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Wendy Marsden
September 10th 03, 08:08 PM
My four year old finally, FINALLY got his dentist visit today, four months
after an x-ray showed a startling five cavities. Our dentist promptly
referred us to a pediatric dentist, saying she wasn't set up to do that
much work on a small kid. The pediatric dentist fit us in for an initial
exam and a teeth cleaning, but couldn't get us an appointment to treat him
until today.

Things started out fine, everyone was cheerful and no one was scared or
anxious. He got in the chair and was laughing and fine. But five minutes
into the nitrous oxide he suddenly started whimpering and curling up and
got clingy and weepy and scared. I wasn't able to figure out what was
causing the anxiety - I really think it was a reaction to the nitrous
oxide. The dentist just thought I had a wimpy boy that I babied - which
wouldn't be a crime if I did, but that doesn't happen to be the case.

The damn dentist threw us out. So much for pediatric dentists knowing
how to work with kids! He offered no solution beyond we'll try again on
Monday. Meanwhile, this dentist is a 45 minute drive from my home, he
isn't a preferred provider in my insurance plan and he thinks I've caused
my son's mouth problems through neglect (which just isn't true.)

The pediatric dentist was talking about scheduling an OR for sometime in
the winter (months and months from now) to do all four fillings at
once. I'm disinclined to put my kid through general anasthesia
again. (Long story, but probably related to why he has such weirdly
horrible teeth: he had a traumatic illness and hospitalization 15 months
ago.)

I'm thinking of finding a dentist that does NOT use nitrous oxide but who
will prescribe a valium before the visit. What do you think?

-- Wendy

iphigenia
September 10th 03, 08:20 PM
Wendy Marsden wrote:
> The pediatric dentist was talking about scheduling an OR for sometime
> in the winter (months and months from now) to do all four fillings at
> once. I'm disinclined to put my kid through general anasthesia
> again. (Long story, but probably related to why he has such weirdly
> horrible teeth: he had a traumatic illness and hospitalization 15
> months ago.)
>
> I'm thinking of finding a dentist that does NOT use nitrous oxide but
> who will prescribe a valium before the visit. What do you think?

Are you concerned about all forms of being knocked out? My pediodontist
gives chloral hydrate to kids over 3. Or maybe Versed would be an option.
The other thing to consider WRT general anesthesia is that this is a
different kid - 15 months makes a big difference in a small child's life -
and maybe you could talk to the anesthesiologist about the prior bad
experience, s/he could look at the medical records and maybe identify
something the previous anesthesiologist used that caused a bad reaction. But
of course if your instinct is telling you not to let him be put under, that
takes precedence.

--
iphigenia
www.tristyn.net
"i have heard the mermaids singing, each to each.
i do not think that they will sing to me."

Jenn
September 10th 03, 08:26 PM
In article >,
Wendy Marsden > wrote:

> My four year old finally, FINALLY got his dentist visit today, four months
> after an x-ray showed a startling five cavities. Our dentist promptly
> referred us to a pediatric dentist, saying she wasn't set up to do that
> much work on a small kid. The pediatric dentist fit us in for an initial
> exam and a teeth cleaning, but couldn't get us an appointment to treat him
> until today.
>
> Things started out fine, everyone was cheerful and no one was scared or
> anxious. He got in the chair and was laughing and fine. But five minutes
> into the nitrous oxide he suddenly started whimpering and curling up and
> got clingy and weepy and scared. I wasn't able to figure out what was
> causing the anxiety - I really think it was a reaction to the nitrous
> oxide. The dentist just thought I had a wimpy boy that I babied - which
> wouldn't be a crime if I did, but that doesn't happen to be the case.
>
> The damn dentist threw us out. So much for pediatric dentists knowing
> how to work with kids! He offered no solution beyond we'll try again on
> Monday. Meanwhile, this dentist is a 45 minute drive from my home, he
> isn't a preferred provider in my insurance plan and he thinks I've caused
> my son's mouth problems through neglect (which just isn't true.)
>
> The pediatric dentist was talking about scheduling an OR for sometime in
> the winter (months and months from now) to do all four fillings at
> once. I'm disinclined to put my kid through general anasthesia
> again. (Long story, but probably related to why he has such weirdly
> horrible teeth: he had a traumatic illness and hospitalization 15 months
> ago.)
>
> I'm thinking of finding a dentist that does NOT use nitrous oxide but who
> will prescribe a valium before the visit. What do you think?
>
> -- Wendy



I can't believe they gas kids for simple dental procedures

years ago my young teen son had nitrous for an extraction -- I was
reluctant to allow it because I know nitrous is often abused as a drug
and I didn't want to introduce it to him -- I needn't have worried --
the effect was much as you describe for your child. my son had a sort
of nightmarish experience -- really miserable, anxious, depressed --
and swore he would never have the stuff again and didn't

dragonlady
September 10th 03, 09:03 PM
In article >,
Jenn > wrote:

> In article >,
> "iphigenia" > wrote:
>
> > Wendy Marsden wrote:
> > > The pediatric dentist was talking about scheduling an OR for sometime
> > > in the winter (months and months from now) to do all four fillings at
> > > once. I'm disinclined to put my kid through general anasthesia
> > > again. (Long story, but probably related to why he has such weirdly
> > > horrible teeth: he had a traumatic illness and hospitalization 15
> > > months ago.)
> > >
> > > I'm thinking of finding a dentist that does NOT use nitrous oxide but
> > > who will prescribe a valium before the visit. What do you think?
> >
> > Are you concerned about all forms of being knocked out? My pediodontist
> > gives chloral hydrate to kids over 3. Or maybe Versed would be an option.
> > The other thing to consider WRT general anesthesia is that this is a
> > different kid - 15 months makes a big difference in a small child's life -
> > and maybe you could talk to the anesthesiologist about the prior bad
> > experience, s/he could look at the medical records and maybe identify
> > something the previous anesthesiologist used that caused a bad reaction. But
> > of course if your instinct is telling you not to let him be put under, that
> > takes precedence.
> >
> my FIL is an anesthesiologist and he is explosively opinionated about
> using general anesthetic in a dental office -- the death rate of office
> administered general anesthetic is pretty high -- especially considering
> that they are administered for trivial problems to healthy people
>

I guess you have to define trivial. I'm not sure I could have managed
having my wisdom teeth out without a general.

OTOH, I am sincerely dentist-phobic. I think I'd like to find a
hygenist who cleans under a general . . .

meh
--
Children won't care how much you know until they know how much you care

Jenn
September 10th 03, 09:14 PM
In article >,
dragonlady > wrote:

> In article >,
> Jenn > wrote:
>
> > In article >,
> > "iphigenia" > wrote:
> >
> > > Wendy Marsden wrote:
> > > > The pediatric dentist was talking about scheduling an OR for sometime
> > > > in the winter (months and months from now) to do all four fillings at
> > > > once. I'm disinclined to put my kid through general anasthesia
> > > > again. (Long story, but probably related to why he has such weirdly
> > > > horrible teeth: he had a traumatic illness and hospitalization 15
> > > > months ago.)
> > > >
> > > > I'm thinking of finding a dentist that does NOT use nitrous oxide but
> > > > who will prescribe a valium before the visit. What do you think?
> > >
> > > Are you concerned about all forms of being knocked out? My pediodontist
> > > gives chloral hydrate to kids over 3. Or maybe Versed would be an option.
> > > The other thing to consider WRT general anesthesia is that this is a
> > > different kid - 15 months makes a big difference in a small child's life
> > > -
> > > and maybe you could talk to the anesthesiologist about the prior bad
> > > experience, s/he could look at the medical records and maybe identify
> > > something the previous anesthesiologist used that caused a bad reaction.
> > > But
> > > of course if your instinct is telling you not to let him be put under,
> > > that
> > > takes precedence.
> > >
> > my FIL is an anesthesiologist and he is explosively opinionated about
> > using general anesthetic in a dental office -- the death rate of office
> > administered general anesthetic is pretty high -- especially considering
> > that they are administered for trivial problems to healthy people
> >
>
> I guess you have to define trivial. I'm not sure I could have managed
> having my wisdom teeth out without a general.
>
> OTOH, I am sincerely dentist-phobic. I think I'd like to find a
> hygenist who cleans under a general . . .
>
> meh


me too -- I remember waking up alone in a room on my back with my mouth
full of cotton rolls and wondered what would have happened to my brain
if some of that had gotten lodged in my throat while I was unconscious

Mark Probert
September 10th 03, 09:48 PM
"Roger Schlafly" > wrote in message
. net...
> "Wendy Marsden" > wrote
> > The pediatric dentist was talking about scheduling an OR for sometime in
> > the winter (months and months from now) to do all four fillings at
>
> Get a new dentist. Do not pay any bill (since he didn't do the work
> requested).
>
> There is no need to use anasthesia or painkillers for simple fillings.
> Just say no.

Why put the kid through filling which may actually be quite painful to them.
When i was a kid, my parents took me to a reduced rate dental clinic and one
of the ways they reduced the rate was to skip the pain killers.

Today, over 50 years later, I am still very apprehensive about returning to
a dentist, and get a mild case of me pre-combat anxieties that I got when I
was in Vietnam.

JoAnna
September 10th 03, 09:54 PM
"Wendy Marsden" > wrote in message
...
> My four year old finally, FINALLY got his dentist visit today, four months
> after an x-ray showed a startling five cavities. Our dentist promptly
> referred us to a pediatric dentist, saying she wasn't set up to do that
> much work on a small kid. The pediatric dentist fit us in for an initial
> exam and a teeth cleaning, but couldn't get us an appointment to treat him
> until today.
>
> Things started out fine, everyone was cheerful and no one was scared or
> anxious. He got in the chair and was laughing and fine. But five minutes
> into the nitrous oxide he suddenly started whimpering and curling up and
> got clingy and weepy and scared. I wasn't able to figure out what was
> causing the anxiety - I really think it was a reaction to the nitrous
> oxide. The dentist just thought I had a wimpy boy that I babied - which
> wouldn't be a crime if I did, but that doesn't happen to be the case.
>
> The damn dentist threw us out. So much for pediatric dentists knowing
> how to work with kids! He offered no solution beyond we'll try again on
> Monday. Meanwhile, this dentist is a 45 minute drive from my home, he
> isn't a preferred provider in my insurance plan and he thinks I've caused
> my son's mouth problems through neglect (which just isn't true.)
>
> The pediatric dentist was talking about scheduling an OR for sometime in
> the winter (months and months from now) to do all four fillings at
> once. I'm disinclined to put my kid through general anasthesia
> again. (Long story, but probably related to why he has such weirdly
> horrible teeth: he had a traumatic illness and hospitalization 15 months
> ago.)
>
> I'm thinking of finding a dentist that does NOT use nitrous oxide but who
> will prescribe a valium before the visit. What do you think?
>
> -- Wendy

I had some kind of panic attack at the dentists while on nitrous as a
teenager ...never used it again!! I have had all my wisdom teeth pulled with
just novacaine. same with the root canal I had and any fillings.

as a child we had a fillings done with nothing IIRC. Certainly not nitrous.
Do they need something for pain? ther aren't any nerves in babyteeth are
there?

Rosalie B.
September 10th 03, 10:55 PM
x-no-archive:yes

"JoAnna" > wrote:
>
>"Wendy Marsden" > wrote in message
...
<snip>>
>> Things started out fine, everyone was cheerful and no one was scared or
>> anxious. He got in the chair and was laughing and fine. But five minutes
>> into the nitrous oxide he suddenly started whimpering and curling up and
>> got clingy and weepy and scared. I wasn't able to figure out what was
>> causing the anxiety - I really think it was a reaction to the nitrous
>> oxide. The dentist just thought I had a wimpy boy that I babied - which
>> wouldn't be a crime if I did, but that doesn't happen to be the case.
>>
>> The damn dentist threw us out. So much for pediatric dentists knowing
>> how to work with kids! He offered no solution beyond we'll try again on
>> Monday. Meanwhile, this dentist is a 45 minute drive from my home, he
>> isn't a preferred provider in my insurance plan and he thinks I've caused
>> my son's mouth problems through neglect (which just isn't true.)
>>
I think I'd go back to my regular dentist and ask her to do one
filling at a time.
<snip>>
>> I'm thinking of finding a dentist that does NOT use nitrous oxide but who
>> will prescribe a valium before the visit. What do you think?
>>
>> -- Wendy
>
>I had some kind of panic attack at the dentists while on nitrous as a
>teenager ...never used it again!! I have had all my wisdom teeth pulled with
>just novacaine. same with the root canal I had and any fillings.
>
>as a child we had a fillings done with nothing IIRC. Certainly not nitrous.
>Do they need something for pain? ther aren't any nerves in babyteeth are
>there?
>
There definitely ARE nerves in baby teeth at least until they are
ready to fall out.

I had fillings done as a child not only with no anesthetic but with
the old slow drills. It did hurt. DD#1 had a couple of baby teeth
pulled (canines I think) without anesthetic and I'm sure it hurt her
too (I didn't know they weren't going to use anesthetic until
afterwards - she wasn't too happy about it - she was about 7)

I never actually had any anesthetic for regular teeth work until I was
about 26. I did have sodium penthol (sp?) (as a gas) for impacted
wisdom teeth when I was 18. The next ones I had out I had some other
anesthetic.


grandma Rosalie

dejablues
September 11th 03, 02:47 AM
I think it depends on the dentist. My 5-yr-old had one cavity that was
filled without any anesthetic at all (not even Novocaine) , the dentist was
fabulous and just talked him through the whole thing. He was horribly
expensive though. He wasn't even a ped. dentist. The only pediatric dentist
in our town is the Medicaid dentist who I knew about through the grapevine
of the county MH/MR agency (who I used to work for) . I refused to use him.
I went through five dentists before I found a good one.


"Wendy Marsden" > wrote in message
...
> My four year old finally, FINALLY got his dentist visit today, four months
> after an x-ray showed a startling five cavities. Our dentist promptly
> referred us to a pediatric dentist, saying she wasn't set up to do that
> much work on a small kid. The pediatric dentist fit us in for an initial
> exam and a teeth cleaning, but couldn't get us an appointment to treat him
> until today.
>
> Things started out fine, everyone was cheerful and no one was scared or
> anxious. He got in the chair and was laughing and fine. But five minutes
> into the nitrous oxide he suddenly started whimpering and curling up and
> got clingy and weepy and scared. I wasn't able to figure out what was
> causing the anxiety - I really think it was a reaction to the nitrous
> oxide. The dentist just thought I had a wimpy boy that I babied - which
> wouldn't be a crime if I did, but that doesn't happen to be the case.
>
> The damn dentist threw us out. So much for pediatric dentists knowing
> how to work with kids! He offered no solution beyond we'll try again on
> Monday. Meanwhile, this dentist is a 45 minute drive from my home, he
> isn't a preferred provider in my insurance plan and he thinks I've caused
> my son's mouth problems through neglect (which just isn't true.)
>
> The pediatric dentist was talking about scheduling an OR for sometime in
> the winter (months and months from now) to do all four fillings at
> once. I'm disinclined to put my kid through general anasthesia
> again. (Long story, but probably related to why he has such weirdly
> horrible teeth: he had a traumatic illness and hospitalization 15 months
> ago.)
>
> I'm thinking of finding a dentist that does NOT use nitrous oxide but who
> will prescribe a valium before the visit. What do you think?
>
> -- Wendy

Cathy Weeks
September 11th 03, 03:46 AM
> I had some kind of panic attack at the dentists while on nitrous as a
> teenager ...never used it again!! I have had all my wisdom teeth pulled with
> just novacaine. same with the root canal I had and any fillings.

