Sunday, August 22, 2010

teeth: the cause of, and solution to, all life's problems

So Cal needs a root canal.

The dentist calls it a "pulpotomy and a baby cap," but I figure anything that involves drilling and reaming out of pulp and covering with a little tooth hat sounds close enough to a root canal to me. I'm not sure how it quite got this far--I mean, we don't have the Sonicare toothbrush and a water pick, but we do, you know, brush his teeth twice a day and all try not to pack his molars with caramels or anything. But a few weeks ago Cal started complaining that one of his back teeth was hurting and I took him to the dentist and now here we are.

Cal has not notoriously been great with doctors (I blame poetic justice) but now that he's five and is at least approaching the age of reason, some combination of preparation and rationalization will temper the flight-or-flight response that typically characterized his medical interactions between the ages of two and four-and-a-half. Meaning he understands the need for doctors (occasionally) and will even comply with their exams, but when the pointy things start coming out, may the good lord help us all. Which is why I'm not really feeling great about the prospect of this root canal.

However, we're going to a pediatric dentist, and that helps immensely. Not only are they much more accustomed to dealing with kids (dur) but they have all sorts of enticements and incentives to get the kids to comply with their picking and drilling. I counted a total of four giant flat screen TVs playing all Pixar all the time, and that along with the embarrassment of riches that was the reward rack. (Strangely, the "treat" that captivated Cal the most was the new toothbrush and mini toothpaste, though certainly there were stickers and erasers and other tchotchkes that I'm still finding underfoot.) They made sure his first visit was a benign one, with just a tooth cleaning and X-rays, but obviously the next time we go we're going to have to Get Down To Business and I'm just not sure how that's going to fly.

However, to his (and their) credit, Cal did tremendously well the last time we were there (see the above picture, and his feigned nonchalance with the hand behind his head), and they say they use a little low-grade nitrous for sedation, at least during the local injection, so that's as much as I could ask for, I suppose. Actually, what I would ask for would be a pediatric anesthesiologist and a propofol infusion, but I will take what I can get.


  1. Anonymous11:34 PM

    Poor little man!
    Did he go for regular checkups before? I'm surprised the cavity wasn't caught earlier
    Oh well, at least it's his deciduous tooth :)

    -A dentist

  2. Down here on the other side of the world they do all that stuff under GA... no idea how your health system works, but can you at least ask for it?

  3. You mean you're not going to pack a nice little IV kit and a syringe full of the magic white juice in your pocket?

  4. My youngest (now 18) has reflux and had thousands of dollars worth of dental work because the acid in his stomach ate through his teeth. The enamel in baby teeth is very thin. It felt like he had a new abscessed tooth every week for awhile there.

    Once your little boy gets his adult teeth he should do much better.

  5. Lisa C.1:58 AM

    If you're really worried about his anxiety some doctors will sedate with Valium prior to the procedure.

    My son had to have two cavities filled when he was 6 and did fine with the nitrous.

  6. You said: "Actually, what I would ask for would be a pediatric anesthesiologist and a propofol infusion, but I will take what I can get."

    Yes, but what will we do for Cal?

    I actually watched my subgingival restoration on the monitor as they were doing it through the operating microscope. I don't know how Cal might do with that, but it could be an option that he might find strangely entertaining. Just thought I'd put it out there.


  7. Yeah, I considered the PO midazolam route, but apparently those are considered special "sedation" appointments and the dentist is booked out for those through September.

    However, PO midazolam for the parents should be standard in my opinion.

  8. Poor Cal!

    He'll do ok with the nirtous and the local, I'm sure. At least his tooth will feel better then.

  9. If he can get past the local anesthesia injection, he'll be fine. As long as the Pixar can distract him from the sounds and smells!

  10. Anonymous8:15 PM

    Root canal is a general, blanket, lay term. That is all.

  11. Anonymous1:28 AM

    Ugh. I went thru that. My son was 4 and never had an inkling of a cavity. Suddenly he was in pain so I took him to his pediatric dentist who determined it was abscessed (or infected whatever). He sent him to a pediatric oral surgeon. We gave him half a demoral 1/2 an hour before and he drew the funniest pictures on the way to the dentist--starting with his usual precise drawing and got progressively loopy. When he was 9 the tooth needed to come out (still no other cavities) so we went back and they gave us a whole pill. I gave him paper to see what he would draw this time. He was really into drawing Calvin & Hobbes and when I got to the oral surgeons office he had drawn an impeccable Calvin with a GIANT MONSTER with scary teeth looming over him ready to pounce. As you know drugs are wack+kids are funny and geniuses. He did really well for the pulp thing with mild anesthesia at age 4 but the followup cap with the dentist was a scream-fest--primarily because he had to hold still. I was in the room for both. With the dentist he got laughing gas and I held his legs and chatted to distract him. Good luck--it'll be harder on you than him. My son doesn't even remember the earlier procedure at the surgeon or the dentist. Chances are he'll remember the prize more than the procedure. - kbow

  12. Anonymous1:30 AM

    Oops. It was Valium, not Demerol. I'M NOT A DOCTOR. Just a nerd. I would never confuse Ruby with PHP! - kbow

  13. It's cool that li'l Cal was a strong man right there and got through with his dentist, all with the help of the mini toothpaste treat.

    Our daughter's second visit to the dentist went pretty smooth as well, though she needs some little sedation to get her chipped tooth fixed. She also has problems with pointed stuff and drills when she sees them getting the work done in any of her teeth. In any case, Colorado Springs' dental care for children is to be trusted.