Dental Sedation

[Mom28GreatKids]

So, anyone with experience with needing sedation for a SN child for dental work?  DS had his first dental appointment today.  It went. . . well . . . not great.  It was hard on him with his Apraxia.  He can't hold liquid in his mouth well, and Mr. Thirsty the suctioner wasn't keeping up.   :lol: He spit he flouride treatment (painted on) all over the hygienist.  It was about as fun as it sounds. 

 

So, he has 2 spots of decay on his front two teeth where there are enamel abnormalites (fissures where the enamel did not form correctly when the teeth were developing).  Our dentist said he really had no chance-  the pits and fissures are very hard to keep clean and very easy to decay. DS only drinks water- no juice, milk, no bottle or sippy, etc. Our dentist is the most gentle man in the world, so I trust him when he says he doesn't think ds would do well with just nitrous oxide and needs to be sedated, so he referred him to a ped dentist who specializes in kiddos with special needs. Anyone been there done that?  I guess there is a cocktail that doesn't put him completely out they will try first.  They did say that some kiddos do not react the expected way with this and need a general.  Oh my. Thanks. 

[Alessandra]

I can share my experience.

 

For regular kid dentistry, we love our pediatric dentist. The dental chairs are all kid sized, and each room has a different chair color and theme. The place is jam packed with toys. Multiple little toys are given out after the session. Iirc, our first visit didn't even involve cleaning.

 

As for sedation, I have had both nitrous oxide and sedation with an anesthesiologist, both times for wisdom teeth. I am not an expert, so I can only tell you what happened to me. The nitrous oxide was awful. I woke in the middle of the procedure, don't remember much. But after I got home, I spent the rest of the day alternately laughing uncontrollably and weeping. No one warned me about this. Somehow I did not attribute it to the drug -- I though I had finally gone crazy.

 

Next time, an anesthesiologist gave me Valium and Demerol intravenously. The Demerol eliminated pain and Valium made me forget what was happening, although apparently it does not make you unconscious. Afterward, I believe I asked when they were going to start, but the procedure was finished, lol. I woke up feeling refreshed. It's not general anesthesia, but you *feel* as though you are out.

 

As for pain meds, the first doctor told me to call him if I had pain, otherwise take aspirin. It was awful, as pain doesn't necessarily happen in office hours. Pain on and off for about 10 days. Horrible.

 

Second doctor gave me two pain meds, one to take prophylactically for a few days, one for severe pain. I only needed the first med, and pain was gone by day four.

 

I hope you get some answers from people who are actually familiar with how they work on children!

[PeterPan]

I would talk with your behaviorist. My ds did fine with nitrous. Your ds may benefit from social stories and other things the behaviorist could do to prepare him.  Also, our dentist did a mock, not really much of anything appt the first time we went and let things rot for 6 months before ever actually doing anything serious.  Are the cavities SO important?  Are these teeth that will fall out?  If they're going to fall out eventually and the teeth won't become painful or something, you could consider just blowing it off and reapproaching in 6 months.  Otherwise his first experience with the dentist is I went there and it turned into more, don't want to go back.  You want the opposite.

 

I'm just tossing out different approaches.  I think there could be different ways of handling it like that, which is why you'd talk with the behaviorist.

[PeterPan]

My ds had nitrous his first two times with fillings and he had NO problems with it.  He fell asleep and it was no big deal, no side effects.  I've heard the nitrous can deplete things in the body.  It may be that adults (and some kids) are more depleted on those things already.  It may be that effects just vary.  For my ds there was no ill effect.  He went calm, and just as he started to snooze (farther than they wanted) they turned it off so he would rouse.  

 

Honestly, it sounds like you're having behavior challenges that need the behaviorist involved.  She can bring in some social stories, practice, talk about what will happen, practice with animals, etc.  No matter what you do and no matter what lengths you go to, you're probably still going to need this.  Even sedation won't change that.  To me it's actually worse in a way, because it's saying when I go this extremely disconcerting thing happens.  What you don't want to happen is that it becomes some experience that is negative where he won't go back, and you can't always predict what thing he latches onto that is that for him.

 

Anyways, that's why I'm saying talk with the behaviorist.  We had ds *observe* dd and me getting cleanings one year before he went.  Then his first time it was super light, super short, super jolly, with no attempt to find cavities, even though they were doubtless there.  Then 6 months later we went back and got the very bad news and he was ok with it.  That's why I'm saying you *could* decide not to treat.  