Root canals are usually not particularly painful - by the time you
need one, the nerve is usually dead.

> as a child we had a fillings done with nothing IIRC. Certainly not nitrous.
> Do they need something for pain? ther aren't any nerves in babyteeth are
> there?

YES!! Baby teeth most definitely have nerves. By the time they fall
out, no, because by then the root and nerve are long gone.

I had one filling done with no anesthesia other than nitrous. It was
shallow, and didn't penetrate much beyond the surface of the tooth,
and wasn't anywhere near the nerve, but it was still very
uncomfortable. Never again. I wouldn't force a little kid to have
that done. And doing so is likely to turn out a child who is scared
of the dentist, and won't be as willing to go.

PLEASE don't make little ones do it without some sort of anesthesia
(doesn't have to be nitrous - there are alternatives)

Cathy Weeks
Mommy to Kivi Alexis

toypup
September 11th 03, 06:34 AM
"iphigenia" > wrote in message
...
> Wendy Marsden wrote:
> > The pediatric dentist was talking about scheduling an OR for sometime
> > in the winter (months and months from now) to do all four fillings at
> > once. I'm disinclined to put my kid through general anasthesia
> > again. (Long story, but probably related to why he has such weirdly
> > horrible teeth: he had a traumatic illness and hospitalization 15
> > months ago.)
> >
> > I'm thinking of finding a dentist that does NOT use nitrous oxide but
> > who will prescribe a valium before the visit. What do you think?
>
> Are you concerned about all forms of being knocked out? My pediodontist
> gives chloral hydrate to kids over 3.

After a few deaths that occurred within a short span of time, Kaiser stopped
filling any prescriptions for children for chloral hydrate written by
dentists. (The deaths weren't Kaiser related, but Kaiser didn't want to be
involved in one, either.) That was a few years ago, but I'm sure their
policy still stands. I would never let my child be sedated with chloral
hydrate outside a hospital setting.

PF Riley
September 11th 03, 08:00 AM
On Wed, 10 Sep 2003 20:14:16 GMT, "Roger Schlafly"
> wrote:

>"Wendy Marsden" > wrote
>> The pediatric dentist was talking about scheduling an OR for sometime in
>> the winter (months and months from now) to do all four fillings at
>
>Get a new dentist. Do not pay any bill (since he didn't do the work
>requested).
>
>There is no need to use anasthesia or painkillers for simple fillings.
>Just say no.

You, Roger, are an idiot.

I would really love seeing you try to put four fillings into a
four-year-old boy without anesthesia or "painkillers." Not only is it
excessively cruel, but dangerous.

Moron.

PF

Ilse Witch
September 11th 03, 03:22 PM
Wendy Marsden wrote:

> The damn dentist threw us out. So much for pediatric dentists knowing
> how to work with kids! He offered no solution beyond we'll try again on
> Monday. Meanwhile, this dentist is a 45 minute drive from my home, he
> isn't a preferred provider in my insurance plan and he thinks I've caused
> my son's mouth problems through neglect (which just isn't true.)

Wendy, if I were you I would definitely NOT return to that man. My
father is a dentist, and I have seen what trauma it can cause in
people if they are treated like that as young children. Please go
and find a pediatric dentist who knows how to deal with children.

It sounds to me that your son may have some generic problem, e.g.
in some people the tooth enamel is very thin and causes lots of
cavities even with proper oral care. You want a dentist that takes
all of these things into account and trusts you if you tell that
you take good care, and not one that immediately blames it on you.

Perhaps your family dentist has another suggestion for you?

--
-- I
mommy to DS (14m)
guardian of DH
EDD 05-17-2004
War doesn't decide who's right - only who's left

Jenn
September 11th 03, 04:08 PM
In article >,
"JoAnna" > wrote:

> "Wendy Marsden" > wrote in message
> ...
> > My four year old finally, FINALLY got his dentist visit today, four months
> > after an x-ray showed a startling five cavities. Our dentist promptly
> > referred us to a pediatric dentist, saying she wasn't set up to do that
> > much work on a small kid. The pediatric dentist fit us in for an initial
> > exam and a teeth cleaning, but couldn't get us an appointment to treat him
> > until today.
> >
> > Things started out fine, everyone was cheerful and no one was scared or
> > anxious. He got in the chair and was laughing and fine. But five minutes
> > into the nitrous oxide he suddenly started whimpering and curling up and
> > got clingy and weepy and scared. I wasn't able to figure out what was
> > causing the anxiety - I really think it was a reaction to the nitrous
> > oxide. The dentist just thought I had a wimpy boy that I babied - which
> > wouldn't be a crime if I did, but that doesn't happen to be the case.
> >
> > The damn dentist threw us out. So much for pediatric dentists knowing
> > how to work with kids! He offered no solution beyond we'll try again on
> > Monday. Meanwhile, this dentist is a 45 minute drive from my home, he
> > isn't a preferred provider in my insurance plan and he thinks I've caused
> > my son's mouth problems through neglect (which just isn't true.)
> >
> > The pediatric dentist was talking about scheduling an OR for sometime in
> > the winter (months and months from now) to do all four fillings at
> > once. I'm disinclined to put my kid through general anasthesia
> > again. (Long story, but probably related to why he has such weirdly
> > horrible teeth: he had a traumatic illness and hospitalization 15 months
> > ago.)
> >
> > I'm thinking of finding a dentist that does NOT use nitrous oxide but who
> > will prescribe a valium before the visit. What do you think?
> >
> > -- Wendy
>
> I had some kind of panic attack at the dentists while on nitrous as a
> teenager ...never used it again!! I have had all my wisdom teeth pulled with
> just novacaine. same with the root canal I had and any fillings.
>
> as a child we had a fillings done with nothing IIRC. Certainly not nitrous.
> Do they need something for pain? ther aren't any nerves in babyteeth are
> there?
>
>

many people think baby teeth don't have nerves or roots because when
they are pushed out the roots have been dissolved by the permanent teeth
coming below -- baby teeth are just like permanent teeth - roots and all
-- [otherwise they would fall out from chewing] and they hurt just like
regular teeth

however if the cavity is deep, a local can be used -- there is no need
for a general anesthetic for simple dental care

Jenn
September 11th 03, 04:09 PM
In article >,
(Cathy Weeks) wrote:

> > I had some kind of panic attack at the dentists while on nitrous as a
> > teenager ...never used it again!! I have had all my wisdom teeth pulled with
> > just novacaine. same with the root canal I had and any fillings.
>
> Root canals are usually not particularly painful - by the time you
> need one, the nerve is usually dead.

LOL usually a root canal is done when the tooth is highly inflamed,
often infected -- they are excruciatingly painful

>
> > as a child we had a fillings done with nothing IIRC. Certainly not nitrous.
> > Do they need something for pain? ther aren't any nerves in babyteeth are
> > there?
>
> YES!! Baby teeth most definitely have nerves. By the time they fall
> out, no, because by then the root and nerve are long gone.
>
> I had one filling done with no anesthesia other than nitrous. It was
> shallow, and didn't penetrate much beyond the surface of the tooth,
> and wasn't anywhere near the nerve, but it was still very
> uncomfortable. Never again. I wouldn't force a little kid to have
> that done. And doing so is likely to turn out a child who is scared
> of the dentist, and won't be as willing to go.
>
> PLEASE don't make little ones do it without some sort of anesthesia
> (doesn't have to be nitrous - there are alternatives)
>
> Cathy Weeks
> Mommy to Kivi Alexis

Sue
September 11th 03, 04:12 PM
My personal dentist numbs the area where the cavity is going to be filled
with a shot of some sort. No gas at all. Both of my kids have cavities, so I
will see what their dentist uses for cavities, if anything.

My oldest daughter had to have a dental procedure and she was put under
general anesthesia, but that involved going to the hospital, putting in an
IV and having the anesthesiologist on board and nurses.
--
Sue
mom to three girls

Wendy Marsden > wrote in message
...
> My four year old finally, FINALLY got his dentist visit today, four months
> after an x-ray showed a startling five cavities. Our dentist promptly
> referred us to a pediatric dentist, saying she wasn't set up to do that
> much work on a small kid. The pediatric dentist fit us in for an initial
> exam and a teeth cleaning, but couldn't get us an appointment to treat him
> until today.
>
> Things started out fine, everyone was cheerful and no one was scared or
> anxious. He got in the chair and was laughing and fine. But five minutes
> into the nitrous oxide he suddenly started whimpering and curling up and
> got clingy and weepy and scared. I wasn't able to figure out what was
> causing the anxiety - I really think it was a reaction to the nitrous
> oxide. The dentist just thought I had a wimpy boy that I babied - which
> wouldn't be a crime if I did, but that doesn't happen to be the case.
>
> The damn dentist threw us out. So much for pediatric dentists knowing
> how to work with kids! He offered no solution beyond we'll try again on
> Monday. Meanwhile, this dentist is a 45 minute drive from my home, he
> isn't a preferred provider in my insurance plan and he thinks I've caused
> my son's mouth problems through neglect (which just isn't true.)
>
> The pediatric dentist was talking about scheduling an OR for sometime in
> the winter (months and months from now) to do all four fillings at
> once. I'm disinclined to put my kid through general anasthesia
> again. (Long story, but probably related to why he has such weirdly
> horrible teeth: he had a traumatic illness and hospitalization 15 months
> ago.)
>
> I'm thinking of finding a dentist that does NOT use nitrous oxide but who
> will prescribe a valium before the visit. What do you think?
>
> -- Wendy

Tsu Dho Nimh
September 11th 03, 04:47 PM
Wendy Marsden > wrote:

>Things started out fine, everyone was cheerful and no one was scared or
>anxious. He got in the chair and was laughing and fine. But five minutes
>into the nitrous oxide he suddenly started whimpering and curling up and
>got clingy and weepy and scared.

It's not 100% side effect free. See anything below that could
reduce your kid to a trembling, whimpering, clingy creature:

More common
Shivering or trembling
Less common
Blurred or double vision or other vision problems; dizziness,
lightheadedness, or feeling faint; drowsiness; headache; mood or
mental changes; nausea (mild) or vomiting; nightmares or unusual
dreams.

It's most often used WITH novocaine, not as the only
anaesthectic.

>The damn dentist threw us out. So much for pediatric dentists knowing
>how to work with kids!

I wuuld file a formla writte complaint with whoever governs these
people. If they don't recognize the symptoms of an adverse
reaciton, and didn't warn the kid he's "feel floaty, they deserve
to be reprimanded.

>He offered no solution beyond we'll try again on
>Monday. Meanwhile, this dentist is a 45 minute drive from my home, he
>isn't a preferred provider in my insurance plan and he thinks I've caused
>my son's mouth problems through neglect (which just isn't true.)

>The pediatric dentist was talking about scheduling an OR for sometime in
>the winter (months and months from now) to do all four fillings at
>once. I'm disinclined to put my kid through general anasthesia
>again.


>I'm thinking of finding a dentist that does NOT use nitrous oxide but who
>will prescribe a valium before the visit. What do you think?

Valium before, and a good calm manner, and liberal quantities of
novocaine should do it.


Tsu Dho Nimh

--
When businesses invoke the "protection of consumers," it's a lot like
politicians invoking morality and children - grab your wallet and/or
your kid and run for your life.

Cathy Weeks
September 11th 03, 09:28 PM
Wendy Marsden > wrote in message >...
> In misc.kids Cathy Weeks > wrote:
>
> > PLEASE don't make little ones do it without some sort of anesthesia
> > (doesn't have to be nitrous - there are alternatives)
>
> What are the alternatives? When he had a tooth extracted the oral surgeon
> asked us to give him 4 mg of valium an hour or so before the procedure.
> My husband took him to the procedure and reported no problems. I know
> they used nitrous oxide during the procedure, too, and I assume they
> used some sort of novicaine, but I don't really know.

Well, valium is one option. Are you sure the reaction was to the
nitrous though? The dentist seems like a jerk, and perhaps your son
got frightened. If your son has been fine with nitrous in the past,
then it might be that your kid picked up on other things, and got
scared. It happens, even after going in the past.

There are other drugs that can be given to him, and many novicaine
injections can be done painlessly if the dentist is skillful (not all
of them - injections to the roof of the mouth pretty much always
hurt). I'm not a dentist, but my dad is. I would suggest meeting
with another pediatric dentist and asking some questions.

I knew instantly that our pediatric dentist was wonderful, and he is-
you'll know if you like the new one pretty quickly

> He clearly thought that I
> had freaked the kid out about dentistry before we got there. (Note that
> this is Sammy's 8th dentist visit and he hasn't freaked out before.)

Kids can freak out at any time. He could have picked up on your
tension, or he could have taken a dislike to the dentist for whatever
reason. (And it sounds reasonable if you ask me).

> me. I'm sick to death of the condescending way this ped dentist keeps
> pooh-poohing my concerns, like, "could his sudden onslaught of bad teeth
> be from a medical condition?" to which the dentist said, "no, it's because
> you weren't flossing his teeth."

This guy isn't the dentist for you. Really. Any healthcare provider
should provide basic courtesy and caring.

> My other two kids are ages 10 and 12 and have one cavity between
> them. It's just too weird that all my toddler's bicuspids would go bad
> suddenly. (It's not baby bottle mouth.)

Are you sure that they did go suddenly? Could the dentist have not
caught it before?

> Two different people have pointed out to me that this ped dentist might be
> hard to leave. He's a mandatory child abuse reporter and he already
> believes my child's teeth issues are from neglect. I don't really see how
> a mother who has brought her 51 month old child to a dentist 8 times now
> can be accused of dental neglect, but it's something to consider. I
> think it is QUITE possible he could report me for not obtaining
> treatment [from him] if I don't go ahead with his treatment plan.

Ah, I wouldn't let this guy hold that kind of sway over you. First of
all, do you have your son's visits documented (like in a diary or
planner)? And you have the other dentist's (it sounds like he went to
more than one) records.

In all likelihood if you never go back, he'll never think about it
again. If you mention that you are getting a 2nd opinion, then he
might try and cause problems. Just never contact them again. And if
they call you to follow up, just say that you took him to another
dentist that he connects with better, and give them the name and
number.

> Any advice would be appreciated. I particularly want to know what you
> think about my idea of using valium. I'm not in favor of drugging my
> child on a regular basis (!) and the way he was on valium really creeped
> me out, but I do think it will be too much to ask him (particularly
> now) to open wide and sit still while a guy wrestles around in his mouth
> for 1/2 an hour.

Go to another pediatric dentist and ask some questions. I don't have
a problem with Valium, but I know that nitrous can work well, too.
But a new dentist in a cool new office might be all that's needed.

> The third problem is that I just don't trust this dentist.

Don't go back. Seriously. If you don't trust him, then do NOT let him
work on your little boy.

> I honestly did
> not know he had used nitrous oxide when he did a tooth cleaning. I was
> sitting right there and remember the mask, but it never occurred to me he
> was sedating my child for a teeth cleaning (Sammy's third and first in a
> pediatric practice and he'd never had problems before and he didn't
> then but I didn't realize he was drugged.)

