Child requires several teeth extracted -what are the options?

[aliasojo]

Dentist referred child (9) to hospital, hospital recommend several teeth to be extracted and say own dentist will do this and the hospital will see again afterwards in a few months time, to fit a type of brace.

Child is terrified at the thought of extraction, but hospital just say a type of gas will be used (child will be awake but 'floating') along with numbing gum injection.

What are the alternatives these days?

[the devil made me do it]

Woa the alternative is to make sure the teeth are cared for in the first place, then there would be no need for extractions.

[annie2005]

Woa the alternative is to make sure the teeth are cared for in the first place, then there would be no need for extractions.

Some of us have medical conditions which cause the teeth to crumble and get infected. You have no idea of the misery involved.

An option is to ask your dentist about is a referral to a specialist dentist dealing with the utterly terrified. My cousin got a referral to one of these NHS specialists and swore by him. They can give special sedation not allowed to be administered by a normal dentist. Personally my dentist teaches at the dental hospital so I wasn't bothered by the pain and just got a special prescription from the doctor for a tranquillizer to be taken on the night before and the morning of the extractions. But then my jaw was broken and extractions on an already broken jaw aren't pleasant.

As to the gas or other sedation. Well the problem is that you don't know how you are going to respond until you've had it once. My mother goes out like a light. I get very relaxed and happy but couldn't have it with all of my extractions due to other medications I was on. Some people however fight it and then it's not effective. Is your dentist a good one? For children they will sometimes take the teeth one or two at a time? It's worth finding out the policy in your practice as dental care varies hugely from area to area.

Personally I would do some research because there are a lot of options out there which just didn't exist even a decade ago. Also if there is an infection involved they sometimes now like to begin treating that even before they do the extractions. Not only is it safer for infection spread it makes it less painful to work on the mouth.

Good luck and keep in mind that once the healing is over with any amount of pain is worth it. I speak here as a woman whose dentist finally agreed to extract all of her remaining teeth as a health hazard. That man made me so darned happy even having to re-break my jaw in three places due to complications. It's really worth while to keep on stressing the end of the pain once the teeth are gone and any infection is dealt with.

Forgot to say. If the 9 year old has ever had any previous sedation or anaesthetic then that will help predict their reaction to the gas. Whether they might be frightened and fight it or have any good memories of other hospital staff putting them under too make it less scary. If there is a history of problems with sedation and that is medically supported then you might find your dentist more than willing to make a re-refferral to a specialist rather than taking a risk with a potentially problematic extraction. It's worth asking your dentist if there are any relevant factors which determine their choice of treatment. So that you can have the information to hand before they see your 9 year old.

[Teerah]

Hi aliasojo, it really depends on the reasons for the extractions. If it is for orthodontic reasons then there prob isnt any other option other than what has already been recommended by the hospital. If the teeth require removal due to infection or decay I would have thought that there should be an option for GA extractions. This is certainly the case in Northern Ireland.
Why did your dentist refer to the hospital initially?
The gas you mention is the laughing gas or nitrous oxide which is useful in many circumstances but I find not terribly good if the patient is extremely anxious. Oral sedation is not recommended for children as it can be counterproductive. You need to go back and discuss it with your own dentist as they will know best what services are available in your area.

[beckyandjack]

are these orthodontic extractions? the relative analgesia (i think that's what you mean by the gas) is very effective in this age range of children, it makes you feel like you've had a few pints! It means that the child would be awake and able to communicate with the dentist but care a lot less about what is going on.

IV sedation is not relly used for children this age and the only other alternative is a general anaesthetic which carries it's own risks.

Really a child who is about to undergo orthodontic work should be able to accept simple extractions under local anaesthesia or relative analgesia. If your dentist doesn't offer this then they can be referred to somewhere such as a community dental service who can provide this. Only complex extractions should really be undertaken under a general anaesthetic or at least the child to have tried to have the teeth extracted ubde local/relative analgesia.

hope this helps

[beckyandjack]

oops crossed posts, too slow at typing!!!!!

