Dentist just referred my 6yo for 5 teeth out under GA. Can this be avoided?

[CreatingHavoc]

Dd has had problems with her teeth pretty much from the word go. When they came through when she was a baby they had brown marks on them, which have been largely unexplained by dentists. She also has sensory issues that mean it has always been very difficult to get her to brush her teeth and the only toothpaste she was content using was a fluoride free one. Under the advice of dentists I switched to a fluoride one but that caused further problems due to the change of taste. It was exactly the same as her previous toothpaste, just with added fluoride, but she hates it and it has made her worse if anything. She seems to hate the sensation of toothpaste being in her mouth and will spit out almost immediately. She also has an extremely sensitive gag reflex.

All this has led to her having signs of decay in 5 of her teeth, one of which is now sensitive to cold and causing pain when she eats cold things. Because she is also terrified of the dentist, the dentist we saw today couldn't even get an xray of the tooth. She said the only option now is a referral to the hospital for removal under GA. I want to avoid this as I don't want her having a GA unless absolutely necessary. I am getting a second opinion tomorrow from a private dentist but obviously they may say the same depending how she reacts and how upset she gets. Me and her dad are more worried about the GA than anything and really don't want her to have to be put through all that if at all possible.

Has anyone been in s similar situation and managed to avoid a GA?

I can’t make head nor tail of what you are saying sorry! But you seem determined to blame the dentist! 12 years old when a molar falls out? Really? You have inflated this whole issue. Good luck with the teeth removal and hopefully this will encourage your little one to brush their teeth!

@Eyerollcentral I don't know why you're giving OP such a hard time. Neither problems with the enamel nor problems with brushing for DC with sensory issues are unusual.

As I said in my previous post I m really struggling to understand what she is actually saying. At first the child couldn’t stand to get her teeth brushed and now it’s that has she known about the importance of fluoride (?!) she would have persisted with brushing. It’s not fair to blame the dentist here at all.

I think she's very clear.

If I had had my DC at a dentist more than once and asked about marks on their teeth, and the dentist didn't even discuss problems with enamel I would be very unimpressed. The dentist even seems to have hinted at it by saying the marks were caused by antibiotics without elaborating that OP would need to be extra careful.

Likewise, if I had a DC that only tolerated one type of toothpaste, I would be much more inclined to go with it if the dentist hadn't raised any particular concerns. If I knew they had problems with their enamel, well then that would have to be a battle that was fought.

@CreatingHavoc the Oranurse toothpaste is genuinely tasteless. I tried it and really couldn’t taste anything.
My DD cannot tolerate mint flavoured toothpaste. She says it burns. When she was a toddler I used to lie her across my lap and get the brushing done while she yelled. You just can’t do that with an older child. Once she was able to tell me the problem, I started looking for alternative toothpaste. The dentist was not able to recommend any. I found out about Oranurse on an autism forum.

Honestly, there’s really nothing untoward with a GA for a physically typical child without underlying risks. Unless there is a specific issue linked to your child and a GA I’d just go ahead and have the teeth out without worry.

Hi OP, I'm a recently retired consultant anaesthetist who worked with the local community and special needs dental services for many years.
I won't pretend that bringing your child for a GA is a fun experience, but everyone does their best to make things as smooth as possible for both the child and parents and everyone our team understands the anxiety and is very used to dealing with situations like yours. I know it's easier said than done, but try not to worry too much. Obviously nobody wants an unnecessary GA, and there are some risks, but in a healthy person undergoing a routine procedure they are very small. And you have to balance that risk against the risks of the alternatives of course, and untreated dental caries can lead to significant problems.
I think dental anaesthesia gets a bit of a bad press because people still remember the days of GAs being given by dentists in their own surgeries, and some pretty awful stuff did happen then. But those days are long gone. A dental GA is now given in hospital with the same safety standards applied as to any other procedure.
There are some really useful free resources you can download from the Royal College of Anaesthetists website with information for parents and age appropriate activities for children to help prepare them.
I'm afraid you may be in for a long wait though. Before I retired our service had long waiting lists and we were getting children being referred from the next county because waits there were up to 12 months. The NHS is in a bad way generally and dental services are not a high priority for many Trusts unfortunately. When my dental colleagues and I went to training events and conferences we found that the problems we were facing in our service seemed to be common to more or less everywhere I'm afraid. I hope you don't have to wait too long though and that everything goes smoothly. Talk to the hospital dental nurses about brushing when you are there too, as they may have some good tips. Our service is very much about prevention of future issues not just taking the current problem teeth out and our dental nurses and hygienists are fab - hopefully you will find the same wherever you are.