No offense, but what did you think the mask was for? I'm not sure
that nitrous was necessary for such a minor procedure, and doing all
procedures under it's use seems wierd, buuutttt...

The dentist also had never
> heard of a paradoxical reaction to nitrous oxide (or didn't recognize one
> when it occurred) and he also doens't trust me. BUT he's the only dentist
> around here who does hospital dentistry on kids. The ONLY one.

Go farther away. It's worth it, believe me. A good dentist,
especially in childhood makes all the difference. My dad has
patients that come from more than an hour away because he's so gentle.
For years he had a sign up that said "we cater to cowards".

By the way, the pediatric dentist we take my stepson to doesn't allow
parents in the examining room because he says the parents scare kids
more than he does. He also NEVER does anything on the first visit,
because he wants them to get to know him and not associate him with
getting teeth worked on. He's also got a great sense of humor, and my
stepson *asks* when he gets to go back.

When we walked in for the first time, he was out in the waiting room
talking to a parent, and a little boy around 4 years old. Garrett was
probably seven at the time, and the dentist looked at Garrett and
pointed to the little boy, and deadpanned "He's getting married. He
told me." I knew instantly that the guy was a natural with kids.

That's what I mean - you'll know instantly when you meet a good
pediatric dentist. He also made a copy of Garrett's x-ray to send to
my dad, when he heard that my dad had done G's dentistry before we
moved.

Cathy Weeks
Mommy to Kivi Alexis 12/01

Wendy Marsden
September 11th 03, 11:38 PM
In misc.kids Cathy Weeks > wrote:

> Well, valium is one option. Are you sure the reaction was to the
> nitrous though? The dentist seems like a jerk, and perhaps your son
> got frightened.

As one poster pointed out, he might have been on a bad trip. :-) A
friend of mine who is a dentist (in the air force, not private
practice) pointed out that it releases inhibitions and maybe he was
putting on a brave front but the bravery fell away and he got all sobby
and clingy like he wanted to be. I don't know.

We really weren't tense about this. We were looking forward to getting
his teeth fixed. I pointed out that Mommy can do lots of things but Mommy
can't fix teeth so we needed this guy. I didn't LIKE him, but I didn't
HATE him or distrust him. The opposite was true: I expected he knew how
to make a child feel at ease and trusted him to do that.

>> It's just too weird that all my toddler's bicuspids would go bad
>> suddenly. (It's not baby bottle mouth.)

> Are you sure that they did go suddenly? Could the dentist have not
> caught it before?

I'm trying to recall if he had x-rays taken at his first exam. I think
they might not have done any. He'd had a cleaning approximately 7 months
before he presented with five cavities (including an abscessed
tooth.) There was not indication at the time that there was a problem,
but it wasn't an exam. He'd had been critically ill a year ago and I
wonder if some aspect of that was related - the drugs they treated him
with, or maybe just the physical nature of having tubes in your nose and
throat and not brushing your teeth for 10 or 11 days? It never occurred
to me to brush his teeth when he was not able to take any fluids or foods
by mouth and had tubes in it. (Didn't occur to any of his 14 doctors or
20 nurses either, I might point out.)

>> I honestly did
>> not know he had used nitrous oxide when he did a tooth cleaning. I was
>> sitting right there and remember the mask, but it never occurred to me he
>> was sedating my child for a teeth cleaning (Sammy's third and first in a
>> pediatric practice and he'd never had problems before and he didn't
>> then but I didn't realize he was drugged.)

> No offense, but what did you think the mask was for? I'm not sure
> that nitrous was necessary for such a minor procedure, and doing all
> procedures under it's use seems wierd, buuutttt...

Good question. I'm kicking myself over this one. The dentist weirded me
out at first by insisting that I cancel my imminant cleaning appointment
with our old dentist and make one with him. I didn't see why, and he said
it was because he familiarizes the children with his office procedures and
develops a rapport with him. Okay, fine. So I delayed my son's already
over-due cleaning appointment.

When we finally got there and he did the whole medical shebang I figured
it was just a mock-up. I would definitely recall if he had said, "I'm
giving your son a sedative now." He absolutely did NOT tell me. I sat
there reading a People Magazine (a guilty pleasure of dental offices) and
tried not to hover.

I don't recall my son being odd during or after. He's a cheerful
compliant little boy most of the time. He did fall asleep in the car ride
home, but that's not terribly unusual and it still didn't occur to me that
he had been drugged.

> Go farther away. It's worth it, believe me. A good dentist,
> especially in childhood makes all the difference. My dad has
> patients that come from more than an hour away because he's so gentle.
> For years he had a sign up that said "we cater to cowards".

I have been hearing this. I got into a conversation with my best friend
about this yesterday. Her daughter sees an oncologist 100 miles away. I
was groaning about the logistical nightmares of frequent visits that far
away, and she pointed out that it is worth it for a life-or-death scenario
with one follow-up visit a year. Is it worth it for a happier dental
relationship six times a year? I think not!

> By the way, the pediatric dentist we take my stepson to doesn't allow
> parents in the examining room because he says the parents scare kids
> more than he does.

I'd be okay with this if I trusted the dentist. I don't trust this
guy. He doesn't ask that, either. The office is clearly set up with a
parent chair next to every kid. He has three kids in three different
stations going at a time in one big room. Maybe that's why he threw us
out, he didn't want Sammy's fussing to upset the other kids.

Thanks for your suggestions and insight. I really needed to help get this
straight in my head.

Wendy

Cathy Weeks
September 12th 03, 02:42 AM
Tsu Dho Nimh > wrote in message >...

> I wuuld file a formla writte complaint with whoever governs these
> people. If they don't recognize the symptoms of an adverse
> reaciton, and didn't warn the kid he's "feel floaty, they deserve
> to be reprimanded.

That would be the American Dental Association. http://www.ada.com/

Cathy Weeks
Mommy to Kivi Alexis 12/01

Karen DeMent
September 12th 03, 04:56 AM
Wendy Marsden wrote:
>
> My four year old finally, FINALLY got his dentist visit today, four months
> after an x-ray showed a startling five cavities. Our dentist promptly
> referred us to a pediatric dentist, saying she wasn't set up to do that
> much work on a small kid. The pediatric dentist fit us in for an initial
> exam and a teeth cleaning, but couldn't get us an appointment to treat him
> until today.
>
> Things started out fine, everyone was cheerful and no one was scared or
> anxious. He got in the chair and was laughing and fine. But five minutes
> into the nitrous oxide he suddenly started whimpering and curling up and
> got clingy and weepy and scared. I wasn't able to figure out what was
> causing the anxiety - I really think it was a reaction to the nitrous
> oxide. The dentist just thought I had a wimpy boy that I babied - which
> wouldn't be a crime if I did, but that doesn't happen to be the case.
>
> The damn dentist threw us out. So much for pediatric dentists knowing
> how to work with kids! He offered no solution beyond we'll try again on
> Monday. Meanwhile, this dentist is a 45 minute drive from my home, he
> isn't a preferred provider in my insurance plan and he thinks I've caused
> my son's mouth problems through neglect (which just isn't true.)
>
> The pediatric dentist was talking about scheduling an OR for sometime in
> the winter (months and months from now) to do all four fillings at
> once. I'm disinclined to put my kid through general anasthesia
> again. (Long story, but probably related to why he has such weirdly
> horrible teeth: he had a traumatic illness and hospitalization 15 months
> ago.)
>
> I'm thinking of finding a dentist that does NOT use nitrous oxide but who
> will prescribe a valium before the visit. What do you think?
>
> -- Wendy

Sorry but I think your child may be spoiled and knows how
to get your attention and avoid situations he doesn't
enjoy. While he may have been anxious, you could have
helped more than you did. Nitrous didn't have anything
to do with this incident.

-Karen

Mxsmanic
September 12th 03, 06:18 AM
Karen DeMent writes:

> Sorry but I think your child may be spoiled and knows how
> to get your attention and avoid situations he doesn't
> enjoy. While he may have been anxious, you could have
> helped more than you did. Nitrous didn't have anything
> to do with this incident.

Agreed. These are not the effects of nitrous oxide. And Valium would
be a step in the wrong direction.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

garden_state
September 12th 03, 10:53 AM
> Wendy Marsden wrote:
> >
(snip)
> > The damn dentist threw us out. So much for pediatric dentists knowing
> > how to work with kids! He offered no solution beyond we'll try again on
> > Monday. Meanwhile, this dentist is a 45 minute drive from my home, he
> > isn't a preferred provider in my insurance plan and he thinks I've
caused
> > my son's mouth problems through neglect (which just isn't true.)
> >
> > The pediatric dentist was talking about scheduling an OR for sometime in
> > the winter (months and months from now) to do all four fillings at
> > once. I'm disinclined to put my kid through general anasthesia
> > again. (Long story, but probably related to why he has such weirdly
> > horrible teeth: he had a traumatic illness and hospitalization 15 months
> > ago.)
> >
> > I'm thinking of finding a dentist that does NOT use nitrous oxide but
who
> > will prescribe a valium before the visit. What do you think?
> >
> > -- Wendy
>
Hello Wendy,
I think you should look for another pediatric dentist and that you should
carefully check his/her credentials. He/she should have a degree in
pediatric dentistry and be board certified. Be aware that sometimes
dentists limit their practices to certain types of dentistry without
actually being board certified in that specialty.
Hope this helps.

Penny Gaines
September 12th 03, 10:58 AM
Cathy Weeks wrote in >:
[snip]
> There are other drugs that can be given to him, and many novicaine
> injections can be done painlessly if the dentist is skillful (not all
> of them - injections to the roof of the mouth pretty much always
> hurt). I'm not a dentist, but my dad is. I would suggest meeting
> with another pediatric dentist and asking some questions.
[snip]

In the UK, it is common to put some gel on the place where the injection
will be to numb the skin, and make it less painful. I don't know whatthe
gel contains, but it is used for adults as well as children.

--
Penny Gaines
UK mum to three

Joel M. Eichen D.D.S.
September 12th 03, 01:46 PM
On Thu, 11 Sep 2003 23:56:27 -0400, Karen DeMent >
wrote:

>Wendy Marsden wrote:
>>
>> My four year old finally, FINALLY got his dentist visit today, four months
>> after an x-ray showed a startling five cavities.

Ouch, jujube addict?


>Our dentist promptly
>> referred us to a pediatric dentist, saying she wasn't set up to do that
>> much work on a small kid.

Yup.

> The pediatric dentist fit us in for an initial
>> exam and a teeth cleaning, but couldn't get us an appointment to treat him
>> until today.
>>
>> Things started out fine, everyone was cheerful and no one was scared or
>> anxious.

Not even the dentist ......

> He got in the chair and was laughing and fine. But five minutes
>> into the nitrous oxide he suddenly started whimpering and curling up and
>> got clingy and weepy and scared. I wasn't able to figure out what was
>> causing the anxiety - I really think it was a reaction to the nitrous
>> oxide.

Yes.

> The dentist just thought I had a wimpy boy that I babied - which
>> wouldn't be a crime if I did, but that doesn't happen to be the case.
>>

So the doc is an amateur psychologist?


>> The damn dentist threw us out.

Wow!

> So much for pediatric dentists knowing
>> how to work with kids! He offered no solution beyond we'll try again on
>> Monday. Meanwhile, this dentist is a 45 minute drive from my home, he
>> isn't a preferred provider in my insurance plan and he thinks I've caused
>> my son's mouth problems through neglect (which just isn't true.)
>>

Insurance gumming up the works again .....

>> The pediatric dentist was talking about scheduling an OR for sometime in
>> the winter (months and months from now) to do all four fillings at
>> once.

NO WAY! CEASE and DESIST now!

> I'm disinclined to put my kid through general anasthesia
>> again. (Long story, but probably related to why he has such weirdly
>> horrible teeth: he had a traumatic illness and hospitalization 15 months
>> ago.)

Want to see some interesting court cases?


>>
>> I'm thinking of finding a dentist that does NOT use nitrous oxide but who
>> will prescribe a valium before the visit. What do you think?
>>

Yup, or in the bad old days we slipped the kid a Mickey Finn. That was
chloral hydrate ~ today we have much better!


Joel

>> -- Wendy
>
>Sorry but I think your child may be spoiled and knows how
>to get your attention and avoid situations he doesn't
>enjoy. While he may have been anxious, you could have
>helped more than you did. Nitrous didn't have anything
>to do with this incident.

WHERE did this part come from???

>
>-Karen

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 12th 03, 01:47 PM
Karen, you be NOT a psychologist .... or are you? For God sakes, when
will parents stop and listen to the doctors?

Joel M. Eichen DDS



On Fri, 12 Sep 2003 07:18:14 +0200, Mxsmanic >
wrote:

>Karen DeMent writes:
>
>> Sorry but I think your child may be spoiled and knows how
>> to get your attention and avoid situations he doesn't
>> enjoy. While he may have been anxious, you could have
>> helped more than you did. Nitrous didn't have anything
>> to do with this incident.
>
>Agreed. These are not the effects of nitrous oxide. And Valium would
>be a step in the wrong direction.

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 12th 03, 01:48 PM
Good advice Marian, Thanks!

Joel

*****
On Fri, 12 Sep 2003 09:53:29 GMT, "garden_state"
> wrote:

>
>> Wendy Marsden wrote:
>> >
>(snip)
>> > The damn dentist threw us out. So much for pediatric dentists knowing
>> > how to work with kids! He offered no solution beyond we'll try again on
>> > Monday. Meanwhile, this dentist is a 45 minute drive from my home, he
>> > isn't a preferred provider in my insurance plan and he thinks I've
>caused
>> > my son's mouth problems through neglect (which just isn't true.)
>> >
>> > The pediatric dentist was talking about scheduling an OR for sometime in
>> > the winter (months and months from now) to do all four fillings at
>> > once. I'm disinclined to put my kid through general anasthesia
>> > again. (Long story, but probably related to why he has such weirdly
>> > horrible teeth: he had a traumatic illness and hospitalization 15 months
>> > ago.)
>> >
>> > I'm thinking of finding a dentist that does NOT use nitrous oxide but
>who
>> > will prescribe a valium before the visit. What do you think?
>> >
>> > -- Wendy
>>
>Hello Wendy,
>I think you should look for another pediatric dentist and that you should
>carefully check his/her credentials. He/she should have a degree in
>pediatric dentistry and be board certified. Be aware that sometimes
>dentists limit their practices to certain types of dentistry without
>actually being board certified in that specialty.
>Hope this helps.
>

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 12th 03, 02:19 PM
He could be a very intelligent kid ,,, after all who LIKES the
dentist?


Joel

On Fri, 12 Sep 2003 13:22:57 GMT, Wendy Marsden
> wrote:

>In misc.kids Mxsmanic > wrote:
>> Karen DeMent writes:
>>> Sorry but I think your child may be spoiled and knows how
>>> to get your attention and avoid situations he doesn't
>>> enjoy.
>
>You may be right about him being "spoiled" if your definition is that he
>knows how to get my attention and avoid situations he doesn't enjoy.
>
>>> While he may have been anxious, you could have
>>> helped more than you did. Nitrous didn't have anything
>>> to do with this incident.
>
>> Agreed. These are not the effects of nitrous oxide.
>
>That's certainly the dentist's opinion and I'm glad to hear you say this,
>since it makes him out to be more of a reasonable person if SOME people
>agree with him. And I don't have to feel so guilty for for having trusted
>the guy to start with if he isn't just an outright charletan.
>
>> And Valium would be a step in the wrong direction.
>
>Why? What is a step in the right direction? My goal here isn't to report
>the dentist or feel righteous indignition or champion how wonderful a
>parent I am, my goal here is to get my son's teeth treated. What do you
>suggest?
>
>Wendy

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 12th 03, 02:20 PM
The only cause for REPORTING is if he poisons people with amalgam ,,,
in that case the dentist may get jail time.