[Toothsmith]

Orthodontic extractions will never be done under a general anaesthetic.

Putting a child to sleep to have teeth out has risks - as mentioned above.

This is acceptable if the teeth are diseased, and the child is in pain, but it is not an acceptable risk just to straighten a kids teeth up a bit.

Local anaesthetic and happy gas should do the job fine, but if it doesn't, then nothing will be lost by waiting for the child to grow up a bit and doing the treatment when they're a bit older.

[aliasojo]

Woa the alternative is to make sure the teeth are cared for in the first place, then there would be no need for extractions.

Your comment made me angry and I was about to post a reply based on that anger. Fortunately my good common sense kicked in and I will only ask that since you obviously base your advice on kneejerk assumptions, then please dont post on this thread, your advice is embarrassing.

[jackieb]

Woa the alternative is to make sure the teeth are cared for in the first place, then there would be no need for extractions.

My 13yo daughter has to have teeth removed before she gets her permanant brace. At the moment she has a temporary, removable brace for 9 months to widen her palate, as it's kind of narrow. She has too much teeth for the size of her mouth. Please think before you post.

She was told that normally they don't do extractions under general anaesthetic for cosmetic work, but as she had a fear of the dentist (she used to be terrified, but we now have a super dentist who explains what she's doing - she's even had a small filling without any pain relief! ) we were told she might get them out under general aneasthetic. It depends on how she's feeling. Personally, I think she might manage to get them extracted with local anaesthesia. Her new dentist is that good with her. Our last dentist was horrible with her. He froze her mouth but he called her a big baby for crying, and said she was too old for that, and then refused to finish the job.

[aliasojo]

Orthodontic extractions will never be done under a general anaesthetic.

Putting a child to sleep to have teeth out has risks - as mentioned above.

This is acceptable if the teeth are diseased, and the child is in pain, but it is not an acceptable risk just to straighten a kids teeth up a bit.

Local anaesthetic and happy gas should do the job fine, but if it doesn't, then nothing will be lost by waiting for the child to grow up a bit and doing the treatment when they're a bit older.

Toothsmith, I've quoted you as there are a couple of points I'd like to reply to. :)

Both my eldest 2 (now 26 and 19) had teeth out for the same reason, under general anaesthetic at the hospital years ago when they were around a similar age. Which is why I was surprised the hospital didn't mention it for the youngest. :confused:

Youngest has a double row of front teeth both top and bottom. Her baby teeth show no sign of falling out naturally (although she has lost a couple, it's not enough), her mouth is very small and her second teeth are coming in far too far back behind the front ones and also are coming in very squint as there is just no room for them. She is getting a hard time at school from the other kids because of the state of her mouth and the hospital say it would be better for her to have several removed at this age to make space so that a few years of growth might help before the serious orthodontic work has to start. She wil have to have a type of brace now and also the train track type at around age 13.

Thank you to all for the helpful advice btw.

[Toothsmith]

Chances are the rules probably weren't as strictly adhered to 14ish yrs ago when eldest had it done - also in 1994, GAs were still done in dental practices, so there wasn't as much of a backlog of 'emergency' GAs in the system as there is today, now that they're only allowed in a hospital setting.

Probably the same reason for your 19yr old getting away with it - but that one does surprise me a bit.

Was the necessary orthodontic work quite extreme?? I can't see how just a bog standard 4 adult premolars out would have justified a GA.

[aliasojo]

Tbh, I cant remember how many teeth the eldest two got out. :o We do seem to do quite serious overcrowding in our family though. :rolleyes:

I wonder if there were different practices in Scotland and England years ago? I remember friend's children having similar experiences in those days.

The youngest is to get at least 6 out btw. Wont that mean she'll be in the chair for rather a long time? I honestly dont think she'll cope although I'm obviously being as positive as I can be when discussing it with her.

