22 Sept 2006

Duncan's Dental Crisis

I noticed that Duncan was poking in his mouth a lot over the past few days, chewing his clothes and mouthing toys. When I looked at his teeth this morning, I thought the tooth was cracked. I called the community dentist and managed to get an emergency appointment. She was very accommodating, and Duncan was frightened at first, but we managed, with him sitting on my lap, to allow the dentist to have a good look round his mouth. It turns out that one of his molars is decayed.

He will need either a filling or to have the molar removed. I think it would be less invasive if he had a filling. However, there is no way he could have the procedure under local anaesthetic, so he will need a general anaesthetic, or to be sedated.

I'm worried about the risks here.
I'd like to know, if anyone has any advice they could share on similar experiences they or their children have had.

There's always something.


Anonymous said...

Awh! my poor boy. I'm going to the dentist on Tuesday and i'm a bit nervous my self and I'm all grown up! Don't have much advise expect to say that kids are the best ever at getting over anaesthetics and any time I work in A&E any kid that has to sedated for somthing that the adults find horrible, the child never remembers it. They're usually just thrilled to get a sticker ar something afterwards. x from me

Ruth said...

Removingit might be better unless it is a first tooth cos eventually the filling will need replacing. I have found with my ASD ones they come out of a GA like they have never had one. My eldest had a G.A and I could hear him chatting away comging back to the ward on the trolley. He won't need more than a quick whiff for a tooth out anyway.

ballastexistenz said...

Okay... I just had dental work done under general anesthesia a few months ago. A couple things went wrong, I have no idea how typical they are.

One: One of the reasons for the general anesthesia was that my mouth is really small (as in, has been mechanically widened at the bone level as a kid just to fit the teeth in and get my jaw aligned and they still didn't all fit), and they thought that, just mechanically, there was no way I could keep it open for the duration of the procedure (several hours). What they didn't tell me was, that there was a reason that my jaw couldn't stay open that long, and now I've got severe jaw pain and crunching and ripping noises coming out of it, and a lot of jaw weirdness (they call it "TMJ," but that's just the name of the jaw joint as far as I can tell). Of course, my jaw/mouth/etc wasn't quite normal to begin with either, but it was nothing like this, right now it's still in constant bad pain.

Two: Again with probably a smaller mouth/throat/etc than they anticipated (this isn't an autism thing, it's part of something else), they really screwed up with the anesthesia tubes. I think they used one that was too large. The back of my throat was very scratched up by the end of it, and I -- who can't normally stand pain meds enough to want to take them -- was on three different pain meds rotating throughout the day for weeks in order to be able to eat. Not because of the dental work, but because of the anesthesia tube.

They also scraped up the inside of my mouth a bit with the things they used to hold it open, I think, but that wasn't as bad. And, they screwed up with the anesthesia enough that I woke up in the operating room and heard them say things like "oh shit" and "get her out of here fast" before they wheeled me rapidly into the recovery room. (Same people screwed up with my friend's anesthesia in the opposite direction and tried to discharge her when she still couldn't stay awake, when she had surgery at the same clinic two weeks before. I was there when it happened, she was passing out and lying there shaking and they were trying to discharge her and telling her to "hurry up" and cramming food in her mouth when she couldn't stay awake enough to swallow. Really disturbing to watch.)

I'm not sure if these are typical things, but they're what I just experienced. I still would probably do it again (rather than the alternative) -- when my wisdom teeth have to come out, I'm sure it'll be something like this all over again -- I just won't enjoy it when it happens.

Oh, and when I first got a procedure like that done (I was a kid, had four teeth extracted because all the bone-moving and crap hadn't made room for my teeth -- and they're still today crowded even after the mouth-widening and the tooth removal) -- I woke up alone, with nobody in the recovery room, screamed my head off because I was disoriented and couldn't swallow, and got chastised for waking up in a panic. And there was nobody there, and someone was supposed to be.

Make sure you get the reputation and stuff of the anesthesiologist, and the clinic in general, first. Really, seriously, some people are better than others, some places are better than others, at this kind of stuff.

The Jedi Family of Blogs said...