Ask Jan Drew.


Joel

**

On Fri, 12 Sep 2003 13:22:57 GMT, Wendy Marsden
> wrote:

>In misc.kids Mxsmanic > wrote:
>> Karen DeMent writes:
>>> Sorry but I think your child may be spoiled and knows how
>>> to get your attention and avoid situations he doesn't
>>> enjoy.
>
>You may be right about him being "spoiled" if your definition is that he
>knows how to get my attention and avoid situations he doesn't enjoy.
>
>>> While he may have been anxious, you could have
>>> helped more than you did. Nitrous didn't have anything
>>> to do with this incident.
>
>> Agreed. These are not the effects of nitrous oxide.
>
>That's certainly the dentist's opinion and I'm glad to hear you say this,
>since it makes him out to be more of a reasonable person if SOME people
>agree with him. And I don't have to feel so guilty for for having trusted
>the guy to start with if he isn't just an outright charletan.
>
>> And Valium would be a step in the wrong direction.
>
>Why? What is a step in the right direction? My goal here isn't to report
>the dentist or feel righteous indignition or champion how wonderful a
>parent I am, my goal here is to get my son's teeth treated. What do you
>suggest?
>
>Wendy

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Wendy Marsden
September 12th 03, 02:22 PM
In misc.kids Mxsmanic > wrote:
> Karen DeMent writes:
>> Sorry but I think your child may be spoiled and knows how
>> to get your attention and avoid situations he doesn't
>> enjoy.

You may be right about him being "spoiled" if your definition is that he
knows how to get my attention and avoid situations he doesn't enjoy.

>> While he may have been anxious, you could have
>> helped more than you did. Nitrous didn't have anything
>> to do with this incident.

> Agreed. These are not the effects of nitrous oxide.

That's certainly the dentist's opinion and I'm glad to hear you say this,
since it makes him out to be more of a reasonable person if SOME people
agree with him. And I don't have to feel so guilty for for having trusted
the guy to start with if he isn't just an outright charletan.

> And Valium would be a step in the wrong direction.

Why? What is a step in the right direction? My goal here isn't to report
the dentist or feel righteous indignition or champion how wonderful a
parent I am, my goal here is to get my son's teeth treated. What do you
suggest?

Wendy

madiba
September 12th 03, 04:18 PM
Joel M. Eichen D.D.S. > wrote:

> >> I'm thinking of finding a dentist that does NOT use nitrous oxide but who
> >> will prescribe a valium before the visit. What do you think?
> >>
>
> Yup, or in the bad old days we slipped the kid a Mickey Finn. That was
> chloral hydrate ~ today we have much better!

We still used chloral hydrate supps for restless kids in the early 90's.
I wouldn't use valium on small children but perhaps one of the valium
derivatives with less respir. depression. As a child I remember getting
NiOx at the dentist and it was great.
--
madiba

Cathy Weeks
September 12th 03, 04:59 PM
Karen DeMent > wrote in message >...

> Sorry but I think your child may be spoiled

My aren't you the helpful one? Any useful suggestions?

> and knows how
> to get your attention and avoid situations he doesn't
> enjoy.

You just described all young children. And adults, for that matter.
We ALL seek to avoid situations we don't enjoy, and it's stupid for
adults to assume children shouldn't do this or are spoiled if they do.
How many children do *you* know sit quietly and smile and say "thank
you" when they are about to get an injection, or other possibly
unpleasant situations?

> While he may have been anxious, you could have
> helped more than you did.

Suggestions please! Sanctimonious finger pointing isn't helpful, and
merely makes you look judgemental and unhelpful.

> Nitrous didn't have anything
> to do with this incident.

Whereas I agree that it's likely that the nitrous didn't have anything
to do with it, neither you nor I were there, and neither of us can
make this kind of diagnosis.

Next time, when someone asks for advice, give it. You didn't. You
merely criticized without providing suggestions.

Cathy Weeks
Mommy to Kivi Alexis 12/01

Cathy Weeks
September 12th 03, 05:03 PM
Mxsmanic > wrote in message >...
> Karen DeMent writes:
>
> > Sorry but I think your child may be spoiled and knows how
> > to get your attention and avoid situations he doesn't
> > enjoy. While he may have been anxious, you could have
> > helped more than you did. Nitrous didn't have anything
> > to do with this incident.
>
> Agreed. These are not the effects of nitrous oxide. And Valium would
> be a step in the wrong direction.

Disagreed. They MIGHT be (however unlikely) the effects in NO. And
though I think avoiding drugs when possible is a good idea, why is
Valium a bad idea? If the child is truely scared, it could prevent
further fear. I'm not sure it *is* the right choice (maybe is, maybe
isn't) but it's for her, and a competent pediatric dentist to decide.

As the daughter of dentists, and the wife of a man who has had a
life-long dental phobia due to horrible frightening experiences when
he was about the OP's son's age, I can say that trying to avoid a
dental phobia, especially when one looks about to start, is a really,
really good idea.

And a good pediatric dentist knows how to treat the little ones
without scaring them.

Cathy Weeks
Mommy to Kivi Alexis 12/01

Dr Steve
September 12th 03, 07:24 PM
Personally,,,,, (this has no reflection on the case being discussed),,,,,,
the kids I refer out and refuse to treat, is because of the parents every
time. Difficult children (as regards to dental patients), are made that way
by their parents. This does not take into account very young children, and
I think I remember the child being discussed as only being 4 yrs old.
Children this young needing extensive treatment often need to go the
hospital. And, dental decay in children this small is the fault of the
parents EVERY time. Children cannot be held responsible for their own
dental home care until 5-7 years of age. Even at those ages, they HAVE to
be monitored every brushing session by a parent. Then, we can discuss the
habits of many parent of putting kids to sleep with bottles (or the breast),
giving kids milk or drinks right before bed, various snacks, etc.

--
~+--~+--~+--~+--~+--
Stephen Mancuso, D.D.S.
Troy, Michigan, USA

{remove first 3 dots for email}
.................................................. ...

This posting is intended for informational or conversational purposes only.
Always seek the opinion of a licensed dental professional before acting on
the advice or opinion expressed here. Only a dentist who has examined you
in person can diagnose your problems and make decisions which will affect
your health.
.......................
Please ignore j..d...
~~~~``````````#####----

"Cathy Weeks" > wrote in message
om...
> Mxsmanic > wrote in message
>...
> > Karen DeMent writes:
> >
> > > Sorry but I think your child may be spoiled and knows how
> > > to get your attention and avoid situations he doesn't
> > > enjoy. While he may have been anxious, you could have
> > > helped more than you did. Nitrous didn't have anything
> > > to do with this incident.
> >
> > Agreed. These are not the effects of nitrous oxide. And Valium would
> > be a step in the wrong direction.
>
> Disagreed. They MIGHT be (however unlikely) the effects in NO. And
> though I think avoiding drugs when possible is a good idea, why is
> Valium a bad idea? If the child is truely scared, it could prevent
> further fear. I'm not sure it *is* the right choice (maybe is, maybe
> isn't) but it's for her, and a competent pediatric dentist to decide.
>
> As the daughter of dentists, and the wife of a man who has had a
> life-long dental phobia due to horrible frightening experiences when
> he was about the OP's son's age, I can say that trying to avoid a
> dental phobia, especially when one looks about to start, is a really,
> really good idea.
>
> And a good pediatric dentist knows how to treat the little ones
> without scaring them.
>
> Cathy Weeks
> Mommy to Kivi Alexis 12/01

dragonlady
September 12th 03, 07:30 PM
In article >,
"Dr Steve" > wrote:

> Personally,,,,, (this has no reflection on the case being discussed),,,,,,
> the kids I refer out and refuse to treat, is because of the parents every
> time. Difficult children (as regards to dental patients), are made that way
> by their parents. This does not take into account very young children, and
> I think I remember the child being discussed as only being 4 yrs old.
> Children this young needing extensive treatment often need to go the
> hospital. And, dental decay in children this small is the fault of the
> parents EVERY time. Children cannot be held responsible for their own
> dental home care until 5-7 years of age. Even at those ages, they HAVE to
> be monitored every brushing session by a parent. Then, we can discuss the
> habits of many parent of putting kids to sleep with bottles (or the breast),
> giving kids milk or drinks right before bed, various snacks, etc.
>
> --

I had understood that there were some medicines and some medical
conditions that could well result in having serious dental problems.
That can't possibly be the parents' fault.

meh
--
Children won't care how much you know until they know how much you care

Dr Steve
September 12th 03, 07:38 PM
Those are associated with very sick children.

--
~+--~+--~+--~+--~+--
Stephen Mancuso, D.D.S.
Troy, Michigan, USA

{remove first 3 dots for email}
.................................................. ...

This posting is intended for informational or conversational purposes only.
Always seek the opinion of a licensed dental professional before acting on
the advice or opinion expressed here. Only a dentist who has examined you
in person can diagnose your problems and make decisions which will affect
your health.
.......................
Please ignore j..d...
~~~~``````````#####----

"dragonlady" > wrote in message
...
> In article >,
> "Dr Steve" > wrote:
>
> > Personally,,,,, (this has no reflection on the case being
discussed),,,,,,
> > the kids I refer out and refuse to treat, is because of the parents
every
> > time. Difficult children (as regards to dental patients), are made that
way
> > by their parents. This does not take into account very young children,
and
> > I think I remember the child being discussed as only being 4 yrs old.
> > Children this young needing extensive treatment often need to go the
> > hospital. And, dental decay in children this small is the fault of the
> > parents EVERY time. Children cannot be held responsible for their own
> > dental home care until 5-7 years of age. Even at those ages, they HAVE
to
> > be monitored every brushing session by a parent. Then, we can discuss
the
> > habits of many parent of putting kids to sleep with bottles (or the
breast),
> > giving kids milk or drinks right before bed, various snacks, etc.
> >
> > --
>
> I had understood that there were some medicines and some medical
> conditions that could well result in having serious dental problems.
> That can't possibly be the parents' fault.
>
> meh
> --
> Children won't care how much you know until they know how much you care
>

Wendy Marsden
September 12th 03, 08:11 PM
In misc.kids Dr Steve > wrote:
> Those are associated with very sick children.

The child in question had an episode just before he turned three in which
his intestines developed several small ruptures resulting in peritonitis
and an ileus. Emergency surgery and aggressive antibiotics saved his
life, but during his hospitalization I didn't think to brush his
teeth. (Neither did his 14 doctors or 20 nurses.) I don't even know how I
would have brushed his teeth around his GI tube.

Other than that, he has had his teeth brushed by a parent every day since
before he GOT teeth. He also gets regular dental care, fluoride pills and
flouride treatment at the dentist. His siblings are 10 and 12 and have
one cavity between them.

He rarely eats candy, and doesn't drink soda or take a bottle, to bed or
otherwise.

This child showing up with 5 cavities all at once (about a year after his
critical episode, just when he was turning 4) seems to me to be related to
something other than parental neglect.

I might just be fooling myself, though. The dentist certainly didn't
believe me.

Wendy

iphigenia
September 12th 03, 09:42 PM
Wendy Marsden wrote:
>
> I might just be fooling myself, though. The dentist certainly didn't
> believe me.

Frankly, I just think it's really unnecessary of the dentist to blame you
for this.

They say that antibiotics during certain points of pregnancy can result in
really weak enamal in baby teeth. Who knows what other factors might also
come into play in tooth development? Genetics, for one thing.

Gabe had five cavities before he was *two*! He does not eat fruit or candy.
At that point, he had had juice and soda fewer times than I can count on one
hand, and those were incidents where he had a couple sips as a treat. He has
never had a bottle. I have always brushed his teeth carefully. I explained
all this to his pediodontist, who has never indicated to me that he felt I
had been inattentive to his dental needs. In fact, he mentioned that there
are sometimes factors we can't control and praised me for how clean Gabe's
teeth are.

I have really good teeth, but bad teeth run in my family, and I think in my
late DH's family. In fact, I didn't even think of it until a few weeks ago,
but I remember being appalled to notice that DH's sister's three-year-old
had several blackened, obviously severely decaying teeth. So I'm sure that
there are bad-enamel genes in that family, too.

--
iphigenia
www.tristyn.net
"i have heard the mermaids singing, each to each.
i do not think that they will sing to me."

Ilse Witch
September 12th 03, 09:58 PM
Wendy Marsden wrote:
>
> The child in question had an episode just before he turned three in which
> his intestines developed several small ruptures resulting in peritonitis
> and an ileus. Emergency surgery and aggressive antibiotics saved his
> life, but during his hospitalization I didn't think to brush his
> teeth. (Neither did his 14 doctors or 20 nurses.) I don't even know how I
> would have brushed his teeth around his GI tube.

Did you ever check back with the doctor in charge if this
episode could have caused the dental problems now? It might
be helpful in finding more specialized care for your son,
and he may even be able to refer you to someone who does
take you serious.

The dentist is right in saying that many parents will claim
that their children receive good dental care even when it's
not the case. But your situation clearly is exceptional, and
should be treated that way.

--
-- I
mommy to DS (14m)
guardian of DH
EDD 05-17-2004
War doesn't decide who's right - only who's left

Cathy Weeks
September 12th 03, 11:22 PM
Joel M. Eichen D.D.S. > wrote in message >...
> He could be a very intelligent kid ,,, after all who LIKES the
> dentist?

My stepson likes his pediatric dentist, and asks when he gets to go
back. The guy has a wonderful sense of humor.

Cathy Weeks
Mommy to Kivi Alexis 12/01

Cathy Weeks
September 12th 03, 11:30 PM
"Dr Steve" > wrote in message >...
> Personally,,,,, (this has no reflection on the case being discussed),,,,,,
> the kids I refer out and refuse to treat, is because of the parents every
> time. Difficult children (as regards to dental patients), are made that way
> by their parents.

In general, I agree. My father, after he got sick of hear parents in
the waiting room say to their misbehaving children "if you don't be
good, I'm going to have Dr. Byland pull one of your teeth," he
actually stops work, goes out to the waiting room, and tells the
parent off for saying such a stupid thing. A) it's a lie, B) Dr.
Byland wouldn't remove a good tooth without good reason and C) PLEASE
DON'T SCARE THE CHILDREN!!!

However, it's not always the case that the parents are at fault in
creating fearful kids.

When my husband was 4 or thereabouts, he need some sort of oral
surgery. He was given a general anesthetic, but it didn't "take", and
he was immobilized by it, but fully aware. When he "woke" up, he told
the dentist that it had hurt, and the dentist didn't believe him, so
my husband proceded to tell the dentist exactly what he had done, and
the dentist, to his credit was horrified. My husband remembers it to
this day, nearly 30 years later. And he takes a valium before seeing
the dentist. He's getting better though, and my father has helped in
that regard - in general, skillful dentistry really doesn't hurt.

