Should I lie to my kid about the dentist?

[CaseyCassum]

Don't eat me alive, please. I just have a question.
My son is 14 and deathly afraid of the dentist. Always has been.
Whenever he was younger, the methods the dentist used to force compliance of children in the denstist's chair were (by today's standards) pretty barbaric.
If a child would fight the dentist and refuse to settle, it was standard practice to strap the child down using a weighted blanket and straps, and then usher the parents out of the room to do the dental work... This happened to my son and I went along with it because I knew no better at the time.

Of course these days I'd never go along with something like that and I'm pretty sure dentists don't even do that sort of thing anymore but that's beside the point.

Well, now my son's capped baby tooth is retained and needs to come out. It's not unusual that baby teeth that are capped in silver need to be extracted, the only problem is my son is beside himself at the thought of the dentist's needle.
A few days ago the dentist told him to wiggle wiggle wiggle! That the tooth needed to be out by his next visit in 6 weeks, or she would have to pull it.

My son is so desperately afraid of the dental needle to numb the gum he is digging and gouging at his baby tooth and it is not budging.
The gum is becoming infected because he is scraping and tearing at it, and his bathroom sink is looking like something from a horror movie.

IV sedation (where an oral surgeon and an anesthesiologist put a patient under) is not possible because he had it two years ago to remove another retained baby tooth and he had a bad reaction necessitating the assistance of paramedics because the anesthesiologist couldn't roust him after he went under... Not doing that again.

I've tried explaining to him that the pain he is causing his mouth right now is alot worse than what the needle stick will feel like but he is having none of it.

For two days he's come to me crying and shaking for hours on end. He's digging in his mouth and gums because he is terrified of the dental needle and I just don't know what to do.

My son has special educational needs and is just about on par with his peers, but while he is 14, he is about as mature as an 11-12 year old developmentally.

He sees a psychiatrist for his ADHD so I was considering asking her what she thinks?

I knew this sounds so trivial but I honestly don't know what to do to help him.

Would I be unreasonable to lie to him and tell him the destist said to stop wiggling the tooth and that it can fall out naturally, only to take him in 6 weeks and hope and PRAY talking him through the oral anesthesia will be possible?

I'm going to really stress this part to him.

I can ask. I'm nit sure what that is but if he can have it we will do it. I think the dentist thought i was exaggerating whenever i explained about his fear. But i need to do something for him to at least help his anxiety.

Im here and thank you for your advice and suggestions. Just feeding a wiggly baby

Isn't there something that can numb the gum before the injection.

I think numbing gel, I didn't know they use that on kids his age but I'm going to ask for it

Not all baby teeth fall out by themselves. Depend on how the new tooth is growing. It may well need pulling out by a dentist.

In my experience the needle actually doesnt hurt as much one tends to think. I hate them too. The dentist can use a dumbing gel first I think. Also there is medication to calm the nerves down but I guess you know that.

I insist on the numbing gel before injections, I can honestly say I’ve never felt the needle going in after having that.

Is there anywhere local that offers the dental wand plus numbing gel? It should be painless. https://happykidsdental.co.uk/making-children-comfortable/the-wand-painfree-injections/

I would suggest to get him counselling about the understandable fear of dentists he has developed after the horror treatment. Also work together with the dentist to make sure she is caring and explaines everything to your son.

I realised that my anxiety comes from doctors and dentists doing something to my body without explaining what and not taking my feelings into account.

WTAF that dentists were strapping children down in the US in the 2010s!!! I am absolutely gobsmacked at that.

How urgent is the removal? I think I would call (or go in) and ask to speak directly to the dentist privately, explain the issue that he's causing with the wiggling, and see what she advises. She may be horrified and say that "keep wiggling" was a jokey comment and not intended to be taken literally.

I would ask her if six weeks is a hard deadline. What the risks are from leaving it longer.

What is actually happening physiologically to a tooth when it is falling out naturally? Because if it's not the gums, then digging at the gums won't make any difference. I would also ask her what the likelihood is of it falling out naturally and if there is anything that you can do (or any way to tell).

Ask her if it is an option to remove the tooth without the injection. Either with a different kind of pain relief/sedation, or with none at all.

