Hospital or dental office for extensive treatment?

My five-year-old daughter has an abscessed molar. She also has five other cavities that must be filled. She doesn't do well with dental visits. She got one filling about a year ago. She had the nitrous oxide. Following the visit, she bit almost completely through her tongue.

The dentist recommends she go to the hospital and have everything done at one time. Our insurance will only pay for the anesthesiologist and drainage of the abscess. What would you recommend? Is the general anesthesia safe for her? They had a hard time getting xrays. He couldn't get her to stay still to get the nitrous oxide mask on.

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First, I would ask your daughter why she "does not do well with dental visits." If it was the tongue-biting incident which bothered her, assure her this does not happen after each dental visit. She probably bit it because it was numb, and she could not feel it. If she was feeling pain (actual pain like "pins and needles", not a pushing or pressure) during the treatment, you should discuss this with the dentist. Perhaps the dentist only needs to reassure her that he will provide more anesthetic (or "sleepy juice" as we usually call it for the children) for the tooth so she will be comfortable. Maybe she could bring a favorite stuffed animal or doll or blanket from home to help her feel more comfortable. If your dentist has a TV and VCR in the operatory, maybe you bring a video to help distract her. If it is just a fear of the unknown, which is the most common fear, have the dentist and assistant explain treatment in her terms and show her some of the instruments (not the sharp ones). See if you and your dentist can find out what upsets your daughter about dental visits. Perhaps the solution will be easier than having general anesthetic.

There are some other approaches you might consider. If this is a general dentist who has been treating your daughter, you might ask him or her for a referral to a pedodontist (children's dentist). Sometimes a pedodontist can be more successful in treating a fearful or uncooperative child. This may be partly due to the environment, which is strictly geared toward children. You could also discuss other alternatives with the dentist, for example some type of conscious sedation. In some cases of extremely fearful or uncooperative children, I have had some success with prescribing valium or other relaxant for the child to take prior to the appointment. This, in combination with the nitrous oxide, can work well. In addition, keeping the appointments short, which may mean doing one or two fillings at a time, can be helpful.

While I believe most dentists would at least like to try to treat all patients in their offices, sometimes it is better to have the treatment done in the hospital under general anesthetic. Some dentists do have the capability to do this in their offices, but it does require special training and equipment. If you decide to have her work done under general anesthesia, all necessary dental work, including a thorough exam with radiographs, a complete cleaning, and all cavities filled, can be accomplished at once. While there is always a certain risk for any of us to undergo general anesthesia, a thorough workup of your daughter's medical history and any other necessary procedures will be done to minimize those risks.

Whatever you decide, you should definitely seek treatment for your daughter. Not only is it important to clear up her current infection, but prompt treatment may prevent another abscess from occurring. Pain from her untreated teeth may further hinder cooperation during routine dental treatment, jeopardize the permanent teeth developing underneath her primary teeth, and affect her health in general.

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