Cathy Weeks
Mommy to Kivi Alexis 12/01

Joel M. Eichen D.D.S.
September 13th 03, 11:49 AM
..... and some kids are so great ... better than their parents ever
are!

This is how the world works ......... if it is a problem tooth or
problem patient, get to a specialist who is an expert at solving THAT
problem.


Joel

On 12 Sep 2003 15:22:14 -0700, (Cathy Weeks)
wrote:

>Joel M. Eichen D.D.S. > wrote in message >...
>> He could be a very intelligent kid ,,, after all who LIKES the
>> dentist?
>
>My stepson likes his pediatric dentist, and asks when he gets to go
>back. The guy has a wonderful sense of humor.
>
>Cathy Weeks
>Mommy to Kivi Alexis 12/01

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 13th 03, 11:50 AM
Good advice Kathy!

It is ALWAYS best to avoid trauma at all costs! 30 years later the
TRAUMATIZED will not go to the dentist!


Joel

On 12 Sep 2003 09:03:45 -0700, (Cathy Weeks)
wrote:

>Mxsmanic > wrote in message >...
>> Karen DeMent writes:
>>
>> > Sorry but I think your child may be spoiled and knows how
>> > to get your attention and avoid situations he doesn't
>> > enjoy. While he may have been anxious, you could have
>> > helped more than you did. Nitrous didn't have anything
>> > to do with this incident.
>>
>> Agreed. These are not the effects of nitrous oxide. And Valium would
>> be a step in the wrong direction.
>
>Disagreed. They MIGHT be (however unlikely) the effects in NO. And
>though I think avoiding drugs when possible is a good idea, why is
>Valium a bad idea? If the child is truely scared, it could prevent
>further fear. I'm not sure it *is* the right choice (maybe is, maybe
>isn't) but it's for her, and a competent pediatric dentist to decide.
>
>As the daughter of dentists, and the wife of a man who has had a
>life-long dental phobia due to horrible frightening experiences when
>he was about the OP's son's age, I can say that trying to avoid a
>dental phobia, especially when one looks about to start, is a really,
>really good idea.
>
>And a good pediatric dentist knows how to treat the little ones
>without scaring them.
>
>Cathy Weeks
>Mommy to Kivi Alexis 12/01

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 13th 03, 11:52 AM
On Fri, 12 Sep 2003 18:24:30 GMT, "Dr Steve" > wrote:

>Personally,,,,, (this has no reflection on the case being discussed),,,,,,
>the kids I refer out and refuse to treat, is because of the parents every
>time.

We agree. It is often a constellation of events and attitudes that
PREVAIL in that family ~ of course I cannot change that, I am simply
reporting it.

Joel

> Difficult children (as regards to dental patients), are made that way
>by their parents. This does not take into account very young children, and
>I think I remember the child being discussed as only being 4 yrs old.
>Children this young needing extensive treatment often need to go the
>hospital. And, dental decay in children this small is the fault of the
>parents EVERY time. Children cannot be held responsible for their own
>dental home care until 5-7 years of age. Even at those ages, they HAVE to
>be monitored every brushing session by a parent. Then, we can discuss the
>habits of many parent of putting kids to sleep with bottles (or the breast),
>giving kids milk or drinks right before bed, various snacks, etc.

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 13th 03, 11:54 AM
Some teeth rot due to Design Defects by the Master Designer .......


*
CRACK!!!! (Lightning!!)


ME: "Oh sorry, I did not mean to be disrespectful!"


Joel


>On Fri, 12 Sep 2003 19:11:55 GMT, Wendy Marsden > wrote:

>In misc.kids Dr Steve > wrote:
>> Those are associated with very sick children.
>
>The child in question had an episode just before he turned three in which
>his intestines developed several small ruptures resulting in peritonitis
>and an ileus. Emergency surgery and aggressive antibiotics saved his
>life, but during his hospitalization I didn't think to brush his
>teeth. (Neither did his 14 doctors or 20 nurses.) I don't even know how I
>would have brushed his teeth around his GI tube.
>
>Other than that, he has had his teeth brushed by a parent every day since
>before he GOT teeth. He also gets regular dental care, fluoride pills and
>flouride treatment at the dentist. His siblings are 10 and 12 and have
>one cavity between them.
>
>He rarely eats candy, and doesn't drink soda or take a bottle, to bed or
>otherwise.
>
>This child showing up with 5 cavities all at once (about a year after his
>critical episode, just when he was turning 4) seems to me to be related to
>something other than parental neglect.
>
>I might just be fooling myself, though. The dentist certainly didn't
>believe me.
>
>Wendy

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 13th 03, 11:56 AM
Good post! I agree. The same parents usually tell the kids that the
policeman will take them away too. Unfortunately this part is mostly
true. The van leaves the dental office and travels to Leavenworth
every Tuesday at 10am.


On 12 Sep 2003 15:30:35 -0700, (Cathy Weeks)
wrote:

>"Dr Steve" > wrote in message >...
>> Personally,,,,, (this has no reflection on the case being discussed),,,,,,
>> the kids I refer out and refuse to treat, is because of the parents every
>> time. Difficult children (as regards to dental patients), are made that way
>> by their parents.
>
>In general, I agree. My father, after he got sick of hear parents in
>the waiting room say to their misbehaving children "if you don't be
>good, I'm going to have Dr. Byland pull one of your teeth," he
>actually stops work, goes out to the waiting room, and tells the
>parent off for saying such a stupid thing. A) it's a lie, B) Dr.
>Byland wouldn't remove a good tooth without good reason and C) PLEASE
>DON'T SCARE THE CHILDREN!!!
>
>However, it's not always the case that the parents are at fault in
>creating fearful kids.
>
>When my husband was 4 or thereabouts, he need some sort of oral
>surgery. He was given a general anesthetic, but it didn't "take", and
>he was immobilized by it, but fully aware. When he "woke" up, he told
>the dentist that it had hurt, and the dentist didn't believe him, so
>my husband proceded to tell the dentist exactly what he had done, and
>the dentist, to his credit was horrified. My husband remembers it to
>this day, nearly 30 years later. And he takes a valium before seeing
>the dentist. He's getting better though, and my father has helped in
>that regard - in general, skillful dentistry really doesn't hurt.
>
>Cathy Weeks
>Mommy to Kivi Alexis 12/01

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 13th 03, 11:58 AM
True, teens often come over for a cleaning and request the nitrous but
SKIP the cleaning!

N2O ~ nitrous oxide ........

Legally dispensed at the Vet during concerts .... They sell it in
balloons .... can you believe that?

Joel
Philadelphia PA


On Fri, 12 Sep 2003 17:18:55 +0200, (madiba) wrote:

>Joel M. Eichen D.D.S. > wrote:
>
>> >> I'm thinking of finding a dentist that does NOT use nitrous oxide but who
>> >> will prescribe a valium before the visit. What do you think?
>> >>
>>
>> Yup, or in the bad old days we slipped the kid a Mickey Finn. That was
>> chloral hydrate ~ today we have much better!
>
>We still used chloral hydrate supps for restless kids in the early 90's.
>I wouldn't use valium on small children but perhaps one of the valium
>derivatives with less respir. depression. As a child I remember getting
>NiOx at the dentist and it was great.

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 13th 03, 12:00 PM
I dunno ... beat the crap outa him??

<<joking, sorry>>


On 12 Sep 2003 08:59:59 -0700, (Cathy Weeks)
wrote:

>Karen DeMent > wrote in message >...
>
>> Sorry but I think your child may be spoiled
>
>My aren't you the helpful one? Any useful suggestions?
>
>> and knows how
>> to get your attention and avoid situations he doesn't
>> enjoy.
>
>You just described all young children. And adults, for that matter.
>We ALL seek to avoid situations we don't enjoy, and it's stupid for
>adults to assume children shouldn't do this or are spoiled if they do.
> How many children do *you* know sit quietly and smile and say "thank
>you" when they are about to get an injection, or other possibly
>unpleasant situations?
>
>> While he may have been anxious, you could have
>> helped more than you did.
>
>Suggestions please! Sanctimonious finger pointing isn't helpful, and
>merely makes you look judgemental and unhelpful.
>
>> Nitrous didn't have anything
>> to do with this incident.
>
>Whereas I agree that it's likely that the nitrous didn't have anything
>to do with it, neither you nor I were there, and neither of us can
>make this kind of diagnosis.
>
>Next time, when someone asks for advice, give it. You didn't. You
>merely criticized without providing suggestions.
>
>Cathy Weeks
>Mommy to Kivi Alexis 12/01

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 13th 03, 12:03 PM
Cool post but there's a bit of confusion. How does a Yahoo! e-mail
account help prevent cavities?


Joel


On Sat, 13 Sep 2003 05:21:20 GMT, "Linda"
> wrote:

>Well flamed Cathy.
>If I could add to the discussion about routinely kicking out parents. My
>son had a foot injury when he was age three. In the ER, the Dr was trying
>to admin LA and then stitch up his foot. I gently held my son, and spoke
>calmly to him, explaining what was happening. I had him look in my eyes and
>breath nice and slow with me. I kept him quiet and calm. The doctor still
>sat back and said to me: "He needs to go under GA, I can't get him frozen
>properly, I can tell he is still feeling it." Jamie didn't cry, but I guess
>he was still flinching. Anyhow, the point is, sometimes the parent is a
>help, not a hindrance. If some strange nurse was trying to hold him still,
>it probably would not have worked as well.
>Maybe a large percentage of parents are a problem in the operatories, but
>there is a percentage of us who are very helpful. I would be offended by a
>doctor who would tell me I cannot assist if my son is distressed. Kick me
>out if my presence doesn't help, but at least give me a chance.

You wrote:

>Linda - hygienist mom of two teens (no restorative so far - yahoo!)
>
>"Cathy Weeks" > wrote in message
om...
>> Karen DeMent > wrote in message
>...
>>
>> > Sorry but I think your child may be spoiled
>>
>> My aren't you the helpful one? Any useful suggestions?
>>
>> > and knows how
>> > to get your attention and avoid situations he doesn't
>> > enjoy.
>>
>> You just described all young children. And adults, for that matter.
>> We ALL seek to avoid situations we don't enjoy, and it's stupid for
>> adults to assume children shouldn't do this or are spoiled if they do.
>> How many children do *you* know sit quietly and smile and say "thank
>> you" when they are about to get an injection, or other possibly
>> unpleasant situations?
>>
>> > While he may have been anxious, you could have
>> > helped more than you did.
>>
>> Suggestions please! Sanctimonious finger pointing isn't helpful, and
>> merely makes you look judgemental and unhelpful.
>>
>> > Nitrous didn't have anything
>> > to do with this incident.
>>
>> Whereas I agree that it's likely that the nitrous didn't have anything
>> to do with it, neither you nor I were there, and neither of us can
>> make this kind of diagnosis.
>>
>> Next time, when someone asks for advice, give it. You didn't. You
>> merely criticized without providing suggestions.
>>
>> Cathy Weeks
>> Mommy to Kivi Alexis 12/01
>



On 12 Sep 2003 08:59:59 -0700, (Cathy Weeks)
wrote:

>Karen DeMent > wrote in message >...
>
>> Sorry but I think your child may be spoiled
>
>My aren't you the helpful one? Any useful suggestions?
>
>> and knows how
>> to get your attention and avoid situations he doesn't
>> enjoy.
>
>You just described all young children. And adults, for that matter.
>We ALL seek to avoid situations we don't enjoy, and it's stupid for
>adults to assume children shouldn't do this or are spoiled if they do.
> How many children do *you* know sit quietly and smile and say "thank
>you" when they are about to get an injection, or other possibly
>unpleasant situations?
>
>> While he may have been anxious, you could have
>> helped more than you did.
>
>Suggestions please! Sanctimonious finger pointing isn't helpful, and
>merely makes you look judgemental and unhelpful.
>
>> Nitrous didn't have anything
>> to do with this incident.
>
>Whereas I agree that it's likely that the nitrous didn't have anything
>to do with it, neither you nor I were there, and neither of us can
>make this kind of diagnosis.
>
>Next time, when someone asks for advice, give it. You didn't. You
>merely criticized without providing suggestions.
>
>Cathy Weeks
>Mommy to Kivi Alexis 12/01

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Steven Fawks
September 13th 03, 01:27 PM
This post hints at my advice. Check out another children's dentist.
There are several children's dentists in Kansas City (one hour from my
office).

After trying about all of them, guess how many I refer to.

ONE!

I would also express to your child that the dental work is absolutely
necessary and is going to be done. This next dental visit will be the
last chance he has to avoid the hospital.

Good Luck,
Fawks

BTW, working with kids is tough. One minute everything seems perfectly
normal and they are cooperative. The next minute they may be squirming
and whimpering. It's almost like working with a time bomb ticking down
and you can't even see the clock (but you know it's still ticking).
Distractions, gentleness, and speed come in handy (and often nitrous).

>
> My stepson likes his pediatric dentist, and asks when he gets to go
> back. The guy has a wonderful sense of humor.
>
> Cathy Weeks
> Mommy to Kivi Alexis 12/01

Steven Fawks
September 13th 03, 01:32 PM
While I can't advise anything specifically over the internet, the more I
hear of the story, the more I would lean towards sedation.

Best wishes,
Fawks

>
> He rarely eats candy, and doesn't drink soda or take a bottle, to bed or
> otherwise.
>
> This child showing up with 5 cavities all at once (about a year after his
> critical episode, just when he was turning 4) seems to me to be related to
> something other than parental neglect.
>
> I might just be fooling myself, though. The dentist certainly didn't
> believe me.
>
> Wendy

Steven Fawks
September 13th 03, 01:39 PM
Yep, that's a whole different issue. Are these five cavities inbetween
the teeth or on the biting surface? No matter what, a serious illness a
year ago certainly wouldn't help things. It also might have a little to
do with the childs behavior.

Blame at this point is indeed silly. Getting the restorations completed
is the first goal and then you can take actions to make sure that this
isn't a recurrent problem.

Fawks

>
> Some teeth rot due to Design Defects by the Master Designer .......
>
> *
> CRACK!!!! (Lightning!!)
>
> ME: "Oh sorry, I did not mean to be disrespectful!"
>
> Joel

Dr. Steve
September 13th 03, 03:41 PM
I agree fully with the "time-bomb" analogy. I hate it when parents come in
demanding we do all 3-4 filing on a young child at one visit so that the
parent will not be too inconvenienced.

--
=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+
Stephen Mancuso, D.D.S.

~`~`~`~`~`~`~`~`~`~`~`~`~`~`~`~`


"Steven Fawks" > wrote in message
...
>> BTW, working with kids is tough. One minute everything seems perfectly
> normal and they are cooperative. The next minute they may be squirming
> and whimpering. It's almost like working with a time bomb ticking down
> and you can't even see the clock (but you know it's still ticking).
> Distractions, gentleness, and speed come in handy (and often nitrous).
>

wc
September 13th 03, 05:47 PM
Karen wrote to someone regarding the qualities of Nitrous Oxide:

>Sorry but I think your child may be spoiled and knows how
to get your attention and avoid situations he doesn't
enjoy. While he may have been anxious, you could have
helped more than you did. Nitrous didn't have anything
to do with this incident.