I would reassure your son that nothing is going to happen unless he is OK with it and you will work with him and the dentist for as long as it takes to find a solution.

Basically the solution to dental phobia is a dentist who the patient trusts and feels in control with. That is never going to happen if you (collectively) are throwing around ultimatums like in 6 weeks we're going to take it out, however well meaning. It sounds like he's OK with being in the chair and having a check up, and the problem is the injection. Is that right? If that's where you're at, then that's already extremely good and you can 100% work with that. But he needs to feel in control. Which means giving him agency and choice. Of course he can't just make the choice not to go to the dentist. But I think that even an 11 year old can have different options explained to them. My dentist (not UK, I know UK dentistry can be scarce so this might not be standard) says to me that she truly doesn't mind if I come in and I won't even open my mouth. She says "All that we lose is time." She ALWAYS emphasises that I can raise my hand at any point during treatment and she or the hygeinist will immediately step away and stop. This makes so much difference, I can't tell you. I used to be so afraid of injections that I would have fillings without them, and I used to avoid the dentist for years at a time. Now I can go for a full on cleaning and not stress about it at all. It's not the most pleasant way to spend an hour, but it's totally manageable and I don't have to deal with adrenaline comedown exhaustion for the rest of the day.

If he feels anxious about the needle, I would make a suggestion to see if she can try out a numbing gel or spray for him. Then perhaps with one of those pick things, testing it on his hand to show that it doesn't pierce the skin, she could show him that he can't feel when she pokes with the pick. But he has to be in control here, he has to be the one making the decisions.

So I would get the dentist to speak to him about the different options, which I see as these:

1. Wait for it to fall out naturally (explain any downsides related to this, and any extra care e.g. needing to use mouthwash to prevent infection)
2. Don't take it out at all, even if it never falls out (explain what would happen, if there is something very bad which happens in this scenario, maybe talk about how you'd know you were getting close to that point)
3. Take the tooth out with injection pain relief. Talk about options such as gels etc which can help mitigate the injection pain. Try out the gel, perhaps on another area of the body e.g. his hand, or directly in his mouth if he is comfortable with that.
4. Take the tooth out with no pain relief. Talk about what the expected pain level is likely to be - would it be very painful or is it possible that it could be minor. Talk about the option to use the "hand brake" to stop at any point.
5. Take the tooth out with a different kind of sedation or pain relief such as an anti-anxiety medication. (Perhaps to help him cope with the needle).

If there is no immediate rush but this might become a problem in the future, it might be an idea simply to say leave it for now, but try to use the option format above to work on a different procedure, perhaps something like a deep cleaning or similar, so that he gains an experience of something happening at the dentist that isn't as bad as he fears. Or just keep building positive experiences at the dentist.

I think if you go in with deceiving him then it's just likely to reiterate the trauma and once he is an adult he will totally stop going to the dentist. If you want him to be able to handle dental visits as an adult, then the most important thing you can do is show him how to advocate for himself and retain control of the process.

It might be helpful to speak to the psychiatrist in that she may be able to suggest some kind of anti-anxiety medication. But other than this I don't know if it would be of that much use.

My ds (14) had 4 teeth removed recently so he can start orthodontic treatment. My ds has anaesthetic injections and it honestly was very straightforward, yes a little uncomfortable but not painful and very quick. I just held his hands and the dentist did her thing.

What an unbelievably cruel practice! Sounds barbaric.
I'm sure you don't need telling this OP, but he needs treating some way or another, even if that means having it done in hospital. If that tooth becomes infected due to his DIY dentistry, it could lead to sepsis, which can ultimately cause death.

I'd ask about sedation, it doesn't need to be strong like for appendix. How does he react badly? Can they work round it (eg if it makes him vomit, they can put anti-nausea in the drip too)

Dd1 had dental phobia. She used to be in a complete state just walking into the dentist to get an appointment. Now the dentist (he's lovely) has got in his friend to do sedation when she's needed it every time. He doesn't even charge that much extra.
But last time she needed a small filling he suggested she tried just local anaesthetic. She managed it! Both me and the nurse were in tears in the back room afterwards. It's taken 8 years.
But for her, knowing that she could say "stop" and he would have just booked sedation for her next time made a huge difference; it helps her feel in control.

Hi everyone! Thansk so much for the advice and thanks again for not skinning me alive. .any moons ago i was a young parent trying to figure out what was best and I qas only following the guidance I was given so I'm grateful you all realize that. I really expect to be drawn and quartered.
I think i will start by asking the dentist to examine the tooth again and make absolute sure it MUST come out. I did see the xrays and the tooth is pushing on the root of another tooth at an angle because the baby tooth won't come out but I will check again that the tooth must come out.
If it needs to come out then i will certainly ask for numbing gel.
I was also considering asking his psychiatrist about something to help his anxiety on the day of... Does that sound like something I should do?
He already takes celexa (recently switched from Ritalin) so I was thinking maybe a single dose of something stronger prescribed by his psychiatrist?
Whenever my husband needs an MRI his Dr. prescribes him a single xanax (the noise and tiny space agitate his PTSD).
Do you all think that's something that could benefit my son?
Thanks again for all the feedback.

Sedation as in general? IV sedation? He cannot do that.. The first time he had general was at the dentist and they had to call an ambulance because he wouldn't come back from it. He wasn't rousting. The second time (we thought the first was a fluke and it was absolutely necessary so had no choice really) was when his appendix ruptured and he needed surgery. He was kept for two extra days because the hospital had the same issue bringing him round afterwards.

I was going to also suggest this. Whenever I go to the dentist for “work” they do the numbing gel first and I don’t even feel the needle.

And I’m in the US and am horrified at dentists who hold kids down. Never experienced that with my lot and they’re much older than 14!

Have you heard of dentists who do it? In all the years since we moved away from the island i haven't encountered one who does it. Some remember the practice but they all comment how they've never done it before. I even had to sign a form saying i agree to the restraining method or they wouldn't treat him. I thought it was standard but of course i know now that it was bizarre... He still remembers it and mentioned it a few days ago whenever he say the dentist foe his cleaning (that is what prompted the tooth removal, he had yearly xrays done)

Thos might be a daft suggestion but might hypnotherapy be an idea?

Doesn't sound crazy to me. I was actually googling it.

OP not sure if "sedation" is being used as a catch all term for a GA here? Apologies if I'm wrong, but dental work in the U.K. is frequently done under sedation where patient remains awake at all times and can talk etc, but is calmed in much the same way they might be by take diazepam

On that - would diazepam perhaps help with this? 14 is young but it may not be too young, my dd had it at 15

I worry there is a bit of a misunderstanding as far as sedation lol. GA is IV sedation where they put him to sleep using an IV. An anesthesiologist (a doctor of anesthesia) administers it and is present for the entire procedure. He cannot have this because of prior complications 😔.

He understands he will be anesthetized and won't feel pain during the procedure, he just cannot get past the doctor needing to use a needle to administer the local (numbing medicine).
I am going to talk to his dr about a single dose of diazapam or something to help.
I've just tried talking to him again and he starts breathing heavily and shaking so I've let it drop for now.
plus I'm still googling hypnotherapy and apparently it is a thing for children with phobias... who knew...

Yeah…I’ve had some questionable dentists in the US going back much further than 10 years and no this is isn’t standard, encouraged, taught, or accepted practice anywhere.

I think you need to talk to him about what to expect, yes numbing gel before a lidocaine shot is very common (so much so you shouldn’t even have to ask), staying in the room with him during the procedure, and telling him he can and should talk to the dentist during the procedure to understand what is going on.

Look if he freaks out and can’t do the procedure that’s not the end of the world, but he should be learning what his rights are as a patient and what’s standard during procedures as he has a lifetime of them ahead of him.

I’m also going to suggest you do the same, it sounds like your calibration of normal for procedures need to be reset a bit too

Look up conscious sedation… it’s administered by IV, but the patient is awake the whole time. They won’t remember anything. This is different from GA, different drugs and level of sedation

It still may not be an option for your son but it may be.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5490120/

Could he have a drug to calm him down? An appropriate equivalent to taking Valium to control fear of flying?