercecupcake at 8:13 AM on April 15, 2013 [3 favorites]

Be sure you know what's involved, and what's involved in the articles you're reading-- does your dentist's "general anesthesia" consist of nitrous (laughing gas) or "twilight" IV anesthetic? I'm guessing it's not hospital-level, respirator-required full general, as administered by an anesthesiologist, which I'm also guessing is what most articles are about; it's probably sedation/analgesia. This wiki article breaks it down.
posted by supercres at 8:15 AM on April 15, 2013 [2 favorites]

Responding to your side note question...
IANADentist, but from what I've read, baby teeth with cavities should be filled, as a cavity is considered an infection which could spread. Filling the tooth allows a healthy pathway for adult teeth to grow, as well as prevents potential problems for your child down the line, specifically tooth aches which can also affect speech and chewing. Just something to consider...
posted by MeatheadBrokeMyChair at 8:21 AM on April 15, 2013 [3 favorites]

Different people react to anesthesia in different ways. My brother and I were both completely under when we got our wisdoms out (I was 17 when mine were pulled...I think my brother was 16) and everything went fine during.

Coming out of it, though, apparently I (and I don't remember this at all) started punching and kicking people, and even popped one of the nurses in the jaw. I remember being VERY MAD ABOUT EVERYTHING on the drive home. Once it wore off, I was more or less back to normal (just achey and tired).

My brother, on the other hand, was extremely happy. He kept doing tricks in the wheelchair they made him sit in, and started hitting on the nurse (who was our mother's age). He was super energetic and peppy for the next hour.

Just saying this so you have an idea of what to expect (which is to say, expect anything) when your daughter comes out of the procedure.
posted by phunniemee at 8:23 AM on April 15, 2013

She could be alternatively restrained and her mouth wedged open with rubber spacers. How comfortable she will be is really unclear.
posted by parmanparman at 8:36 AM on April 15, 2013 [1 favorite]

Best answer: I am an anesthesiologist in a children's hospital and it is very common for us to do general anesthesia on children for dental work; about 3 days a week we have a room set aside for dental patients and occasionally 2 or even 3 rooms (out of 7 locations in our OR). The reasons for doing it under anesthesia range from the sheer magnitude of the work to be done to behavioral issues with the patient to the patient having some medical condition that the dentist is not comfortable dealing with alone. If anesthesia is administered by a trained provider (based on your profile you are in Canada, where all anesthetists are physicians; no CRNAs or AAs) it is extremely safe. I often tell parents that their child is more likely to be injured in a car accident on the way to or from the hospital than during their anesthetic. Having said that, there are things that can increase the risk. First of all, when you say "general anesthesia", do you mean anesthesia administered in a special location by an anesthesiologist as opposed to sedation administered by someone on the dental care team? The former is far safer than the latter, even though it seems like "sedation" is less invasive than anesthesia. The difference is that with an anesthesiologist involved you have a person whose entire attention is devoted to monitoring the patient and keeping them safe as opposed to possibly being distracted by what is going on with the dental procedure. Also, if your child has any additional problems, especially with the heart or lungs, that can increase their anesthetic risk, sometimes significantly. As long as any other health problems are addressed beforehand, though, the increased risk is minimal. The best way to allay your fears is probably to speak with the anesthesiologist ahead of time. They will have access to enough information to tell you if there is anything specific to worry about and answer any questions you have. Any physician who works with kids spends a certain amount of time allaying concerns of parents; it just goes with the territory.

We have done many, many dental procedures in our hospital since it opened in 1999 and I am not aware of any deaths and only one major complication; that was in a child with other serious medical problems. If my 8 year old daughter needed dental work under anesthesia for some reason, I would not hesitate to consent.

As always with this sort of question, feel free to ask for more details if needed, either here or via MeMail. A good resource on anesthesia for parents and families is at the Society for Pediatric Anesthesia's website.
posted by TedW at 8:40 AM on April 15, 2013 [21 favorites]

You need to fill cavities in baby teeth because the decay/infection can spread. Unless the tooth is loose and on the verge of coming out, you have to fill those cavities. My sister had a few baby-teeth cavities filled in.
posted by ablazingsaddle at 8:46 AM on April 15, 2013

Baby teeth cavities untreated can be extremely painful and the bacteria can end up damaging the emerging adult teeth. Unless her tooth is wobbly enough to be pulled shortly, treating them is healthier.

My daughter had five or six baby teeth pulled for major damage at the age of nine under GA. I knew the risk was reasonable and that it was for a relatively straightforward short proceedure that would be very beneficial, so I was fine with it. I had GA as a kid for ear problems, and remembered it as an alright experience too.

However, she woke early from the sedation in the recovery room and freaked out - mouth full of blood, surrounded by strangers, feeling woozy. I heard her screaming from the waiting room and sprinted down to grab her - I don't even remember quite what happened, just one minute I heard her and the next, I was in the elevator back to her room, with her held in my arms, half-conscious and drooling blood all over my chest. I think I just grabbed her and ran past all the nurses, I know it got a bit complicated with them following us up to the room and lots of yelling (mostly me when they tried to take her out of my arms.)

So while they probably won't let you in the OR - you would be very distracting, in the way and possibly dangerous, they could let you accompany her until she goes under, and then meet her again in the recovery room as she comes round. I have had GAs and sedations as an adult, and it has always been much easier when the hospitals have allowed my husband to be there when I come around, just to hold my hand. With a sensitive autistic child, that seems like an accommodation worth asking for.
posted by viggorlijah at 9:14 AM on April 15, 2013

For all its worth, my autistic son had a dental procedures performed while under general anesthesia, several years ago as a teenager. The procedure was done in a hospital, and was completed without incident. Because he was completely under, the dentist was able to get quite a bit of work done that he never would have been able to do inside a normal dental office. It was a little scary for us to wait through, but we had complete confidence in this particular dentist as he came highly recommended being someone who specializes in working with the special needs population.

So yeah, it's ok to be worried. But for our family, at least, the minimal risk was far outweighed by the reward.
posted by Lokheed at 9:34 AM on April 15, 2013 [1 favorite]

As to the necessity issue, unhealthy teeth are a leading cause of surgical complications and a surprisingly significant contributor to health problems in general. If your daughter has cavities, you want them dealt with sooner rather than later. Period.
posted by valkyryn at 10:25 AM on April 15, 2013

If this is an office setting, make sure they keep her warm enough. When I had this done (as an adult), I had to wear short sleeves, the office is cool (the dentist is working, so he should be kept cool), the IV was cold, everything added up to me shivering a lot before the procedure and when I woke up. This was not fun for me, and probably less fun for your daughter.
posted by amtho at 11:56 AM on April 15, 2013 [1 favorite]

> She could be alternatively restrained and her mouth wedged open with rubber spacers. How comfortable she will be is really unclear.

No. That would be torture. Think about what you're suggesting, here, for a moment.
posted by The corpse in the library at 2:39 PM on April 15, 2013 [3 favorites]

this happened to us with our daughter at a much younger age - 3 weeks before her 3rd birthday. We freaked out, we got a second opinion. The worst part is recovery after GA. It turned out great. Our daughter was begging to run outside and play 3 hours after we got home. This was done at a hospital.

The second opinion dentist said "you can take her to GA and have the results be better and your daughter not traumatized...or you can find a scrupulous dentist who will tie her down to a board and gas her, which in my opinion...is barbaric."

Incidentally, The second opinion dentist didn't charge us and we eventually switched to him for our adult care.
posted by couchdive at 7:16 PM on April 15, 2013