-Karen <

Karen hasn't a clue what she is talking about, neither did the dentist.
I've been an anesthetist for forty years, and Nitrous can indeed make
people cry, laugh, or even violent. I suggest she learn about what she
is talking about before giving such incorrect advise.

Will, CRNA

Mxsmanic
September 14th 03, 11:46 AM
Wendy Marsden writes:

> Why? What is a step in the right direction?

It's strong stuff to give a young child. Indeed, I even have my doubts
about nitrous oxide. You need the ability to provide positive
respiratory support and other resuscitation beyond a certain point, and
most dentist's aren't equipped for that. Anesthesia in children is more
delicate than in adults.

> What do you suggest?

Find a pediatric dentist that can deal with the child. If none can be
found, and the dental problems require attention, the child may have to
be fully sedated (asleep), which requires special support. If multiple
dentists cannot deal with the child, maybe the child or his parents
could use some counseling.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Mxsmanic
September 14th 03, 11:50 AM
Cathy Weeks writes:

> Disagreed. They MIGHT be (however unlikely) the effects in NO.

If you set the required probability low enough, _anything_ MIGHT be an
effect of nitrous oxide. But normally this isn't.

> And though I think avoiding drugs when possible is
> a good idea, why is Valium a bad idea?

Because it's a drug, as you point out yourself. Children have to be
watched more closely because dosage and response are more
individualized. Any kind of heavy sedation or general anesthesia
requires equipment for resuscitation, too.

> As the daughter of dentists, and the wife of a man who has had a
> life-long dental phobia due to horrible frightening experiences when
> he was about the OP's son's age, I can say that trying to avoid a
> dental phobia, especially when one looks about to start, is a really,
> really good idea.

Agreed.

> And a good pediatric dentist knows how to treat the little ones
> without scaring them.

Agreed. Although in some cases the child may be the problem. See how
the same dentist works with other kids, and ask other parents.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Mary Elliott
September 15th 03, 07:07 PM
Catherine Woodgold wrote:
>
> Our pediatric dentist does most of the fillings on
> our children's teeth with no anesthetic. He asks
> them to tell him if it hurts. Apparently it doesn't
> hurt!! I don't know how he does that. Maybe they're
> small, surface fillings or something. My children
> like going to the dentist, apparently because they
> like getting the little prizes the dentist gives
> them at the end of the session. The dentist also
> talks to them in a respectful and friendly way,
> which I'm sure helps a lot.

And your point is?

> They also had some
> local anesthetic for some more serious work --
> similar to the anesthetic I've had at dentists'
> offices: where they inject something into your
> gums to "freeze" that part of your mouth.
> My son also had nitrous oxide at a younger age
> with an other dentist; I worry about long-term
> effects; I don't think it's possible to prove
> something is completely safe.

It's a gas. It has no long lasting consequences.

> Someone I know said that when she had a general
> anesthetic, she couldn't think clearly for 6 months
> afterwards. (That's the kind where you go
> unconscious.) I believe there's a significant
> risk of death with the kind of anesthetic where
> you go unconscious. One in a thousand or something?

Try more like 1 in 50,000.

> Besides the doctor or dentist working on you,
> there should be an anesthetist constantly monitoring
> you until you regain consciousness.

You worry too damned much!

Wendy Marsden
September 15th 03, 07:22 PM
Well, here's my follow-up. My husband brought him back to the dentist
today. I sent my husband because it occurred to me that the [male]
dentist might be one of those people who can't treat women like adults. I
also figured that my husband would have a different demeanor than me and
might be more effective in getting our kid to cooperate.

He didn't even last as long as last time. Their appointment was for
8:30 am and I got a call at 8:38 saying the dentist won't do it.

My husband later said that he thought the dentist was a bit wussy in not
insisting on getting in the mouth when our son got fussy. Apparently he
has no skills in this area because he uses nitrous oxide to knock them
flat during all visits. He did nothing to help our son be less fearful.

DS started to get fearful when the chair was tipped back and then got more
fearful when they put the little pig-snout mask on him and then totally
freaked out after smelling the odd smell. (I had previously asked the
dentist if he could do unscented, apparently he couldn't.)

I conclude now that the freaking out was to the sensation of the mask
experience (and maybe flashbacks to his traumatic hospitalization a year
ago) and not a reaction to the drug itself.

The dentist's two recommendations were to "wait until he's older" (our son
is 51 months) or to schedule hospital dentistry to do all of them at once
under general. Our next course is the obvious thing that the dentist
DIDN'T mention, to try a different dentist. We know we might have to come
back to this one for the hospital dentistry. (He's the only one who does
it that is available to us.)

What's not clear to me is what happens if we don't get these cavities
filled for months or years. One of the five cavities was abscessed in May
and a second one was fairly deep and we discussed whether to restore it or
pull it when we were pulling the abscessed one (which was pulled
promptly.) Nothing has been done with it in three months at this point
and my kid cries everytime we floss there. All of the cavities are
between back teeth, though his teeth are fairly widely spaced. (His front
teeth are all fine.)

We have an introductory meeting set up for Friday with a new dentist.
We've talked this guy up to our kid, explaining that he is our response to
the kid's fear of the other situation.

I'm planning on talking to this dentist about prescribing a sedative to
use before restoration work and NOT using nitrous oxide.

Wendy


In misc.kids Karen DeMent
> wrote: > Wendy Marsden wrote:
>>
>> My four year old finally, FINALLY got his dentist visit today, four months
>> after an x-ray showed a startling five cavities. Our dentist promptly
>> referred us to a pediatric dentist, saying she wasn't set up to do that
>> much work on a small kid. The pediatric dentist fit us in for an initial
>> exam and a teeth cleaning, but couldn't get us an appointment to treat him
>> until today.
>>
>> Things started out fine, everyone was cheerful and no one was scared or
>> anxious. He got in the chair and was laughing and fine. But five minutes
>> into the nitrous oxide he suddenly started whimpering and curling up and
>> got clingy and weepy and scared. I wasn't able to figure out what was
>> causing the anxiety - I really think it was a reaction to the nitrous
>> oxide. The dentist just thought I had a wimpy boy that I babied - which
>> wouldn't be a crime if I did, but that doesn't happen to be the case.
>>
>> The damn dentist threw us out. So much for pediatric dentists knowing
>> how to work with kids! He offered no solution beyond we'll try again on
>> Monday. Meanwhile, this dentist is a 45 minute drive from my home, he
>> isn't a preferred provider in my insurance plan and he thinks I've caused
>> my son's mouth problems through neglect (which just isn't true.)
>>
>> The pediatric dentist was talking about scheduling an OR for sometime in
>> the winter (months and months from now) to do all four fillings at
>> once. I'm disinclined to put my kid through general anasthesia
>> again. (Long story, but probably related to why he has such weirdly
>> horrible teeth: he had a traumatic illness and hospitalization 15 months
>> ago.)
>>
>> I'm thinking of finding a dentist that does NOT use nitrous oxide but who
>> will prescribe a valium before the visit. What do you think?
>>
>> -- Wendy

> Sorry but I think your child may be spoiled and knows how
> to get your attention and avoid situations he doesn't
> enjoy. While he may have been anxious, you could have
> helped more than you did. Nitrous didn't have anything
> to do with this incident.

> -Karen

Dr Steve
September 15th 03, 07:57 PM
Sounds like the child has learned how to avoid the situation altogether.
Most kids are smart enough to do that if given the chance. It is hard to
reason past that behavior for very young children. A guess from a long
distance away is to go to the hospital and get the GA. The child should NOT
remember any of it.

A general suggestion to all parents is to never try to prepare a child for a
dental visit. We have the best of intentions, but invariably end up scaring
the child more by placing new ideas in their heads. Answer all questions as
briefly, but honestly as possible. Just do not offer ANY information. All
too often, parents will place too much importance on a single event (like
visiting the dentist), because it is important to *us*, but we should do the
opposite. I tell parents to treat the visit with the same level of
importance (when in front of the kid), as a trip to the supermarket. If we
tried to explain everything the child would see or experience at the
supermarket prior to their first trip there (at age 3-4), the kid would be
scared to death. Think about a reaction to things the child has not seen
yet by age 3-4, such as automatic doors, HUGE (to the child) metal carts
that they are forced to ride in, but wobble all over the place, all the
strangers everywhere, mountains of boxes, a machine which slices meat,
bright lights, bells going off, and the cash register with its mysterious
moving belt and chirping register.

Most children do not fear the grocery store because, (1) they have been
there since they were weeks old, and (2) no one has given them any reason to
suspect it might be scary. The dental visit should be the same (for the
kid).

Saying things such as "Don't worry it won't hurt", or "don't be scared", or
"don't be frightened of the noises", only plants the thought of fear in
their heads.

I know this advice may be too late for this child. It may not have mattered
in the first place. The important thing is to get the dental problems
sorted out quickly, maintain the child's dental health so that it is not an
issue again, and avoid making the child into a "dentophobic".

The parent will suffer much more from the visit to the hospital for GA than
the child will. Only the parent will remember it a year later. The
hospital will have an entire team ready to administer the anesthetic and get
the treatment done. Don't let the kid live with pain or fear.

It is possible a different dentist may have better luck, but don't count on
it given the history. If you try another dentist, make sure that dentist
has the chance to gain the child's trust prior to trying to fix any teeth.
That often means you get to pay to have the child's teeth cleaned again.
Often it means you get to pay for a whole series of minor little
appointments designed solely to gain the child's trust.

--
~+--~+--~+--~+--~+--
Stephen Mancuso, D.D.S.
Troy, Michigan, USA

{remove first 3 dots for email}
.................................................. ...