[Elizabeth 2]

Hi! 

 

I did work in pediatric dentistry before my kiddos. I would agree in talking with behaviorist, but check terminology with the pedodontists office first so DS doesn't get confused. They are not the same office to office.  Pediatric dentists are great for SN kids if their staff is good with them.  Don't check out the Doctor, check out the staff.  As far as the medications cocktails, there are multiple options depending on where the doctor was trained, and even west coast vs. east coast.  Check them with your pediatrician AND pharmacist to check for possible interactions or to see if they are in the family of any your DS may have had reactions to before.

 

If they are permanant teeth, they need to be done.  ASAP.  Especially front teeth. They are very thin to begin with, and while posterior teeth can sometimes wait, front ones often cannot.  

 

If they are in primary dentition, they will not fall out until kindy, or later is common in SN. They need to be done if it is DS4.  DS7?  Maybe.  

 

Just FYI about diet.  It isn't always drink.  If they eat a grain based (high any carbohydrate diet), that can be enough.  Rice, potatoes, bread.  Those are often more of a problem than juice, milk or soda.  How often does DS eat? Once an hour? Two? If there is not at least 45 minutes from the end of eating to the beginning of the next, then his teeth aren't getting a break.  That's a risk.  So it's not just one thing, but really the whole lifestyle.  

 

Edited because dental speak.

Edited August 17, 2016 by Elizabeth 2

[TranquilMind]

Neurotypical here, but both one of my kids and I have done the conscious sedation with great results. My son handled it better and seemed pretty normal and took a nap after and was fine.

 

I was knocked out for 12 hours. I walked in the house with help and fell asleep for 12 hours afterward. Crazy! All went well though.

[TranquilMind]

Hi!

 

I did work in pediatric dentistry before my kiddos. I would agree in talking with behaviorist, but check terminology with the pedodontists office first so DS doesn't get confused. They are not the same office to office. Pediatric dentists are great for SN kids if their staff is good with them. Don't check out the Doctor, check out the staff. As far as the medications cocktails, there are multiple options depending on where the doctor was trained, and even west coast vs. east coast. Check them with your pediatrician AND pharmacist to check for possible interactions or to see if they are in the family of any your DS may have had reactions to before.

 

If they are permanant teeth, they need to be done. ASAP. Especially front teeth. They are very thin to begin with, and while posterior teeth can sometimes wait, front ones often cannot.

 

If they are in primary dentition, they will not fall out until kindy, or later is common in SN. They need to be done if it is DS4. DS7? Maybe.

 

Just FYI about diet. It isn't always drink. If they eat a grain based (high any carbohydrate diet), that can be enough. Rice, potatoes, bread. Those are often more of a problem than juice, milk or soda. How often does DS eat? Once an hour? Two? If there is not at least 45 minutes from the end of eating to the beginning of the next, then his teeth aren't getting a break. That's a risk. So it's not just one thing, but really the whole lifestyle.

 

Edited because dental speak.

My dentist said exactly the same thing. Bread, cereal bars, grains, carbs are the killer.

[kbutton]

Some people also have bad reactions to general. In my family, extreme nausea is what we do best with that option. 

 

I think I would ask about something like an anti-anxiety--valium, etc. If the cavities are not deep, calm may be all that is needed unless he has sensitive teeth. Calm might get him through an numbing (if needed), and the procedure just fine. Lots of times, the cavities are tiny spots on the surface for little kids.

 

I do think that if your family loses teeth on the early side, and pain is not likely, I would also consider asking what would happen if you let them go since they are going to be some of the first teeth to come out. 

[OneStepAtATime]

I will share our situation but I don't recall the exact meds used.  DS has sensory issues that make normal dental appointments virtually impossible.  Certainly fillings are out if he is fully awake.  We ended up going with conscious sedation for two fillings (two separate occasions) because a previous filling experience was horrible with our normal dentist so he recommended we use a pediatric dentist.  The experience went well for the first filling and the second.  In fact, our normal dentist suggested we permanently shift him to this local pediatric dentist known for being able to handle kids with sensory issues.  They were right.  DS even does well there during normal cleanings.  As someone mentioned up thread, it is the staff that is also critical, not just the dentist.  The pediatric staff there has been trained in how to handle children with sensory issues (and other issues as well).  They are very patient and calm, they do not demean or cut down or anything of that nature, and they know how to sooth and help a child through.  

