tag:blogger.com,1999:blog-16472438.post115656477110541972..comments2024-03-27T00:21:47.263-07:00Comments on Pediatric Dentistry: Sedation in Pediatric DentistryDr. Dean Brandonhttp://www.blogger.com/profile/08709454067987829233noreply@blogger.comBlogger61125tag:blogger.com,1999:blog-16472438.post-53994153153973623022011-10-26T16:36:31.150-07:002011-10-26T16:36:31.150-07:00Well, there are over 60 comments on this post now....Well, there are over 60 comments on this post now. I am closing this thread to comments. There is a lot of information in the post and in the comments. Medications in children is a complex issue that does not lend itself to easy answers. Consultation with your pediatric dentist, anesthesiologist and other health care professionals is indicated.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-64142174214833204202011-10-26T16:33:19.792-07:002011-10-26T16:33:19.792-07:00There is no way for me to tell you what medication...There is no way for me to tell you what medication would be the best. Each child and each case is different. My experience that medications in 2 year olds are unpredictable as to their effect. Yes, we sometimes use demerol or other combinations in two year olds. Even with that, some kids are still fussy and resistant-also, many do quite well. Often general anesthesia is indicated, especially for more complex or extensive treatment.<br /><br />Versed is a great medication, but not often used in 2 year olds as it tends to be a little "wimpy". Still, I have worked on 2 year olds with both medications and had good results. I have even worked on two year olds with no premedication at all other than nitrous oxide and they have been great. Other two year olds, well, there is no medicine that will calm them down enough to do adequate dental work. Like I said, kids are different and the younger they are, the more unpredictable the result of any medication.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-77440286750460120742011-10-26T12:19:23.451-07:002011-10-26T12:19:23.451-07:00My 2 year old has cavities in each of his bottom f...My 2 year old has cavities in each of his bottom first molars (one of them being rather large) and 2 facials also... The doctor mentioned Versed and Demerol. How do you feel about demerol being used as an oral sedative in children that young? Would it be safer to just use the Versed and get the work done in multiple sessions or use the Demerol and get it done all at once?.Brittney.Vaughn.https://www.blogger.com/profile/09766033018970121958noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-48689130874966754092011-09-29T18:32:59.728-07:002011-09-29T18:32:59.728-07:00That's a lot of specific questions. I cannot ...That's a lot of specific questions. I cannot really diagnose here. Please consult your dentist about treatment options. As you can read on the blog, there are many things to consider. Abscessed teeth often need antibiotics before treatment, but not always. Discuss behavior management options with your pediatric dentist. I have taken out teeth on two year olds with sedation, with general anesthesia and sometimes with nothing extra other than numbing up and maybe a little laughing gas. Each case is different and certainly challenging. Good luck.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-78511083895335792882011-09-29T17:27:55.912-07:002011-09-29T17:27:55.912-07:00My 2 year old has a darkened front tooth from a tr...My 2 year old has a darkened front tooth from a trauma. I took her to a ped dentist yesterday who said it would be best to leave it until it falls out on its own (it has root resorption). However, since the appt. the last two days she has been crying and its been causing her pain. She's quit her thumb sucking habit because of the pain. I called the office, and the assistant said the first time they can get her in is on Monday (aren't open Friday). Then without speaking to the dentist first she said they will probably extract the tooth then and there. Since my daughter is in pain now, should my 2-year-old be on antibiotics until the procedure for a possible infection? I didn't see any pus on her gums. <br />If you didn't have much time know a two year old and needed to extract a tooth would you use conscious sedation or gen. anesthesia?Andy & Beccahttps://www.blogger.com/profile/01063030646303564902noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-89288871446152404322011-09-12T18:36:44.312-07:002011-09-12T18:36:44.312-07:00That's a lot of questions. Each case is diffe...That's a lot of questions. Each case is different. I had a 5 year old this morning where we did four fillings all at once with no problem. There are other kids that definitely need sedation to do even one filling or crown.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-18717333867370464422011-09-12T18:00:40.744-07:002011-09-12T18:00:40.744-07:00My seven year old daughter has 4 cavities. One in ...My seven year old daughter has 4 cavities. One in each corner of her mouth. They are moderate cavities. Can the dentist fill them all at once? Or will she need tocome in at different times do you think? And filling is better if they are moderate cavities than caps, right? Also, which is more painful? Thanks, worried mom....Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-16472438.post-25453829675856285282011-07-27T15:59:30.450-07:002011-07-27T15:59:30.450-07:00We have over a dozen employees just to handle and ...We have over a dozen employees just to handle and figure out insurance. There are hundreds of policies. Most policies change from year to year, so I cannot really comment on insurance as I do not have enough information. I can say that, at least here, for hospital cases, the hospital's bill (anesthesia services, nursing and the anesthesiologist, supplies, etc) are totally separate from our charges.