[pavlovs_dog]

poor little love - she's going through the mill a bit lately isn't she?

no advice, just hugs :grouphug: keep your chin up chuck

[spender]

My 10 year old had two abcesses where the baby teeth would not come out and the new teeth were trying to push up. Had referral to a dental centre and could have an apointment in about 14 days on NHS. However paid for fast rack, had a injection in the hand, out like a light, went to phone hubby but did not have time to get through before they called me into recovery. Very quick and seemed a painless way for him, just had a quick grizzle with the scratch of the initial needle which lasted a few SECONDS before he was out. There was an anethestic admistering the drugs.

[aliasojo]

That seems much less traumatic to me spender. I will need to have a proper chat with our dentist to see exactly what is available in our area, NHS or private if need be.

[Toothsmith]

It's not just an NHS rule.

I would be surprised and - to be honest - horrified, if you could get teeth taken out by GA for orthodontic purposes.

Lets be honest - it's your fears that are coming to the surface here, not your child's.

RA is an excellent way of doing something that is very routine, and will be done in no time at all.

It takes me about 2-3 mins to get 4 adult premolars out of a 12 yr old once everything's gone numb (And the numbing process is generally pretty easy as well so long as Mum is kept at a distance and not allowed to crush the child's hand as it happens :D). Kid often doesn't even know I've started when I've finished!

Stay in the waiting room, and let them get on with it.

[aliasojo]

Lets be honest - it's your fears that are coming to the surface here, not your child's.

It takes me about 2-3 mins to get 4 adult premolars out of a 12 yr old once everything's gone numb (And the numbing process is generally pretty easy as well so long as Mum is kept at a distance and not allowed to crush the child's hand as it happens :D). Kid often doesn't even know I've started when I've finished!

Stay in the waiting room, and let them get on with it.

Please dont insult me Toothsmith. You dont know me or my daughter therefore you have no business making sweeping statements like those above. I am no silly ditzy teenager. I am a middle aged woman who has to deal with people with disibilities and irrational fears and it's my job as their carer and parent to do this in the best way possible.

I do appreciate your advice on dentistry but you dont know enough about us to comment as you have.

[DizzyMum]

Hello,

My son had three teeth out for orthodontic reasons about a year ago when he was twelve. All were done at our dentist with a local anasthetic (sp!?). He's never needed anything more than a check up in the past so, it was all new and quite daunting for him.

We had two appointments - the first were for two baby teeth and because they have no roots it was very quick and easy. The second appointment was for an adult tooth which was a bit harder because of the longer roots but, because the baby teeth had been so straightforward I think it helped.

Also, we've got a good dentist who's nice and just got on with it with no fuss which definitely helps.

For each appointment the whole process was over and done with in about five minutes and pretty much forgotton about ten minutes after that (apart from the gaps).

Hope that helps a bit.

Em

[DizzyMum]

Sorry - should have added that most of the five minutes at each of our appointments was waiting for the pain relief to kick in - the actual extractions themselves took seconds

Em

[squirrelchops]

I had a lot of orthodontic work as a teenager, including 5 teeth extracted. Then train track braces on upper and lower teeth as well as a brace on the inside of my bottom teeth. Followed by removeable braces.

Although the teeth extraction can be horrid (personally it didn't bother me) some people find the fitting of the brace very uncomfortable. If your daughter is very sensitive in her mouth you may need to bear this in mind. I found the bands they put bewteen your teeth to separate them for the wires particularly sore but again I got on with it. Howver had friends who really suffered.

My orthodentist was very good though as left enough room for my wisdom teeth to come through so have no pain from them at all fortunately. Also when I look in the mirror and see my lovely teeth I am glad I had them doen as they were so over crowded.

[sweetserendipity]

Hi alias :hello:
It sounds like my youngest daughter has a similar problem - she still has baby teeth on one side, top & bottom, with adult teeth poking through as well. Had her at the Dentist a couple of weeks ago & daughter was advised to brush her teeth firmly, rather than !!!!!footing around them as she had been doing, as this would encourage the baby teeth to come out of their own accord. Unfortunately they are still hanging in there, & causing smelly breath(!), so daughter is booked into Dentist again this Thursday. As far as I know the Dentist is going to pull the baby teeth out (they are wobbly) but I'm not sure what, if any, anaesthetic will be used. I'll let you know.
Hope your daughter gets on ok.
Sweet

[sweetserendipity]

Lol, just noticed my post was censored!! Think moggy if you hadn't worked it out!! :rotfl:

[the devil made me do it]

Your comment made me angry and I was about to post a reply based on that anger. Fortunately my good common sense kicked in and I will only ask that since you obviously base your advice on kneejerk assumptions, then please dont post on this thread, your advice is embarrassing.

Big apologies :o

[Toothsmith]

Please dont insult me Toothsmith. You dont know me or my daughter therefore you have no business making sweeping statements like those above. I am no silly ditzy teenager. I am a middle aged woman who has to deal with people with disibilities and irrational fears and it's my job as their carer and parent to do this in the best way possible.

I do appreciate your advice on dentistry but you dont know enough about us to comment as you have.

I'm sorry you've misunderstood me.

The bottom line is that if your daughter is too scared to go through RA assisted local anaesthetic extractions, then the treatment should be postphoned until she can. Or even just LA with no RA.

It is completely unjustified to put a child through anything that's likely to put them off dentistry forever when the treatment can easily be done just as well in a few years time.

It's also unjustified to put them through a proceedure with a small, but finite risk of harm just to achieve the same result.

[aliasojo]

I'm sorry you've misunderstood me.



At the risk of turning this into WW3....what is there to misunderstand?


Quote:

Lets be honest - it's your fears that are coming to the surface here, not your child's.

I would say that's quite a clear comment. :confused:

Stay in the waiting room, and let them get on with it.

:rolleyes:

I have no issue with the rest of your advice, I appreciate what you are saying. I just think your more personal comments are unfair given that you have no knowledge of us, or my daughter's 'issues'. And these are something that cant be 'grown out of'.

[Toothsmith]

None of it was meant as a critisism.

I honestly dont think she'll cope although I'm obviously being as positive as I can be when discussing it with her.

Kids pick this sort of thing up. They are very sensitive to emotions.

When parents ask me what they should tell their kids - I always say "as little as you possibly can." Certainly don't go into any detail at all.

What will the dentist do? "I'm not really sure - numb your gum and wobble your teeth out" How does he numb my gum? " I really don't know. Sprays something on it I think." Keep things vague, don't mention the word 'hurt' at all - even to say "It won't hurt" Adults always say that when something will. Kids know that!
Don't say 'injection', 'pr1ck' (site doesn't let me spell that right!!) 'scratch'.

Kids DO play up if a parent is in the room. I generally let Mums or Dads in if they really want, but place them in the chair in the corner, and they must stay there (and be quite!)

Dentists - at least decent ones - can cope with nervous kids. RA makes everything so much easier, and she really won't have a problem at all. If your dentist has RA, I would guess he's/she's experienced in coping with very very nervous kids.
I had a 5 yr old who despite my best efforts to save them, needed 4 baby teeth out and a couple of fillings on some poorly formed adult teeth. She was a very nervous patient. Although she'd accepted fillings in baby teeth fine with me, I thought extractions was a step too far at this stage. She had those out using RA and local with no bother at all. (I referred her for the RA - I don't have the equipment here)


RA and local really is the way to go - it's fantastic. If anything more IS necessary, then orthodontics at the moment really isn't appropriate.

[aliasojo]

None of it was meant as a critisism.

Kids pick this sort of thing up. They are very sensitive to emotions.