 

As for the conscious sedation itself, it has been fine.  Completely.  He drank the medication, then sat with me watching cartoons until it took effect.  It was pretty obvious when it did.  Nothing he said made much sense and he was placidly happy instead of analyzing everything and wanting to have in depth political and historical discussions.  :)  He walked with assistance to the room for the procedure and when they laid him on the chair they then wrapped him in netting (a sort of cocoon).  I was afraid he would freak out at the netting but he felt safer, more protected.  I was shocked.  He was calm for the procedure, he was calm during the recovery while they waited for the drug to wear off, and he was calm on the drive home.  He had mild nausea for a couple of hours and slept a lot the rest of the day but he woke up the next day not really remembering much of anything and was fine.

 

Knock on wood that we never have to do dental sedation again but if we do I am definitely going with the conscious sedation DS did before.  

[Kat w]

I didn't read the other responses

. but yes ma'am, been there, done thst. We started out with a pediatric dentist who specializes in SN kids.

 

For regular cleanings even , we get twilight, I forget what the cocktail is, but our ped. Dntist has loads of experience.

 

The apraxia is both to the opposite extremes with my guys.

 

The twilight made the difference . both boys do great with it. No adverse affects. And they come home with a treat from the dentist office :)

 

Our ped dentist and from what I've seen with real life friends, dental issues and SN (depnding on the SN) seem to go hand in hand, esp when apraxia is involved.

 

Alot of people think of apraxia as a mere speech impediment . it's runs way deeper than that.

It's the motor planning thst prevents certain things in the mouth region.

 

All 3 of my kids with any kind if need( dd24 dyslexic and other things) all seem to have, teeth coming in, misplaced at the roof of the mouth ( how does a tooth get inside the roof of the mouth? Idk. Ped dentist said it's not uncommon ), a whole host of problems.

 

I have one guy who keeps his cheeks clamped tight all the time (lo tone guy), the other one mouth is very loos and no feeling in it.

(Yes o know, and I got thst right, it should be the other way around , anomoly )

 

Both cause tons of problems with getting even cleanings done.

 

It has made the difference getting twilighted. I think twilight in and if itself is the term for a specific cocktail. Not completely sure on that tho.

 

Maybe you could Google it. But, I just want to set your mind at ease, my boys do grandly with it. No problems. I have a couple friends who use the same ped dentist who specializes in SN, they don't have trouble with it either.

 

I know it sounds scary and really can be, we've done great with it.

Our ped dentist, said he doesn't have kids have trouble either.

Drugs have come a long way.

 

What the SN dentist normally does esp them getting it for the first time, goes slow with it. Administering the meds slow enough to have the early indicators of any kind of trouble , time to show up.

 

It really amazed me how well it all went the first time and everytime after.

 

These dentist that specialize in SN kids REALL do a great job.

 

It's gone very well for us . and like you, was our only option . it wasn't gonna happen otherwise.

Edited August 17, 2016 by Kat w

[Kat w]

Oh, I read the first few sentences of onesteps response... That's right . your guy is a sensory guy...mine are too.

 

Twilight will be your friend mama :)

 

I always laid in the chair, and have my boys lay on top of me.

 

We've done that from the very first dental exam.

Works. Being on mama gives them comfort.

 

Apraxia plus sensory= twilight being a bestie lol

 

ETA: having a ped. Dentist that *specializes* in special needs makes a huge difference. They understand and see everyday what our kids go through.

 

 

That's a very important distinction between a regular ped. Dentist vs a SN Ped. Dentist.

 

They don't even compare in fact.

Yes, a ped. Dentist will also see NT Kids but they usually have have furtered education in special needs kids.

 

Our kids have different issues at hand such as , apraxia. That changes the playing field and they did good by you to recommend a ped. Dentist that *specialize s* in special needs kids.

 

We were referred out by our regular ped dentist, to a ped dentist who specializes in SN kids.

She called one up on the phone and got us in.

 

ETA:

The ped dentist that specializes in SN kids , about him laying on you, may go into OCEA blah blah...nope. OCEA hasn't seen our kids lol.

 

We've never had a problem with a dentist letting us do that.

I did have a friend that a dentist said it...she came to mine and had no problem.

 

Your lil guy is young. Can't imagine him not being comforted by laying on you.