<br /><br />It is also not uncommon that treatment proposed (estimated) might change somewhat in the hospital once you get in there. It is common to give an estimate that takes into account the possibility of more extensive treatment. It is better to do that than underestimate and then have to tell the parent they have crowns or additional work that they may not have anticipated.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-89305797185971726482011-07-27T14:23:45.500-07:002011-07-27T14:23:45.500-07:00My 3 year old son had some decay on his upper fron...My 3 year old son had some decay on his upper front teeth. So, we took him to have x rays done. The dentist recommended that we do the procedure in the hospital, which I agreed to. His office submitted the pre-treatment est. through insurance, at the worst case scenario with caps and everything. So my wife and I paid for everything up-front. After the procedure was done then I got a bill from the hospital, not the dentist. So, I was concerned because caps were not needed, but fillings were used. Which resulted in a lot cheaper procedure, which I thought. I contacted the dentist's office and they said that there was no balance. But after looking into it I compared the hospital call on the pre-treatment est. and the EOB from the dental insurance, and there was a difference of $261. How can this be? This seems unethical! Also, is any of the dental work covered under medical? <br />Thank you for your time!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-16472438.post-67646602964992847972011-07-21T13:52:03.193-07:002011-07-21T13:52:03.193-07:00I have not seen a problem with just food allergies...I have not seen a problem with just food allergies and sedative drugs. It is important to coordinate with your doctor and provide a good medical history to avoid any problems. Most of the time I see antibiotic allergies like penicillin allergy.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-50911448757197570942011-07-21T10:51:01.372-07:002011-07-21T10:51:01.372-07:00We 7 year old son is going to have two molars extr...We 7 year old son is going to have two molars extracted and spacers put in. He is allergic to milk and eggs and I'm wondering if any of the possible sedation drugs or the spacers could pose a problem due to his food allergies.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-16472438.post-3665901402671770942011-06-18T15:17:42.614-07:002011-06-18T15:17:42.614-07:00Sorry I cannot comment in detail. I am at a meetin...Sorry I cannot comment in detail. I am at a meeting. Basically medications can be ok to use at correct doses etc. Etc. A two year old is highly unlikely to cooperate without any meds. Usually general anesthesia is needed because oral meds are very unpredictable in 2 year olds. If it's a lot of work you can inquire. If it's just one tooth a quick thing then that's different. Some baby teeth stay till 12 years old or older.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-27094664104273821062011-06-18T15:05:43.574-07:002011-06-18T15:05:43.574-07:00My 2 year old, 30 pound daughter needs to have ext...My 2 year old, 30 pound daughter needs to have extensive dental work done including cavity fillings and root canals . The pediatric dentist stated that she would need to use oral sedatives which I am not comfortable with. How safe are these products especially for a child her size? Also, would it cause more harm to just wait to have the work done in another year or so?snowflake130.52https://www.blogger.com/profile/00980877409192494534noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-27920591452309100402011-04-21T15:41:33.746-07:002011-04-21T15:41:33.746-07:00Firstly, oral medication can be a little unpredict...Firstly, oral medication can be a little unpredictable as absorption rates from the gut vary. I have seen kids seem a little loopy after the procedure. They can be disoriented or not understand how weird they may feel. The max effect would be during treatment (usually) that's why they seem to do so well. Then later on a different reaction. Not common but can happen. The main thing is to make sure they meet discharge criteria before leaving the office. Versed is particularly known for some kids being inconsolable after treatment. Bit that's usually very young preschoolers and even then only about 10% or less of them.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-63449666210205142322011-04-21T03:14:59.481-07:002011-04-21T03:14:59.481-07:00My 3yr. old went to the dentist yesterday to have ...My 3yr. old went to the dentist yesterday to have 3 crowns done. I had agreed to conscious sedation. After finishing the dentist remarked how she had never had a patient do as well as my daughter. She did not cry or fall asleep. She did use the papoose board which is always done at this particular office. It was within 10-15 minutes of leaving the office that my daughter started reacting to the medication. As soon as we got home I thought she was going to take a nap and instead she started thrashing around, crying, not speaking clearly and trying to walk which she could not do on her own. It was very similar to dealing with an intoxicated adult. After speaking later that evening to my dentist she said that my daughter had a very delayed reaction to the oral medication. The medication was given around 1:10pm and her erratic behavior began around 2:45pm. The behavior lasted for about one hour before she fell asleep. After sleeping for one hour she woke, ate, and was back to her normal self. Have you ever heard of this happening. A child being very calm and responsive during the procedure then later reacting aggressively?