February 13, 2008,
T.D. asks from Monterey Park, CA on February 11, 2008
Root Canal for a 4 Year Old
I finally took my very apprehensive 4 year old son to the dentist and found out that he needs to get a root canal because he has a cavity that has already reached the nerve as well as a filling (for his 2 front teeth). I think we will be getting a cap for one of the teeth him because he just turned 4. He'll also need to go under general anesthesia. Anyone else have experiences with root canals or caps for little ones?
So What Happened?™
My son just had his procedure today and it went very well. The dentist and the anesthesiologist were awesome and walked us thru the whole procedure. We had to reschedule once because he had a cough the week before the scheduled appt. The drs made sure that he was healthy before putting him under so that it would be safe. They gave him a quick shot before hand so that he would be sedated before the IV line went in. And then they did the procedure. He was up and ready to play after about 2 hours of waking up. We're definitely watching him today, since he's not 100%, although he's acting like he is. The cap they put looks fabulous- it's a plastic one that looks just like his other teeth. It's hard to tell which one has the cap! If you need a referral to a pediatric dentist or ped. dental anesthesiologist, I would highly recommend ours - Dr. Eddie So & Dr. Richard Stafford (respectively).
Thank you everyone for your help!
L.M. answers from Los Angeles on February 11, 2008
Children generally keep their top two front teeth until the ages of 5-6 years old. If the permanent teeth are close to erupting, the dentist will usually recommend extracting the teeth. If the baby teeth have substantial root structure left and are needed to hold the space, it is usually recommended to do the "baby" root canal, otherwise known as a "pulpotomy", along with a final restoration. We don't generally recommend general anesthesia unless the child is totally uncontrollable. Some dentists will use Nitrous Oxide, or Oral Conscious Sedation in their office. Others will also employ the use of a "papoose board", or "hugging blanket" in order to gain patient cooperation. All of these are options that can be discussed with a dentist. Since your dentist has already recommended General Anesthesia, I am assuming that he/she has already determined that he/she cannot effectively control your child to do the needed work. I would suggest getting a second opinion. Call some other offices to see what options are available in your area.
T. answers from Las Vegas on February 11, 2008
Been there done that when my son was actually 2yrs
We had him put out and pulled 4 "marshmallow" teeth - but he also has silver crowns.
Kids are pretty tough - I'm sure yours will be fine.
I do however feel a lot of it has to do with the dentist - we were fortunate to find a great one!
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M.M. answers from San Diego on February 12, 2008
Hey T., I've worked for two different pediatric dentists for many years. You have already received a bunch of good advice, but I wanted to add a couple of things.
1- I would stay away from a "gentle" or oral sedative unless your son sat still and did very well for his exam/cleaning. The reason is that oral sedation calms some kids and makes others ten times more hyper/hard to control. It isn't a strong sedative, so they can easily fight it if they want. If they are already apprehensive, they often (not always) do. That can make for a very bad experience and often you end up having to go with the full sedation anyway. Full sedation isn't bad, I promise! I have seen so many mothers go through it and it is SO TOUGH, but the kids do great and don't end up with a terrible fear of dentists.
2-I would NEVER strap a kid to a papoose board. I have only seen this done 2-3 times, but it was TERRIBLE. I have also treated many kids who had it done in other offices, and they were deathly afraid the the dentist, some even at 14 & 15 years old.
3-As far as the baby root canal...it sounds so terrible, doesn't it? It really isn't! It is actually not very similar to an adult root canal. You don't clean out every canal. You simply clean out the top part of the nerve and put a little medicine in there. I actually think it is often easier than a filling. I know some people recommended pulling it. Space maintainers can be great, but personally I think your son is probably too young. (ask your dentist for sure b/c each child's teeth are different). If you put it in too early (like 2-3 years before the permanents come in) you run the risk of it not working and then have some serious orthodontic problems later.
4-As far a the cap/crown goes....there are two types. The first is metal with a white front. The second is all white. The metal is a TON stronger and will last a LOT longer especially if your kid is a grinder. However, sometimes the white front chips a little. These crowns will also look a lot thicker/bigger. On the other hand, most kids eventually grind through the all white cap in 6-18 mo and have to have it replaced, but it looks a TON better cosmetically.
Hope this helps and good luck! I know it can be so tough. Oh, one more thing...studies show that kids who see the dentist (just for a quick lap exam, no xrays etc) before they are two have fewer cavities and less apprehension later in life, so maybe you could make a quick appt for your daughter. Most good pediatric dentists will do it for free at that age! Good luck!
N.F. answers from Los Angeles on February 11, 2008
they arent so bad...ask the dentist about pulling the tooth. if its one that will grow in soon that may be better and less expensive, if it wont grow in soon you could also get a space maintainer to hold the space til the permanent tooth grows in.
S.H. answers from Los Angeles on February 13, 2008
Hi...we have the same kind of boy! Don't know how much I'm helping, but we have an appointment for our 5 year old to have all EIGHT molars filled (& possible cap) next week. He's having it done under a General Anasthetic too, at a kids' surgery center. We're not going to tell him until the day of or day before and explain that he's going to have a nap and wake up with his teeth fixed. And that he'll get to have fruit popsicles and jello (rare thrill)! We are so worried about 8 silver fillings and all that mercury, that I'm going to call a naturopathic dentist and discuss "ozone" therapy. It may be too late for our little ones to use it, or maybe not? It's a drag to do all this to teeth that will fall out, but also no good to have dental infections making them toxic....Anyway, I'm curious about alternative therapies. I do think a GA is actually a good idea for our son, since he wouldn't do well with 8 intense appointments in the chair. I found this site this morning: http://www.naturesdesigndentalspa.com/pedia.html. We're in Canada these days, but there might be similar places in So Cal. Best of luck with this. He'll probably have the surgery on the 19th--want me to report back?
S., freelance working mom to 5 and 13 month old boys
H.F. answers from Los Angeles on February 11, 2008
Does he really have to go under general anesthesia? I know that little ones don't like to sit to still for dentists but I've heard that some dentist can use a gentle sedative instead of knocking them totally out.
P.S. answers from San Diego on February 13, 2008
Hi T.. My 4yo son chipped his front tooth last year and had to have a root canal and cap put on. His dentist did nitrous gas to relax him and then did local anesthesia. He grimaced at the shot, but after that he was basically asleep. Except if you spoke to him he responded. As soon as the procedure was done, they have him oxygen and he was fully awake and normal. Just used Tylenol after the local wore off for a few hours. He's no worse for wear and the cap has lasted so far.