When parents ask me what they should tell their kids - I always say "as little as you possibly can." Certainly don't go into any detail at all.


I appreciate the reply. Unfortunately your advice directly contradicts the advice given to us by the Consultant who my daughter is under. We are supposed to discuss everything with her otherwise her irrational fears grow legs and she will manifest the most simplest of things into huge issues.

Damned if we do, damned if we dont.

[xxvickixx]

I quite agree, the deception on my Mothers part only increased my anxiety with regard to my needle/hospital/white coat phobia.
I felt that I could never relax in that situation as I could no longer trust anyone as to what was going to happen next.

[xxvickixx]

Toothsmith, I am sure you will not mind me saying that from a phobic's point of view your attitude would put me off the dentist.

I know it is all about different stokes for different folks but personally I find it sad that you come across as dismissive of these patients real and genuine fears.

I am sure you don't mean to make people feel this way as I can see that you are a helpfull person who's advice is appreciated by many.

[Toothsmith]

Toothsmith, I am sure you will not mind me saying that from a phobic's point of view your attitude would put me off the dentist.

I know it is all about different stokes for different folks but personally I find it sad that you come across as dismissive of these patients real and genuine fears.

I am sure you don't mean to make people feel this way as I can see that you are a helpfull person who's advice is appreciated by many.


Adults and kids need different approaches.

The way I suggest kids are helped over fears is completely different to helping adults over fears.

Plus - here I'm talking to a non-phobic adult about how to help her phobic kid - So I can be a bit more economical with my typing fingers!!!

[xxvickixx]

Apologies Toothsmith, I didn't make myself clear, I was a very phobic child, and to a lesser degree a phobic adult thanks to therapy and the patience of understanding health professionals.

I was just trying to explain how I felt as a child and to offer some constructive feedback.

[Toothsmith]

That's great Vicki - thanks.

But the main thrust of what I've been trying to say is - Is this treatment really necessary, and maybe putting it off for a while is better than giving a child a GA?

For anyone with problems accepting dental treatment - particularly the very young - you should really stick to the absolute minimum in terms of intervention, whilst pushing prevention, and regular 'easy' visits to boost confidence.

As more of Aliasojo's daughter's situation comes out, obviously the more complex it seems.

I do think it a bit unfair aliasojo, that your consultant expects you to give full explainations about situations that you're unsure of yourself. I can't see how that would help anything. But taking your daughter to the dentist to allow him/her to give a good explaination first - and to talk to you alone about what he feels you should tell her - would be a good step to take.

[jackieb]

My daughter's present dentist is a gem. She explains everything that is happening. She showed her the suction thing and made my daughter laugh with it - which was unthinkable beforehand. She tells my daughter to squeeze her hand anytime that she wants her to stop. She praises her up all the time too. Our last dentist was very gruff. He never took off his mask, and he made no attempt to reassure her at all. I seriously thought about putting in a complaint against him as he was so horrible.
My daughter is incredibly shy but she chats away to her dentist now. And she rarely acknowledges anyone outside of our family. I can't praise our dentist (and the dental nurse) enough.

[Miss Shopsmart]

You might want to consider going to the Centre for Excellence in London - it is a teaching dental school practice. Not only will he get the latest treatment - problably implants - but the cost will be reduced.

[aliasojo]

You might want to consider going to the Centre for Excellence in London - it is a teaching dental school practice. Not only will he get the latest treatment - problably implants - but the cost will be reduced.

Have you even read this thread at all? :confused:

[xxvickixx]

:j I like the sweeter softer side to you Toothsmith. x

[aliasojo]

Ok, I'm going to just leave it there now.

Thanks for all the useful advice.

I assumed this would be a simple question but it hasn't really worked out that way and I'm annoyed at myself for feeling the need to justify my posts by sharing things about my daughter that I didn't intend to talk about.

If nothing else, I think this thread may well have cured my habit of 'sharing' our family stuff on the net and I'm sure that's no bad thing.