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-16472438.post-39866861999796811802011-03-10T16:34:10.844-08:002011-03-10T16:34:10.844-08:00I can't really in a specific case, but cavitie...I can't really in a specific case, but cavities do get worse with time. Having a very young child with treatment needs does present with tough choices. If you do not feel comfortable with the papoose, then I would not do that. However, many people in similar circumstances do have a few choices: You can read more on the blog here of course. There is a lot of stuff about this situation. Nitrous oxide laughing gas is very wimpy on a preschooler, especially a one or two year old.<br /><br />In office conscious sedation may be an option that might be considered, however, medicines at safe dosages vary in their response the younger the child--in other words it might not sedate them enough to get the job done. I did have a two year old today where it worked great. General anesthesia is predictable and the work can be done with him asleep--often this is the best choice especially if there is a lot of work to be accomplished. I don't do too many one year olds in the hospital-I usually wait till they are two-but I have done several older one year olds. If you wait till age two, things may be worse, and the behavior issue will likely still be there, (but if you would feel more comfortable at two then discuss this option with your dentist to see how bad things might be by then (like more treatment needs). So, in summary, read more here and of course ask your dentist (who I hope is a pediatric dentist) for all the options. Good luck and God Bless. I am sure it will all be ok.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-23652875582376798642011-03-10T11:11:17.782-08:002011-03-10T11:11:17.782-08:00Hello.
Help PLease!!!!
My 16 month old has caviti...Hello. <br />Help PLease!!!!<br />My 16 month old has cavities on the backs of 2 out of his 6 teeth. PLus a fracture in the front of one of the above 2. We have gone to 2 different dentists so far and they both have extremely different views on treatment. 1 wants to papoose and the other wants to put him under general. I am going to try a third, just to see what another option might be. Is it possible to do nitrous oxide on a child this young? I am lost!!! I know papossing is out for me, but general anethsia sounds a bit extreme. Is there a major risk if we wait until he is 2? <br />Any advice would be great. Thanks :)Mommy1https://www.blogger.com/profile/06362027484029845255noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-46271655125276703542011-01-31T15:36:36.227-08:002011-01-31T15:36:36.227-08:00Yolanda. Any decision is ultimately up to you. E...Yolanda. Any decision is ultimately up to you. Each case is different, but usually a two your old, I'd say most of the time we are doing work under general anesthesia in the hospital. We do many sedations in the office as well. As you read here, sedation is a serious issue. When proper guidelines are used it can be a safe and effective manner to accomplish work. Still, if you have read anything here, you will have seen medications and the reaction to medications is variable. Many two year olds, well, they will still be resistant to treatment even after sedative medications. Once they are say, four years old the medicine is more predictable. It is always ok to ask for more information if you are not sure.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-31383427521715844672011-01-30T21:57:32.011-08:002011-01-30T21:57:32.011-08:00My daughter is 2 and has four cavities since she d...My daughter is 2 and has four cavities since she didn't stand still at her check up they said they have to put her to sleep when they work on her teeth she has asthma and Ive been reading articles about kids that die under sedation. What should I do? Also that dentist office has only been there a year and they would put her to sleep there. Should I let them put her to sleep there go to a University Hospital or rather them not put her to sleep and just tie her down?Yolandanoreply@blogger.comtag:blogger.com,1999:blog-16472438.post-33410351881307613302010-10-01T15:59:14.677-07:002010-10-01T15:59:14.677-07:00As I read this, it sounds like they are saying the...As I read this, it sounds like they are saying they will try with just the "air" (I presume nitrous oxide), but if that does not work the only choice is to restrain to do the work? I have no idea on the Medicaid payment or not. It does sound like he might be a candidate for conscious sedation. I do not know why they would alter the dose based on Medicaid or non-medicaid. I suspect they might have been saying that if they do use sedatives, they would use a small dose due to his age or weight. It could also be that the only medications they feel comfortable using is a milder one. It is unclear.<br /><br />Valium can help someone with anxiety, but for more severe cases other meds might be needed. Firstly, I would not do anything you are not pretty much ok with and understand the possible outcomes. Problem is, there are no easy answers especially if the doctor cannot use the best method for whatever reason. Also, make sure the dentist is a specialist in pediatric dentistry. He may be, but it is not unusual for parents to request no sedation because of financial reasons. Sedation is a costly method, but usually not as costly as general anesthesia.