 

Also, on the breads and carbs and such. What gets missed sometimes when discussing causes of dental issues in SN kids is...what I said in the beggining .

 

SN kids have more dental problems esp when apraxia is involved .

It just 'is'. My SN ped dentist said it's very common with apraxia kids , fir the parent to ha e done everything right, yet, our apraxia kids just have dental issues.

It's not from breads and other carbs ...it's because... They have apraxia.

 

Which is why is all the more important to see a ped. Dentist that knows special needs kids. It's an entire different ball game. And a ped dentist will have taken those classes to learn specifically about our kids.

 

It's different. And they know it because they are educated in it.

 

That's what makes them, a specialist with spec needs kids.

 

It's not that they say, OK, I'll deal with the kids who pitch a fit. No, it's much deeper than that.

They have extra education to learn what makes apraxia and other things affect our kids in what ways.

 

Or, the sensory issues have them chewing . those are things a *special needs* ped. Dentist will have further *education* on and course of action to treat and/or prevent.

Edited August 17, 2016 by Kat w

[Lecka]

I am going to throw this out there.... If there is a chance that his teeth are painful, it could be contributing to his oral aversion. So maybe this could even be helpful.

 

It is a long shot, but it is possible!

 

I would talk to the office he will go to about his needs. Here in a small town in a rural area, any dentist will let you go in early to see where you sit and what the equipment will be.

 

For me -- when my son was little I would take a trear or toy and have him get it there. That kind of thing helps me. It is easy for me though bc a lot of things I am taking my other kids for his test run, so it is not a separate trip.

 

If there is any single use equipment they may let you take one home. I have heard of this with masks where everybody gets a new mask.

 

I would talk to the office and also to anybody who works with your son. I bet they have some good ideas for them. If it is something like -- you have a mask, and they let you take a mask home, you could take the mask to your speech therapist and let her work with it with him.

 

If you find out he needs to be declined and have something on his face, you can practice that. If you find out he needs to keep his mouth open you can practice that.

 

If he doesn't really have to do anything but be relaxed, I do think pre-visits with a treat can be good. You can take a video and then watch the video with him, too.

 

Depending on what the office says and how he might do, that might not be needed. If he might get upset as soon as he realizes you are in a Doctor/dentist office at all then I think it could be worth the effort.

 

If you have time to go a few times you might be able to just go in the door and leave the first time, and work up to sitting in a chair.

 

I have not done this for the dentist, but I have done it for other places.

 

I also had a portable dvd and I would get a new dvd for some things. It was really helpful for a while, and easy for me to put away and then get out when I needed something special like that.

Edited August 17, 2016 by Lecka

[Mom28GreatKids]

Thanks everyone. His consultation is this afternoon. She will go over everything that they will do on the day of the procedure.

 

First approach with be oral sedation. It is a little cocktail that he will drink in office. My problem is he won't take Motrin, antibiotics, vitamins. Nothing. So not sure he will drink it. It could also not work, or do the opposite end hype him up. If he won't they will do a general.

 

Have an email into his BT. Hoping she will have some good ideas too. She is very good at getting back with me with lots of good strategies to try.

 

Lecka, it is possible they are tender. Now I know they are there it is so obvious. Poor kid. Regular dentist says they will decay fast so leaving them is not an option. My kids don't lose those teeth til they are at least 7. My other son is almost 8 and hasn't lost them yet.

 

Will keep you all posted.

[Lecka]

I would seriously consider taking a favorite older sibling and taking a video of him drinking a drink in the office. It is easy with a phone and it could help, and it is not hard.

 

Good luck!!!!

 

I know it seems corny, but video modeling is one of those things where it turns out to be a lot better than I thought it would be.

Edited August 17, 2016 by Lecka

[Mom28GreatKids]

That is such an interesting idea Lecka. I will try it. 😃

[Lecka]

Video modeling is actually a thing. I read a book partly about it and then I have seen it around.

 

There is "in vivo" modeling (real people) and "video" modeling.

 

There are some studies showing that sometimes and for some kids video modeling can be more effective.

 

For my son it was better for a lot of things (compared to a Social Story or another kind of explanation or preparation) when he was younger.

 

But partly he had a receptive language delay that made verbal explanations more difficult for him.

 

But even without that, there are some kinds of things where it can still be good, or som kids it works well for.

[Tiramisu]

We did oral sedation with one 2yo. Twice. We had to, otherwise it would have been dangerous.