I haven't really got any advice as such but I had 5 teeth out under GA when I was 9. I was a nervous and shy child, but found the whole procedure fine and actually quite enjoyed the attention.
I think you will just have to go for it. Having had a dying nerve in a tooth just recently I would try and avoid it coming to that as the pain was horrendous.

My 6yo has a dead front tooth with an abscess, she’s had the abscess for a year (initially treated with antibiotics but still there and drains itself). The dentist did attempt to extract it with a local but she wouldn’t tolerate the needle so it’s still there. The only option was a GA which with a waiting list I felt was pointless as the tooth should fall out any time - recommended to wobble it out ourselves which we’ve had no success with! She has no feeling in the tooth as the nerve is dead from a previous injury. There’s no other option here except a GA extraction - no way would a dentist attempt an extraction with a local of a molar on a 6yo - the child is not going to open their mouth for a huge needle if they won’t let a toothbrush inside, and the dentist won’t force the issue.

Fluoride toothpaste used to hurt my gums, it would burn, my dentist told my parents the brushing was more important and if I could only brush with water then that was OK.

I used to use eucryl powder.

As for blaming dentists, you might struggle to clean her teeth but you are in control of her diet.

Have you tried disclosing tablets? If she can see what she is brushing away it might help.

My dd had 4 out under GA when she was 6 or 7 , wouldn't have known she had had one ! I had booked the day off work to look after her and she could have gone back to school ! I presumed she would be like me ( takes me at least 24 hours to get over a GA) but she was absolutely fine .

My son has had at least 50 GAs in his life, I have really lost count. 30 of them were in the space of 6 weeks when he was turning 4 (proton radiation treatment). I remember being incredibly worried when he needed his first GA for eye surgery when he was 1 - it's entirely normal to worry. There are risks, but sometimes it's unavoidable. Stay positive.

Avoid SLS in toothpaste but not flouride. With enamel issue you'll also need to use MI paste like 'tooth mousse' smeared on teeth just before bed.

GA is a far better alternative than putting a child through having adult fingers poking about in her mouth for 20 mins, plus needles, the suction hoover thing etc etc. Being asleep through that is the best way.

I’m petrified of the dentist and would rather have GA for any extractions in the future as I had one under local last year and it was so traumatic that it’s compounded my fear to a point where I can’t bring myself to even go for checkups. I need my wisdom teeth out also as they’re impacted but if they won’t do it under GA I won’t have it. GA is very safe to have, even for little ones, and she won’t have any scary memories of the extractions

I had GA when I was 5 (tonsillectomy), and then when I was about 12 or 13 to remove impacted wisdom teeth. I think GA is pretty safe overall, especially when balanced against the risk of not getting necessary procedures done.

Ive heard good reports of Oranurse from autism community groups we are in. Worth a try.

Thanks all for the advice and reassurance, it's massively appreciated. Really. I thought it was an extreme reaction to have her sent for GA but it appears to be quite common, so I'm less anxious now. She does need them out, they are causing her problems and I don't like seeing her in pain. Thankfully the dentist said it doesn't look like it's infected at the moment but it may become infected, so need to keep a close eye.

Her diet is relatively good, she only has sweets on special occasions (she still has sweets left from Halloween) and she normally prefers savoury snacks. Although I've read that crisps aren't great either and she they are her preferred snack.

I will try the oranurse toothpaste as well, thanks to the people who suggested that.

I remember having 5 teeth out under local over three days as a child (3 out, a day off, then 2 more out 😳) ...it was pretty grim tbh and I think the GA would very be sensible in your case.