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-27687199884130951372010-10-01T14:57:44.801-07:002010-10-01T14:57:44.801-07:00my 9 yr.old has been treated for serve anxity unde...my 9 yr.old has been treated for serve anxity under a physciatrist for the past 2 yrs. his anxties r a better but still there. Last yr, he flipped out at the dentist & they were unable to fill his second cavity. I was told to bring him to a pediatric dentist which we did today . they told us they would give consious sedation & sweet air when we made the appt. Once we showed four the appt. today they said they can only give himsweet air as he to old medicaid won't pay & if we pay they will only give the dose of a child 1/2 his size.Once home they called & said once sweetair was give &if he was unble to do the work ,they would tie him to a board COULD NOT & stop them. Is this true & any suggestions?wWe have CDPHP (medicade).Live hunter,ny Help please.Also said valium wouldn't work before sweet air from physc.Unknownhttps://www.blogger.com/profile/12673091385924999001noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-26326801415152952502010-08-10T19:48:07.624-07:002010-08-10T19:48:07.624-07:00Oh, my. If I read your comment correctly, this is ...Oh, my. If I read your comment correctly, this is a tragedy. I cannot say if any kind of dental treatment had anything to do with this or not.<br /><br />Just a general remark: Nitrous oxide is fairly mild and has a very good safety record. The effects wear off in a few minutes after administration is stopped. In the extremely rare cases when dental treatment and sedation have been implicated in morbidity or mortality, it is because of many things going "wrong" at once like large overdosages of several medications, underlying medical conditions, inappropriate medical response or monitoring, or protocols not being followed, etc. Most every case I have read, problems have happened the day of and during drug administratin and treatment, not several days later.<br /><br />If you want to contact me further, please feel free to mail me at our office: Dr. Dean Brandon Alabama Pediatric Dental Associates and Orthodontics, 4001 Balmoral Drive Huntsville, Alabama 35801. God Bless.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-69198590235296390652010-08-10T11:35:20.968-07:002010-08-10T11:35:20.968-07:00My 19 mo yr old daughter was diagnosed with a gum ...My 19 mo yr old daughter was diagnosed with a gum infection when i took her to see a dentist bc i noticed her gums where swollen. They told me yes she has a gum infection and also she has two cavities. The office that day was pretty busy, so he told me to come back and hed clean her teeth and prescribe medication for her. He took her back, bc parents are not allowed, when he brought her back to me he told me he filled in her two cavities too.(while she has an infection in her mouth?), Wed, was the Dentist appointment, and She had past away in her sleep Friday morning. Toxicolligy test are in the process, but what i found out was he gave her nitrous oxide when he realesed her detal records. I was not aware she was even going to get her cavities filled that day, but giving a 19 mo old notrous oxide with severe asthma problems? Everything thats been happening has just been crazy, Can you please help me out or give me feedback on your opinion of what have shouldve happened that day?mcorbettbmhttps://www.blogger.com/profile/11756199319903223093noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-54871764886489359912010-05-30T05:55:53.376-07:002010-05-30T05:55:53.376-07:00Insurance companies are bizarre on what they cover...Insurance companies are bizarre on what they cover and what they do not. Whatever the outcome, the patient usually ends up on the short end of the stick so to speak. Looks like the dentist's fees were the lowest of those you listed. I believe what you are referring to is general anesthesia in the hospital not in office sedation. The dentist has no control over the charges of a hospital. Each case is different, and it depends, but the dentist's fees you mentioned are not unusual for a moderate amount of dental work on a young child. The fee "just to drive" to the hosptial is likely reflective of not only travel time, but pulling two assistants and the doctor and some instruments and supplies out of the office for several hours. (We have a similar fee although not quite as much). Hospitals usually fee a base fee plus by the amount of time in the OR, but, as you can see, it's still a whole lot! <br /><br />Think about if you had no insurance at all. That is one reason (among many) that in-office sedation is offered as an option for some cases. Still, we have several young children every week whose cases need to have general anesthesia. In-office sedation is just not an appropriate option for them.<br /><br />See my other posts on hospital dentistry, etc.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-17306405161140476312010-05-29T18:19:39.444-07:002010-05-29T18:19:39.444-07:00We took our two year old for his second cleaning a...We took our two year old for his second cleaning and they discovered two cavities that spread across his front four teeth. They recommended them be fixed at the hospital and he be put under for the procedure. I had to pay $966 up front, and $500 of that was a fee the dentist charges to drive from the practice to the center which is not re-imbursable by my insurance. Total before insurance paid for everything, the bills amount to over $8000.00, with my out of pocket being close to $2500. It was $5500 for the hospital, $2000 for anesthesia, $1800 for the dentist. Is that normal?? I can't wrap my head around having four teeth filled and it costing more than delivering a baby.Anonymousnoreply@blogger.com