 

The pediatric dentist knows how to make them take it when they won't. It sounds cruel but he had her lie down and he poured it in her mouth without warning and held her nose so she would swallow. I was a little freaked but It was done in a second or two.

 

As the dentist warned me, sometimes hyper kids will have the opposite effect and get revved up. That happened to our DD so we had to work hard to keep her from falling down. But she was really funny with the things she would say and everyone in the waiting room was laughing. That actually made it easier.

 

After it was clear the med took effect, she was brought back again and given gas. And that took time, too, but he spoke to her so gently and sweetly until she finally settled down.

 

The procedure went quickly.

 

We had to give her soda for the sugar and caffeine after.

 

Afterward you have to make sure they don't chew their lips while they are numb.

 

Fasting from the night before was hard.

 

So while it was stressful for me, DD had great memories of it. Whenever we drove by his office, she would shout for joy. She was so happy seeing him for subsequent visits. And when he developed a hand problem and had to retire early, we were so sad.

Edited August 17, 2016 by Tiramisu

[Ravin]

I've only ever taken my kids to a pediatric dentist. I would get the referral and then see what the Ped dentist has to say about what level of sedation is needed.

[Kat w]

Video modeling is actually a thing. I read a book partly about it and then I have seen it around.

 

There is "in vivo" modeling (real people) and "video" modeling.

 

There are some studies showing that sometimes and for some kids video modeling can be more effective.

 

For my son it was better for a lot of things (compared to a Social Story or another kind of explanation or preparation) when he was younger.

 

But partly he had a receptive language delay that made verbal explanations more difficult for him.

 

But even without that, there are some kinds of things where it can still be good, or som kids it works well for.

That's a great idea. Had never heard of that before.

[Mom28GreatKids]

His appointment went well. The place was like a carnival. He was jumping around, climbing across the seats, etc, but he did let her look and even allowed the tech to get x-rays which is nothing short of a miracle. And of course the over stimulation there made him crash later. But, it provided the needed distraction for the exam.

 

So we go the 28th of Sept for the procedure. We are going to try oral sedation first. If he doesn't do well, they will abort and we will do a general in Oct. Good thing- if he doesn't do well, they will subtract what we paid for the oral sedation from the price of the general so we won't be out more. It is super expensive, but there is no way it's getting done any other way. So, now to figure out prevention so this doesn't happen again. Thanks OhE for the tips about the calcium.

 

Thanks for the stories of success. It makes me feel better about it. This poor kid. His genes just seem to give him no chance at anything. I feel so bad. When I told the dentist we have 8 kids, and only 3 fillings in 18+ years, she was shocked. So this is new. Oh and his BT is working on a plan for the day of. Heck, maybe she will just go with me she is so great with him. . . And great with me as well. 😂 There are days I could use behavior therapy- like when I was on the phone with the driver's Ed people the other day, my son came in and said, doesn't sound like you are toterateing stupid. 😂 Nope son, I am not.

[Kat w]

That's awesome. :)

So glad to hear .

That's really great of them to subtract the price of oral of it doesn't work :)

 

Sounds like you have a great dentist. Yay! :)

Edited August 18, 2016 by Kat w

[Tiramisu]

My DD who had the most cavities in her baby teeth is doing great with her adult teeth. Better than my others who didn't have the same problem with their baby teeth.

 

Keep the hope!

Edited August 19, 2016 by Tiramisu

[PeterPan]

 There are days I could use behavior therapy- like when I was on the phone with the driver's Ed people the other day, my son came in and said, doesn't sound like you are toterateing stupid. 😂 Nope son, I am not.

 

That's what's wrong with me.   :lol: 

 

PS.  So glad the appts are going well! 

Edited August 19, 2016 by OhElizabeth

[Mom28GreatKids]

That's what's wrong with me. :lol:

 

PS. So glad the appts are going well!

Me too. We would get along well IRL OhE. Lol. 😂

[PeterPan]

You know things have gone a little far when you start thinking that the reply to threads should be "open a bag of chocolate and keep eating till this problem goes away..."   :lol:

 

Of course that's what I've been working off this past year, so I'm NOT doing that again.  But I was really tempted.  Like I had to tell myself NOT to make cookies tonight.  I have this tendency to eat most of the batch.   :001_rolleyes:   Of course I had this theory tonight that making the cookies together with ds would be ABA.  I kept telling myself that.   :smilielol5: