Advice please re: v nervous DD and dental treatment

[releasethehounds]

Advice please for a desperate mom!

DD1 (12) has very protruding top front teeth and her orthodontist has pushed her up the NHS waiting list because it is so severe, and I was delighted to hear she can have her brace next April. However, she still has one baby tooth which has been wedged in place by two adult teeth and therefore has to be removed by the dentist asap before her brace is fitted.

I made an appointment so yesterday I took her to the dentist to extract the baby tooth. I knew she would be scared as she has generally been scared of a lot of things over the years (blood tests, dogs, sleeping in her own room etc etc), but I didn't make a fuss about it and explained to her that the baby tooth had to come out before she could have her brace. Despite this, she was much worse at the dentist that even I expected; me, the dentist and 2 nurses spent over an hour trying to convince her to let the dentist take her tooth out, but she was terrified of both the needle and pulling the tooth out. Eventually the dentist gave up and we made another appointment to try again at another sister dental centre (a long drive away) which can use Entinox (gas and air) which can relax some patients.

I'm really upset about this as I know what DD1 is like and I don't think even the gas and air will help her to have the injection. Although they were very understanding, they told us last night that this would be DD's last chance, and if she refuses treatment they will cancel her braces in April.

I'm devastated by this - I won't bore you with the full story but it has taken a lot of work and worry for me to sort out the braces for DD1 and now I feel she is going to lose the chance. I can't bear to think of her going through secondary school with very buck teeth, but I'm out of ideas.

Has anyone any experience of very nervous dental patients and what I can do to help her?

TIA

Please....

I dont know if this is any help, but can you request a GA?
I recently had a GA for a relatively minor procedure which could have been done awake but due to PTSD was impossible for me to be awake IYKWIM

ds1 once banged his teeth and lost 2, the consultant said he would do a LA to remove one and I flatly refused, I think the trauma of holding down a young child to administer a GA is just awful and he knew that I wouldnt go ahead and let him remove it without a GA.

It depends how you feel about general anaesthesia or if there are any health implications, but sometimes its kinder. Ive seen a lot of paeds in theatre for dental work, just because its too traumatic to do it any other way.

HTH

sorry meant holding down a child to administer a LA (local) not a GA
You would be allowed to be there for a GA until shes off to sleep

Thanks mosschops - I did ask about a GA last night but the dentist said it was too risky. I've thought about contacting other dentists, as I believe some will give a GA, although I'm very worried about the risk. It may come to that though.

The other thing that worries me is that if DD is so nervous about having a tooth out, will she also refuse having her brace fitted when it comes to the time, as I have heard braces can be uncomfortable, even painful.

My sister (46) was extremely phobic about the dentist. She desperately needed work doing (and some false teeth) and I hunted high and low to find a dentist. And he has made all the difference...he and his son specialise in nervous patients. For the first few appointments I was allowed to sit next to her and she held onto me. Now she goes on her own. It really is worth hunting around for the right dentist, although time is not on your side here as I appreciate.
I don't think entonox will help as it is rather 'instant' and involves equipment going over/near her mouth. You need her to be relaxed before even entering the surgery.
A small oral sedative in either tablet or liquid form a couple of hours beforehand?
Arrange to have your own teeth cleaned and polished and have her there so she can see what's going on, ask questions?
Or get referred to a dental hospital.

Thanks springlamb - I will investigate the sedative idea but I don't want any medication to react with the injection (if she'll have it!).

Would DD's dentist need to refer her to a dental hospital?

at too risky, is he living in the 1950's????

general anaesthesia these days is very safe, but would need to be done at a dental hospital, and you need to find a specialist paeds anaesthetist.
Some sedative would be a good option too, I agree with spring

Have to do school run now but I'll log on later, thanks.

bumping for the evening crowd.

bump again!

My DD had a GA when she had 2 teeth out aged 4, Im not sure whats too risky about it. It is difficult and she refused to have the magic cream on her hand to give her the injection and in the end they put her to sleep with the gas mask over her face, it was horrible and she struggled and struggled and then just went limp which was heart breaking but I think you have to be hard and just do it and its over before you know it.

If she is that phobic I would look at going somewhere that will give her a GA, we had it done on the NHS but we did have to go to Guys Hospital in London to have it done - I think this was more to do with her ages though.

Having a brace fitted isnt nice and you have to have impressions made of your teeth. This involves basically biting down on a big bit of playdough - I found it hard to do when I was her age and used to gag and nearly be sick. I think you are in for a long haul with it all tbh I really feel for you

Thanks socialbutterfly - yes, you're right - the whole process is going to be a rough one. I'm not looking forward to the brace being fitted, but now all I can think about is getting her baby tooth removed, or she won't be getting a brace anyway!

I have spoken frankly to DD who assures me that she will definitely have the LA injection next week and I believe she intends to, but I just hope she is brave enough when the time comes...

I explained to her that it's really essential she has the brace as her overbite is very severe and the orthodontist says she is biting on soft palate which could lead to serious damage later on. I know I'm putting the fear of God into her but I explained that she may end up having to have a big operation when she's older if she doesn't have the brace now.

Feel awful really but it's a possibility.

Thanks again all for your help - wish me luck next week!

Release the Nitrous Oxide is brilliant for children that want to cooperate but are just very scared. The other advantage is that it raises pain thresholds so she will find the local anaesthetic easier. I would recommend sitting down and talking her through what will happen.
They will put a little rubber nosepiece on that will have pipes coming out either side. These take the air to the nosepiece and take it away. The air smells a bit funny but will help you relax. Once you feel comfortable they will make the tooth go to sleep, you will feel a stingy scratch at first but this won't last long and as the tooth goes to sleep the tooth and gum will feel big. The dentist will make sure the tooth is fast asleep before doing anything else. Then they will wobble the tooth just like she would do when she has a loose baby one. This tooth just needs more help.

Really emphasise the gas will help, that if she can try to relax it will all be very quick and that having the tooth out will mean she can have the braces. Really emphasise the positives.

Is your DD bothered by the way her teeth look as this may well help motivate her to try to cooperate.

Community Dental Services can help with children who are very nervous of dental treatment, they work by desensitisation and using things like the Nitrous oxide. Another option is referral to a Children's Dental Hospital if there is one reasonably close to you. GA is a last resort but would be very brief and I can't see why it wouldn't be done unless your local department refuses Orthodontic extractions.

I hope you dd manages to have it done next week.

Good luck to your DD, releasethehounds - maybe the GA issues are more to do with waiting lists?

I hope she can conquer her fears and make good use of the gas and air :)

Hi again everyone - thanks for all the advice.

Milly - you've made me a little more hopeful that the gas and air will help DD and I shall pass on your information to her. Yes, she is bothered by her appearance as she says when people are talking to her they aren't looking at her eyes, they're looking at her teeth, and she has already had one nasty comment at school . However, this may convince her to get on with dental treatment.

Here's hoping the gas and air will do the trick, but if not, I'll need to contact the Community Dental Services, as Milly advised.

Snowmash - thanks for your support, and thanks to everyone for your help. I'll let you all know next week if she manages to get that tooth removed!

Hi everyone - an update!

DD managed to have her baby tooth removed today - huge relief.

However, it was very traumatic as she was predictably very nervous and started to panic the second the mask for the gas and air was put on! Whether it was because she was so upset that this happened, but she reacted badly to the gas and air and at one point she started shouting for me, even though I was there all the time, holding her hand. She then ripped the mask off her face, sat up and started scratching her fingers against the screen above. The dentist, myself and 2 assistants had to pull her back into the seat and she was given more oxygen. After a few seconds she seemed to realise that I was there and she calmed down and went ahead with the rest of the treatment.

DD says she will never have gas and air again as it was like "having a nightmare - everyone in the room looked like playdough characters". If she needs treatment in the future she has agreed to just go ahead with the injection without gas and air, as that was the worst part for her.

Anyway, all's well that ends well and at least she did have the tooth removed and she can have her brace in April. (I'm trying not to think about how stressful that may be!)

I bought her a T-shirt for her bravery today and my parents also bought her a pair of earrings, so she's feeling much better now!

Thanks again to all those who sent messages and advice. It has been invaluable to me.

Great news. Well done to your DD! She sounds very grown up about it so hopefully the brace won't be too traumatic for her.

That's great news although the trip appears to have been eventful. Has she got friends with braces as I'd suggest she chats to them about what it involves?

Thanks again. I'll now have to start asking around about experience with braces but I won't make an issue about it with DD as I don't want her to get worked up about that! I believe there are a couple of girls in her class due to have braces as well this year so hopefully this will encourage her to keep up and go ahead with the treatment.

I've never had braces and don't really know anyone close who has, but it's much more common now so will ask around. When you hear about wires pinching the inside of your mouth and gums etc it is a bit off-putting.

Anyway, that's one bridge down and another one to cross!