B had his first filling 4 years ago when he was 6 & had it done under nitrous oxide (aka "laughing gas") followed by injected novacaine, which I highly recommend. He goes to a pediactric dentistry specialist who is aware of B's AS, etc. (& thanked me profusely for telling him...). Because I was a dental researcher in my "past life" he began seeing the dentist when he was 2 1/2, & so is pretty "ho-hum" when it comes to dental appointments :) I was upset when B needed the filling because it was an indication that B has inhereted my lousy tooth morphology, predisposing him toward cavities :( The dentist has a separate room for fillings with all sorts of distractions while the kids are being prepped & the nitrous administered. I sat with him the whole time & although B swears there were no needles involved, I saw the dentist put the novacaine in :) It took B a bit longer than the dentist expected to fully recover (he uses oxygen to bring them back), since he thought B could go back to school, but C & I decided to forget that when he needed an arm to wobble, smiling, out to the car. We took him to the diner for a milkshake instead... did I mention the dentist put sealants on the rest of B's permanent molars while he was under? :) In either case, B was fully recovered from the anaesthesia by mid-afternoon & has no bad memories of the experience, which is essential from my standpoint, since my own childhood dental experiences made me phobic (I see a dentist specialising in phobics).
Concerning pulling vs fillings... my experience as a researcher would make me lean toward the less-invasive process of filling the tooth. There are more follow-ups with an extraction, & if it's a permanent tooth, then you have to worry about how it'll be replaced. B has oral-motor issues that would make having anything that could come loose in his mouth, such as a temporary false tooth or bridge, a problem because he has only in the past 2 years stopped automatically swallowing anything loose in his mouth, like a hard candy. We've already made sure his future orthodontist understands this, & he's assured us that B won't have to wear any appliances that are removable. I hope this helps!

Hazel said...

Jude had a GA when she was 5. She locked her thumb in the car door, and when the door opened her thumb was a mess. I was worried about the GA and so asked what the risks were. I wished I hadn't asked because they bluntly told me everything, and I was very scared to sign the form allowing her to go to theatre. The biggest risk, as I remember, for a young child is upon going to sleep, and when waking up. They told me that children choke when the GA is administered. I went with Jude to the operating theatre and held her while they administed the drug. Immediately she fell limp, her head went back, and she started choking. They ushered me out of the room, told me it was normal, and in an hours time she was awake and ready to see me. She was so relieved that she didn't remember anything or experience any more pain. She was very sick for 24 hours, vomitting and white as a ghost, but it was only really 24 hours before she was back to her normal self again.

I had my wisdom teeth removed recently with sedation. I underwent that procedure twice. One time they gave me a lot more sedation than the other time. If you go for sedation, make sure they give him a good amount of it. I remember nothing from the first time. Until Steve led me out of the dentist chair and into a rest room, with another guy who was as high as a kite too. It was really just like taking drugs, I think. I dont remember any pain, although I could follow instructions such as "open your mouth wider". On the way home I tried to eat a hairbrush, thinking it was an ice cream! Yes, Steve loves to tell that story! I was wacked for days afterwards, from the sedation, but other than that it was fine.

Elderfaery said...

EEK! I couldn't read the comments cos they were grisley. Willow and Meadow have extremely resilient teeth..so much so that i have noticed that if they are brushed too often that they appear to weaken slightly. Ash is a different case. He is the only of my children who has been allowed sugary stuff before the age of three and i can see it in his teeth. *sigh* I had two fillings when I was a kid but those two teeth had to be pulled when I was in my teens..I opted for a GA...and you might as well consider it an option....but then..couldn't the dentist at least try with a local first and see if it is okay? If it doesn't work out then there is always a GA to fall back on.

María Luján said...

Hi Shanna
My son had cavities in three teeth.Two of these cavities were growing even with repeated efforts to increase Ca in his diet and other nutritional approaches.
When the cavities were small, the dentist filled one of them- with my son asleep with no anesthesia. Unfortunately, the filling provoked an infection and it should to be removed with a concomitant treatment with antibiotics. We are doing a daily cleaning with an special gel and toothpaste and also a careful cleaning of the cavities- When my son is sleeping. Two of his three affected frontal teeth were necrosed and therefore decayed literally in pieces. The filling was an special one, with an special product-without allergens or metals. However, for us, the filling was a bad idea. Now, his third tooth is also decaying. Because these are not the definitive teeth we are trying to improve his mineral status and general health. We are planning a procedure to have with the dentist about the definitive teeth (probably fluoride treatments and special gels and daily treatment beyond the toothpaste). Probably the unnoticed medical conditions during the first/second year ( my son is celiac and milk allergic) affected very negatively his teeth.
Ma Luján