This posting is intended for informational or conversational purposes only.
Always seek the opinion of a licensed dental professional before acting on
the advice or opinion expressed here. Only a dentist who has examined you
in person can diagnose your problems and make decisions which will affect
your health.
.......................
Please ignore j..d...
~~~~``````````#####----

"Wendy Marsden" > wrote in message
...
> Well, here's my follow-up. My husband brought him back to the dentist
> today. I sent my husband because it occurred to me that the [male]
> dentist might be one of those people who can't treat women like adults. I
> also figured that my husband would have a different demeanor than me and
> might be more effective in getting our kid to cooperate.
>
> He didn't even last as long as last time. Their appointment was for
> 8:30 am and I got a call at 8:38 saying the dentist won't do it.
>
> My husband later said that he thought the dentist was a bit wussy in not
> insisting on getting in the mouth when our son got fussy. Apparently he
> has no skills in this area because he uses nitrous oxide to knock them
> flat during all visits. He did nothing to help our son be less fearful.
>
> DS started to get fearful when the chair was tipped back and then got more
> fearful when they put the little pig-snout mask on him and then totally
> freaked out after smelling the odd smell. (I had previously asked the
> dentist if he could do unscented, apparently he couldn't.)
>
> I conclude now that the freaking out was to the sensation of the mask
> experience (and maybe flashbacks to his traumatic hospitalization a year
> ago) and not a reaction to the drug itself.
>
> The dentist's two recommendations were to "wait until he's older" (our son
> is 51 months) or to schedule hospital dentistry to do all of them at once
> under general. Our next course is the obvious thing that the dentist
> DIDN'T mention, to try a different dentist. We know we might have to come
> back to this one for the hospital dentistry. (He's the only one who does
> it that is available to us.)
>
> What's not clear to me is what happens if we don't get these cavities
> filled for months or years. One of the five cavities was abscessed in May
> and a second one was fairly deep and we discussed whether to restore it or
> pull it when we were pulling the abscessed one (which was pulled
> promptly.) Nothing has been done with it in three months at this point
> and my kid cries everytime we floss there. All of the cavities are
> between back teeth, though his teeth are fairly widely spaced. (His front
> teeth are all fine.)
>
> We have an introductory meeting set up for Friday with a new dentist.
> We've talked this guy up to our kid, explaining that he is our response to
> the kid's fear of the other situation.
>
> I'm planning on talking to this dentist about prescribing a sedative to
> use before restoration work and NOT using nitrous oxide.
>
> Wendy
>
>
> In misc.kids Karen DeMent
> > wrote: > Wendy Marsden wrote:
> >>
> >> My four year old finally, FINALLY got his dentist visit today, four
months
> >> after an x-ray showed a startling five cavities. Our dentist promptly
> >> referred us to a pediatric dentist, saying she wasn't set up to do that
> >> much work on a small kid. The pediatric dentist fit us in for an
initial
> >> exam and a teeth cleaning, but couldn't get us an appointment to treat
him
> >> until today.
> >>
> >> Things started out fine, everyone was cheerful and no one was scared or
> >> anxious. He got in the chair and was laughing and fine. But five
minutes
> >> into the nitrous oxide he suddenly started whimpering and curling up
and
> >> got clingy and weepy and scared. I wasn't able to figure out what was
> >> causing the anxiety - I really think it was a reaction to the nitrous
> >> oxide. The dentist just thought I had a wimpy boy that I babied -
which
> >> wouldn't be a crime if I did, but that doesn't happen to be the case.
> >>
> >> The damn dentist threw us out. So much for pediatric dentists knowing
> >> how to work with kids! He offered no solution beyond we'll try again
on
> >> Monday. Meanwhile, this dentist is a 45 minute drive from my home, he
> >> isn't a preferred provider in my insurance plan and he thinks I've
caused
> >> my son's mouth problems through neglect (which just isn't true.)
> >>
> >> The pediatric dentist was talking about scheduling an OR for sometime
in
> >> the winter (months and months from now) to do all four fillings at
> >> once. I'm disinclined to put my kid through general anasthesia
> >> again. (Long story, but probably related to why he has such weirdly
> >> horrible teeth: he had a traumatic illness and hospitalization 15
months
> >> ago.)
> >>
> >> I'm thinking of finding a dentist that does NOT use nitrous oxide but
who
> >> will prescribe a valium before the visit. What do you think?
> >>
> >> -- Wendy
>
> > Sorry but I think your child may be spoiled and knows how
> > to get your attention and avoid situations he doesn't
> > enjoy. While he may have been anxious, you could have
> > helped more than you did. Nitrous didn't have anything
> > to do with this incident.
>
> > -Karen

wc
September 15th 03, 08:01 PM
Mary Elliott wrote:

>> It's a gas. It has no long lasting consequences. <<

It does if not given with enough oxygen . . . another "anesthetist"
without a clue, aren't you Mary.

>I believe there's a significant
>> risk of death with the kind of anesthetic where
>> you go unconscious. One in a thousand or something?


Try more like 1 in 50,000. ( Mary's reply . . . incorect )

Oh, it's much higher than that . . . I've been an anesthetist for
forty years, and never killed anybody.


>>> Besides the doctor or dentist working on you,
>> there should be an anesthetist constantly monitoring
>> you until you regain consciousness.<<

You worry too damned much! ( Mary's reply . . . typical )

The writer above is 100 % correct. Dentisty being performed is a one
man or woman job. So is anesthesia. Trouble is, too many dentists do
both, and they have left a long trail of dead patients behind them. The
patient should be monitored by a qualified and licensed anesthetist, not
the office assistant.

Will, crna

Nikki
September 15th 03, 08:27 PM
Dr Steve wrote:

> It is possible a different dentist may have better luck, but don't
> count on it given the history. If you try another dentist, make sure
> that dentist has the chance to gain the child's trust prior to trying
> to fix any teeth. That often means you get to pay to have the child's
> teeth cleaned again. Often it means you get to pay for a whole series
> of minor little appointments designed solely to gain the child's
> trust.

I've not responded before since Hunter has not needed dental work and was
fine with exams and cleaning. One thing I did do was take him when I got my
teeth cleaned before we went. Like you suggested that visit (as well as his
the following week) was just another errand on our agenda, no special
comments were made. We had a family dentist so it was the same guy.

Clearly the OP's child is very anxious (which I image some kids just are, I
don't think my second son is going to respond quite as well as my first just
knowing his personality) but if anyone else in her family needs dental work
(and is not anxious about it) it might benifit him to go along.

I wish her little guy good luck. Cleanings and exams area walk in the part
compared to actual work I imagine.

--
Nikki
Mama to Hunter (4) and Luke (2)

madiba
September 15th 03, 08:47 PM
Mary Elliott > wrote:

> > My son also had nitrous oxide at a younger age
> > with an other dentist; I worry about long-term
> > effects; I don't think it's possible to prove
> > something is completely safe.
>
> It's a gas. It has no long lasting consequences.
<g> Tell that to the folks that were gassed in Auschwitz..
Seriously, thats a bit too simplistic. I think NiOx doesn't do much harm
shortterm, pump the kid full of vit B12 and folic acid (in most multivit
tabs) after the visit to get him back in shape.
Longterm (abuse) can lead to myeloneuropathy..

--
madiba

Penny Gaines
September 15th 03, 08:48 PM
Wendy Marsden wrote in >:

> What's not clear to me is what happens if we don't get these cavities
> filled for months or years. One of the five cavities was abscessed in May
> and a second one was fairly deep and we discussed whether to restore it or
> pull it when we were pulling the abscessed one (which was pulled
> promptly.) Nothing has been done with it in three months at this point
> and my kid cries everytime we floss there. All of the cavities are
> between back teeth, though his teeth are fairly widely spaced. (His front
> teeth are all fine.)

Your kid is 4yo, right?

I think the way to work forward is to accept you and the kid are going to
spend a long time at dentist's surgery. The dentists I have dealt with
(in the UK) would only do one tooth per visit, unless they have two easy
teeth. They would only do teeth on one side of the mouth. With five
cavities, you would expect at least six visits. Ideally they would be every
week, so the kid and the dentist can build up a rapport.

FWIW, did the dentist pull the abcessed one at the visit?

--
Penny Gaines
UK mum to three

dragonlady
September 15th 03, 09:12 PM
In article >,
"Nikki" > wrote:

> Dr Steve wrote:
>
> > It is possible a different dentist may have better luck, but don't
> > count on it given the history. If you try another dentist, make sure
> > that dentist has the chance to gain the child's trust prior to trying
> > to fix any teeth. That often means you get to pay to have the child's
> > teeth cleaned again. Often it means you get to pay for a whole series
> > of minor little appointments designed solely to gain the child's
> > trust.
>
> I've not responded before since Hunter has not needed dental work and was
> fine with exams and cleaning. One thing I did do was take him when I got my
> teeth cleaned before we went. Like you suggested that visit (as well as his
> the following week) was just another errand on our agenda, no special
> comments were made. We had a family dentist so it was the same guy.
>
> Clearly the OP's child is very anxious (which I image some kids just are, I
> don't think my second son is going to respond quite as well as my first just
> knowing his personality) but if anyone else in her family needs dental work
> (and is not anxious about it) it might benifit him to go along.
>
> I wish her little guy good luck. Cleanings and exams area walk in the part
> compared to actual work I imagine.
>
> --
> Nikki
> Mama to Hunter (4) and Luke (2)
>
>

One of the things I did was never discuss the dentist with my kids, and
make DH responsible for their dental care.

I hate dentists. And dental hygenists and technicians. All of them.
Passionately. (Well, not the people, really, just seeing them
professionally.) I try to see a dentist once a decade or so whether I
need it or not. I am terrified of all of it. Yes, I'm trying to get
over it -- but I was afraid I'd communicate my own fear and loathing to
my kids.

It seemed to work; none of my kids hates going to the dentist, and now
that they are old enough to understand how *I* feel they find my phobia
rather amusing.

meh
--
Children won't care how much you know until they know how much you care

Mxsmanic
September 15th 03, 10:57 PM
Mary Elliott writes:

> > Besides the doctor or dentist working on you,
> > there should be an anesthetist constantly monitoring
> > you until you regain consciousness.
>
> You worry too damned much!

Not at all. Any type of general anesthesia requires at least a heart
and blood-pressure monitor, and constant surveillance, plus equipment
for emergency resuscitation if required. Careless use of central
anesthetics like nitrous oxide is quite hazardous.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Mxsmanic
September 15th 03, 11:08 PM
Wendy Marsden writes:

> I had previously asked the dentist if he could do
> unscented, apparently he couldn't.

The smell is the nitrous oxide itself. It has a distinct odor, although
it's not really that unpleasant. There's no way to produce "unscented"
nitrous oxide.

> What's not clear to me is what happens if we don't get these cavities
> filled for months or years.

They are baby teeth, they'll fall out either way. My parents spent a
lot of money on restoration of those teeth in my case, and they lost the
investment when they fell out. Of course you don't want infections or
things like that.



--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

carabelli
September 16th 03, 12:07 AM
"Mxsmanic" > wrote .....................
> They are baby teeth, they'll fall out either way. ..........

Ka-ching

carabelli P.A.

Mxsmanic
September 16th 03, 12:32 AM
carabelli writes:

> Ka-ching

?

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Mark & Steven Bornfeld DDS
September 16th 03, 12:48 AM
Mxsmanic wrote:

> carabelli writes:
>
> > Ka-ching
>
> ?

He still has one of dem old cash registers.

Steve

>
>
> --
> Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

--
Mark & Steven Bornfeld DDS
Brooklyn, NY
718-258-5001
http://www.dentaltwins.com

Tsu Dho Nimh
September 16th 03, 01:09 AM
Wendy Marsden > wrote:

>I conclude now that the freaking out was to the sensation of the mask
>experience (and maybe flashbacks to his traumatic hospitalization a year
>ago) and not a reaction to the drug itself.

Sounds reasonable.

>We have an introductory meeting set up for Friday with a new dentist.
>We've talked this guy up to our kid, explaining that he is our response to
>the kid's fear of the other situation.

Explain to the kid that the other dentist will NEVER be seen
again.

>I'm planning on talking to this dentist about prescribing a sedative to
>use before restoration work and NOT using nitrous oxide.

Yes ... kids who have had major hospitalization can have a bad
case of "white coat phobia" for months or years afterwards.

Tsu Dho Nimh

--
When businesses invoke the "protection of consumers," it's a lot like
politicians invoking morality and children - grab your wallet and/or
your kid and run for your life.

carabelli
September 16th 03, 01:13 AM
"Mxsmanic" > wrote in message
...
> carabelli writes:
>
> > Ka-ching
>
> ?

Deciduous teeth that are lost prematurely *may* allow for mesial shifting of
teeth posterior to the empty site. This *can* impact secondary teeth that
would have erupted normally if their space had been preserved. This doen't
always occur, but it sure can and more often than not.

The Ka-ching was my cash register, I practice orthodontics exclusively.

carabelli

Wendy Marsden
September 16th 03, 02:15 AM
In misc.kids carabelli > wrote:
> Deciduous teeth that are lost prematurely *may* allow for mesial shifting of
> teeth posterior to the empty site. This *can* impact secondary teeth that
> would have erupted normally if their space had been preserved. This doen't
> always occur, but it sure can and more often than not.

I know this. Both of his older siblings are enriching the coffers of an
orthodontist. One sibling, for example, does not have an adult bicuspid
coming in behind a baby tooth. Just isn't there. I'm feel like I work
fine with our orthodontist.

The main reason I want to treat his cavities is that he has tooth
pain. One in particular seems to be causing him problems and it appears
to be tender there when I floss. I'm concerned about it getting infected.

Wendy

carabelli
September 16th 03, 02:44 AM
"Wendy Marsden" > wrote in message
...
> In misc.kids carabelli > wrote:
> > Deciduous teeth that are lost prematurely *may* allow for mesial
shifting of
> > teeth posterior to the empty site. This *can* impact secondary teeth
that
> > would have erupted normally if their space had been preserved. This
doen't
> > always occur, but it sure can and more often than not.
>
> I know this. Both of his older siblings are enriching the coffers of an
> orthodontist. One sibling, for example, does not have an adult bicuspid
> coming in behind a baby tooth. Just isn't there. I'm feel like I work
> fine with our orthodontist.
>
> The main reason I want to treat his cavities is that he has tooth
> pain. One in particular seems to be causing him problems and it appears
> to be tender there when I floss. I'm concerned about it getting infected.
>
> Wendy

I would probably rephrase it to "I am taking advantage of the services my
orthodontist provides and am pleased with the investment". :-)

At least I hope you feel that way 5 - 10 years after their treatment is
completed.

Also, in addition to the comments Dr. Steve posted in this thread, at your
child's next visit, walk in with your child, say hello to everyone and take
a 180 back to the waiting room to read the book you brought. Children feed
off the parent's anxiety. Last week a parent of an 8 yr old decided to come
over and hold the child's hand exactly when I was cementing an appliance
that had been tried in, uneventfully, twice in the previous 3 minutes. That
ensured tears for no reason.

I'm a parent also and understand the empathy we feel. I will never allow a
parent in the back when working on someone under the age of 10 again. They
can come back to discuss, observe other patients (same procedure) etc., but
when it's time to do my job, NO.

I have done this in the past and you would be amazed at the behavior of
children once the parent - life preserver is gone.

Just my two cents worth.

carabelli

NOYB
September 16th 03, 03:17 AM
"carabelli" > wrote in message
...
>
> "Wendy Marsden" > wrote in message
> ...
> > In misc.kids carabelli > wrote:
> > > Deciduous teeth that are lost prematurely *may* allow for mesial
> shifting of
> > > teeth posterior to the empty site. This *can* impact secondary teeth
> that
> > > would have erupted normally if their space had been preserved. This
> doen't
> > > always occur, but it sure can and more often than not.
> >
> > I know this. Both of his older siblings are enriching the coffers of an
> > orthodontist. One sibling, for example, does not have an adult bicuspid
> > coming in behind a baby tooth. Just isn't there. I'm feel like I work
> > fine with our orthodontist.
> >
> > The main reason I want to treat his cavities is that he has tooth
> > pain. One in particular seems to be causing him problems and it appears
> > to be tender there when I floss. I'm concerned about it getting
infected.
> >
> > Wendy
>
> I would probably rephrase it to "I am taking advantage of the services my
> orthodontist provides and am pleased with the investment". :-)
>
> At least I hope you feel that way 5 - 10 years after their treatment is
> completed.
>
> Also, in addition to the comments Dr. Steve posted in this thread, at your
> child's next visit, walk in with your child, say hello to everyone and
take
> a 180 back to the waiting room to read the book you brought. Children
feed
> off the parent's anxiety. Last week a parent of an 8 yr old decided to
come
> over and hold the child's hand exactly when I was cementing an appliance
> that had been tried in, uneventfully, twice in the previous 3 minutes.
That
> ensured tears for no reason.
>
> I'm a parent also and understand the empathy we feel. I will never allow
a
> parent in the back when working on someone under the age of 10 again.
They
> can come back to discuss, observe other patients (same procedure) etc.,
but
> when it's time to do my job, NO.
>
> I have done this in the past and you would be amazed at the behavior of
> children once the parent - life preserver is gone.


Agreed. The parent becomes the child's "ally" against the "big, bad
dentist". "Mommy, please don't let him hurt me."

iphigenia
September 16th 03, 03:52 AM
carabelli wrote:
> Deciduous teeth that are lost prematurely *may* allow for mesial
> shifting of teeth posterior to the empty site. This *can* impact
> secondary teeth that would have erupted normally if their space had
> been preserved.

:nod: That's why I had my son's teeth done. I wasn't willing to let him
spend the next 5-7 years missing teeth, particularly when two of the teeth
that were seriously decaying were second incisors.

--
iphigenia
www.tristyn.net
"i have heard the mermaids singing, each to each.
i do not think that they will sing to me."

Linda
September 16th 03, 04:47 AM
Excellent post Dr Steve - I totally agree - should be mandatory reading for
all parents of little ones. Also - parents, brush those teeth for many
years - my boys were brushed every night by me till almost the age of 10.
Kids usually just don't have the ability to do it well.
Linda.
(hygienist)

"Dr Steve" > wrote in message
. com...
> Sounds like the child has learned how to avoid the situation altogether.
> Most kids are smart enough to do that if given the chance. It is hard to
> reason past that behavior for very young children. A guess from a long
> distance away is to go to the hospital and get the GA. The child should
NOT
> remember any of it.
>
> A general suggestion to all parents is to never try to prepare a child for
a
> dental visit. We have the best of intentions, but invariably end up
scaring
> the child more by placing new ideas in their heads. Answer all questions
as
> briefly, but honestly as possible. Just do not offer ANY information.
All
> too often, parents will place too much importance on a single event (like
> visiting the dentist), because it is important to *us*, but we should do
the
> opposite. I tell parents to treat the visit with the same level of
> importance (when in front of the kid), as a trip to the supermarket. If
we
> tried to explain everything the child would see or experience at the
> supermarket prior to their first trip there (at age 3-4), the kid would be
> scared to death. Think about a reaction to things the child has not seen
> yet by age 3-4, such as automatic doors, HUGE (to the child) metal carts
> that they are forced to ride in, but wobble all over the place, all the
> strangers everywhere, mountains of boxes, a machine which slices meat,
> bright lights, bells going off, and the cash register with its mysterious
> moving belt and chirping register.
>
> Most children do not fear the grocery store because, (1) they have been
> there since they were weeks old, and (2) no one has given them any reason
to
> suspect it might be scary. The dental visit should be the same (for the
> kid).
>
> Saying things such as "Don't worry it won't hurt", or "don't be scared",
or
> "don't be frightened of the noises", only plants the thought of fear in
> their heads.
>
> I know this advice may be too late for this child. It may not have
mattered
> in the first place. The important thing is to get the dental problems
> sorted out quickly, maintain the child's dental health so that it is not
an
> issue again, and avoid making the child into a "dentophobic".
>
> The parent will suffer much more from the visit to the hospital for GA
than
> the child will. Only the parent will remember it a year later. The
> hospital will have an entire team ready to administer the anesthetic and
get
> the treatment done. Don't let the kid live with pain or fear.
>
> It is possible a different dentist may have better luck, but don't count
on
> it given the history. If you try another dentist, make sure that dentist
> has the chance to gain the child's trust prior to trying to fix any teeth.
> That often means you get to pay to have the child's teeth cleaned again.
> Often it means you get to pay for a whole series of minor little
> appointments designed solely to gain the child's trust.
>
> --
> ~+--~+--~+--~+--~+--
> Stephen Mancuso, D.D.S.
> Troy, Michigan, USA
>
> {remove first 3 dots for email}
> .................................................. ..
>
> This posting is intended for informational or conversational purposes
only.
> Always seek the opinion of a licensed dental professional before acting on
> the advice or opinion expressed here. Only a dentist who has examined you
> in person can diagnose your problems and make decisions which will affect
> your health.
> ......................
> Please ignore j..d...
> ~~~~``````````#####----
>
> "Wendy Marsden" > wrote in message
> ...
> > Well, here's my follow-up. My husband brought him back to the dentist
> > today. I sent my husband because it occurred to me that the [male]
> > dentist might be one of those people who can't treat women like adults.
I
> > also figured that my husband would have a different demeanor than me and
> > might be more effective in getting our kid to cooperate.
> >
> > He didn't even last as long as last time. Their appointment was for
> > 8:30 am and I got a call at 8:38 saying the dentist won't do it.
> >
> > My husband later said that he thought the dentist was a bit wussy in not
> > insisting on getting in the mouth when our son got fussy. Apparently he
> > has no skills in this area because he uses nitrous oxide to knock them
> > flat during all visits. He did nothing to help our son be less fearful.
> >
> > DS started to get fearful when the chair was tipped back and then got
more
> > fearful when they put the little pig-snout mask on him and then totally
> > freaked out after smelling the odd smell. (I had previously asked the
> > dentist if he could do unscented, apparently he couldn't.)
> >
> > I conclude now that the freaking out was to the sensation of the mask
> > experience (and maybe flashbacks to his traumatic hospitalization a year
> > ago) and not a reaction to the drug itself.
> >
> > The dentist's two recommendations were to "wait until he's older" (our
son
> > is 51 months) or to schedule hospital dentistry to do all of them at
once
> > under general. Our next course is the obvious thing that the dentist
> > DIDN'T mention, to try a different dentist. We know we might have to
come
> > back to this one for the hospital dentistry. (He's the only one who
does
> > it that is available to us.)
> >
> > What's not clear to me is what happens if we don't get these cavities
> > filled for months or years. One of the five cavities was abscessed in
May
> > and a second one was fairly deep and we discussed whether to restore it
or
> > pull it when we were pulling the abscessed one (which was pulled
> > promptly.) Nothing has been done with it in three months at this point
> > and my kid cries everytime we floss there. All of the cavities are
> > between back teeth, though his teeth are fairly widely spaced. (His
front
> > teeth are all fine.)
> >
> > We have an introductory meeting set up for Friday with a new dentist.
> > We've talked this guy up to our kid, explaining that he is our response
to
> > the kid's fear of the other situation.
> >
> > I'm planning on talking to this dentist about prescribing a sedative to
> > use before restoration work and NOT using nitrous oxide.
> >
> > Wendy
> >
> >
> > In misc.kids Karen DeMent
> > > wrote: > Wendy Marsden wrote:
> > >>
> > >> My four year old finally, FINALLY got his dentist visit today, four
> months
> > >> after an x-ray showed a startling five cavities. Our dentist
promptly
> > >> referred us to a pediatric dentist, saying she wasn't set up to do
that
> > >> much work on a small kid. The pediatric dentist fit us in for an
> initial
> > >> exam and a teeth cleaning, but couldn't get us an appointment to
treat
> him
> > >> until today.
> > >>
> > >> Things started out fine, everyone was cheerful and no one was scared
or
> > >> anxious. He got in the chair and was laughing and fine. But five
> minutes
> > >> into the nitrous oxide he suddenly started whimpering and curling up
> and
> > >> got clingy and weepy and scared. I wasn't able to figure out what
was
> > >> causing the anxiety - I really think it was a reaction to the nitrous
> > >> oxide. The dentist just thought I had a wimpy boy that I babied -
> which
> > >> wouldn't be a crime if I did, but that doesn't happen to be the case.
> > >>
> > >> The damn dentist threw us out. So much for pediatric dentists
knowing
> > >> how to work with kids! He offered no solution beyond we'll try again
> on
> > >> Monday. Meanwhile, this dentist is a 45 minute drive from my home,
he
> > >> isn't a preferred provider in my insurance plan and he thinks I've
> caused
> > >> my son's mouth problems through neglect (which just isn't true.)
> > >>
> > >> The pediatric dentist was talking about scheduling an OR for sometime
> in
> > >> the winter (months and months from now) to do all four fillings at
> > >> once. I'm disinclined to put my kid through general anasthesia
> > >> again. (Long story, but probably related to why he has such weirdly
> > >> horrible teeth: he had a traumatic illness and hospitalization 15
> months
> > >> ago.)
> > >>
> > >> I'm thinking of finding a dentist that does NOT use nitrous oxide but
> who
> > >> will prescribe a valium before the visit. What do you think?
> > >>
> > >> -- Wendy
> >
> > > Sorry but I think your child may be spoiled and knows how
> > > to get your attention and avoid situations he doesn't
> > > enjoy. While he may have been anxious, you could have
> > > helped more than you did. Nitrous didn't have anything
> > > to do with this incident.
> >
> > > -Karen
>
>

Roger Schlafly
September 16th 03, 07:50 AM
"Dr Steve" > wrote
> Most children do not fear the grocery store because, (1) they have been
> there since they were weeks old, and (2) no one has given them any reason
to
> suspect it might be scary.

And (3), no one tortures them in the grocery

> Saying things such as "Don't worry it won't hurt", or "don't be scared",
or
> "don't be frightened of the noises", only plants the thought of fear in
> their heads.

Better to give the child realistic expectations of what is going to
happen. If it is going to hurt, then tell the kid it is going to hurt.

Mxsmanic
September 16th 03, 08:45 AM
Roger Schlafly writes:

> Better to give the child realistic expectations of what is going to
> happen. If it is going to hurt, then tell the kid it is going to hurt.

I'm not so sure. Kids have vivid imaginations and the slightest
suggestion can quickly engender some very frightening and totally
imaginary thoughts. "It's going to hurt a little bit" may evolve into
"it will be hellish, unending torture" by the time the kid actually sits
in the dentist's chair.

As a general rule, any expectation placed into the mind of young
children will tend to become exaggerated, with the degree of
exaggeration being roughly a function of the amount of detail initially
provided multiplied by the time the child waits until the described
event actually comes to pass. If the expectation is positive, things
will go smoothly; if it is negative, things may go very badly.

Adults are like this, too, with situations that they've never dealt with
before. However, since they have considerably more experience, this
helps to temper their exaggerations in _most_ contexts (but not all). I
think a lot of adult fear of dentists still results from this process,
even if it isn't as severe as it can become for children. Phobias in
general may be manifestations of this process as well.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Mxsmanic
September 16th 03, 08:47 AM
carabelli writes:

> Deciduous teeth that are lost prematurely *may* allow for mesial shifting of
> teeth posterior to the empty site. This *can* impact secondary teeth that
> would have erupted normally if their space had been preserved. This doen't
> always occur, but it sure can and more often than not.

Ah, thanks. I was wondering what you were trying to say.

> The Ka-ching was my cash register, I practice orthodontics exclusively.

I see. I've considered braces from time to time, but I've been told by
dentists that my "jaw is too small" (is that possible?) and that my
teeth are crowded as a result, and I'm not sure how they could be
straightened entirely if there just isn't enough space to line them up
perfectly.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Joel M. Eichen D.D.S.
September 16th 03, 12:38 PM
I have tried giving prizes to adult patients but it did not work!


>On Mon, 15 Sep 2003 14:07:06 -0400, Mary Elliott > wrote:

>Catherine Woodgold wrote:
>>
>> Our pediatric dentist does most of the fillings on
>> our children's teeth with no anesthetic. He asks
>> them to tell him if it hurts. Apparently it doesn't
>> hurt!! I don't know how he does that. Maybe they're
>> small, surface fillings or something. My children
>> like going to the dentist, apparently because they
>> like getting the little prizes the dentist gives
>> them at the end of the session. The dentist also
>> talks to them in a respectful and friendly way,
>> which I'm sure helps a lot.
>
>And your point is?
>
>> They also had some
>> local anesthetic for some more serious work --
>> similar to the anesthetic I've had at dentists'
>> offices: where they inject something into your
>> gums to "freeze" that part of your mouth.
>> My son also had nitrous oxide at a younger age
>> with an other dentist; I worry about long-term
>> effects; I don't think it's possible to prove
>> something is completely safe.
>
>It's a gas. It has no long lasting consequences.
>
>> Someone I know said that when she had a general
>> anesthetic, she couldn't think clearly for 6 months
>> afterwards. (That's the kind where you go
>> unconscious.) I believe there's a significant
>> risk of death with the kind of anesthetic where
>> you go unconscious. One in a thousand or something?
>
>Try more like 1 in 50,000.
>
>> Besides the doctor or dentist working on you,
>> there should be an anesthetist constantly monitoring
>> you until you regain consciousness.
>
>You worry too damned much!

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 16th 03, 12:39 PM
Some folks I know had anesthetic and could NEVER think clearly, either
before or after!


>> Someone I know said that when she had a general
>> anesthetic, she couldn't think clearly for 6 months
>> afterwards. (That's the kind where you go
>> unconscious.) I believe there's a significant
>> risk of death with the kind of anesthetic where
>> you go unconscious. One in a thousand or something?

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 16th 03, 12:40 PM
Its a gas!

I thought you meant the gaff on Letterman last night!


On Mon, 15 Sep 2003 19:01:25 GMT, wc > wrote:

> Mary Elliott wrote:
>
> >> It's a gas. It has no long lasting consequences. <<
>
>It does if not given with enough oxygen . . . another "anesthetist"
>without a clue, aren't you Mary.
>
> >I believe there's a significant
> >> risk of death with the kind of anesthetic where
> >> you go unconscious. One in a thousand or something?
>
>
>Try more like 1 in 50,000. ( Mary's reply . . . incorect )
>
> Oh, it's much higher than that . . . I've been an anesthetist for
>forty years, and never killed anybody.
>
>
> >>> Besides the doctor or dentist working on you,
>>> there should be an anesthetist constantly monitoring
>>> you until you regain consciousness.<<
>
> You worry too damned much! ( Mary's reply . . . typical )
>
>The writer above is 100 % correct. Dentisty being performed is a one
>man or woman job. So is anesthesia. Trouble is, too many dentists do
>both, and they have left a long trail of dead patients behind them. The
>patient should be monitored by a qualified and licensed anesthetist, not
>the office assistant.
>
>Will, crna
>

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 16th 03, 12:41 PM
N2O and GA (general anesthetic) are quite different. If you want me to
elaborate in the next 1,000,000 posts, I will!


Joel

On Mon, 15 Sep 2003 23:57:12 +0200, Mxsmanic >
wrote:

>Mary Elliott writes:
>
>> > Besides the doctor or dentist working on you,
>> > there should be an anesthetist constantly monitoring
>> > you until you regain consciousness.
>>
>> You worry too damned much!
>
>Not at all. Any type of general anesthesia requires at least a heart
>and blood-pressure monitor, and constant surveillance, plus equipment
>for emergency resuscitation if required. Careless use of central
>anesthetics like nitrous oxide is quite hazardous.

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 16th 03, 12:42 PM
There is no careless use of N2O.

It is closely controlled and monitored (in Pennsylvania) at least!



Joel

On Mon, 15 Sep 2003 23:57:12 +0200, Mxsmanic >
wrote:

>Careless use of central
>anesthetics like nitrous oxide is quite hazardous.

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 16th 03, 12:42 PM
SPECIALIST TIME.

On Mon, 15 Sep 2003 18:22:00 GMT, Wendy Marsden
> wrote:

>Well, here's my follow-up. My husband brought him back to the dentist
>today. I sent my husband because it occurred to me that the [male]
>dentist might be one of those people who can't treat women like adults. I
>also figured that my husband would have a different demeanor than me and
>might be more effective in getting our kid to cooperate.
>
>He didn't even last as long as last time. Their appointment was for
>8:30 am and I got a call at 8:38 saying the dentist won't do it.
>
>My husband later said that he thought the dentist was a bit wussy in not
>insisting on getting in the mouth when our son got fussy. Apparently he
>has no skills in this area because he uses nitrous oxide to knock them
>flat during all visits. He did nothing to help our son be less fearful.
>
>DS started to get fearful when the chair was tipped back and then got more
>fearful when they put the little pig-snout mask on him and then totally
>freaked out after smelling the odd smell. (I had previously asked the
>dentist if he could do unscented, apparently he couldn't.)
>
>I conclude now that the freaking out was to the sensation of the mask
>experience (and maybe flashbacks to his traumatic hospitalization a year
>ago) and not a reaction to the drug itself.
>
>The dentist's two recommendations were to "wait until he's older" (our son
>is 51 months) or to schedule hospital dentistry to do all of them at once
>under general. Our next course is the obvious thing that the dentist
>DIDN'T mention, to try a different dentist. We know we might have to come
>back to this one for the hospital dentistry. (He's the only one who does
>it that is available to us.)
>
>What's not clear to me is what happens if we don't get these cavities
>filled for months or years. One of the five cavities was abscessed in May
>and a second one was fairly deep and we discussed whether to restore it or
>pull it when we were pulling the abscessed one (which was pulled
>promptly.) Nothing has been done with it in three months at this point
>and my kid cries everytime we floss there. All of the cavities are
>between back teeth, though his teeth are fairly widely spaced. (His front
>teeth are all fine.)
>
>We have an introductory meeting set up for Friday with a new dentist.
>We've talked this guy up to our kid, explaining that he is our response to
>the kid's fear of the other situation.
>
>I'm planning on talking to this dentist about prescribing a sedative to
>use before restoration work and NOT using nitrous oxide.
>
>Wendy
>
>
> In misc.kids Karen DeMent
> wrote: > Wendy Marsden wrote:
>>>
>>> My four year old finally, FINALLY got his dentist visit today, four months
>>> after an x-ray showed a startling five cavities. Our dentist promptly
>>> referred us to a pediatric dentist, saying she wasn't set up to do that
>>> much work on a small kid. The pediatric dentist fit us in for an initial
>>> exam and a teeth cleaning, but couldn't get us an appointment to treat him
>>> until today.
>>>
>>> Things started out fine, everyone was cheerful and no one was scared or
>>> anxious. He got in the chair and was laughing and fine. But five minutes
>>> into the nitrous oxide he suddenly started whimpering and curling up and
>>> got clingy and weepy and scared. I wasn't able to figure out what was
>>> causing the anxiety - I really think it was a reaction to the nitrous
>>> oxide. The dentist just thought I had a wimpy boy that I babied - which
>>> wouldn't be a crime if I did, but that doesn't happen to be the case.
>>>
>>> The damn dentist threw us out. So much for pediatric dentists knowing
>>> how to work with kids! He offered no solution beyond we'll try again on
>>> Monday. Meanwhile, this dentist is a 45 minute drive from my home, he
>>> isn't a preferred provider in my insurance plan and he thinks I've caused
>>> my son's mouth problems through neglect (which just isn't true.)
>>>
>>> The pediatric dentist was talking about scheduling an OR for sometime in
>>> the winter (months and months from now) to do all four fillings at
>>> once. I'm disinclined to put my kid through general anasthesia
>>> again. (Long story, but probably related to why he has such weirdly
>>> horrible teeth: he had a traumatic illness and hospitalization 15 months
>>> ago.)
>>>
>>> I'm thinking of finding a dentist that does NOT use nitrous oxide but who
>>> will prescribe a valium before the visit. What do you think?
>>>
>>> -- Wendy
>
>> Sorry but I think your child may be spoiled and knows how
>> to get your attention and avoid situations he doesn't
>> enjoy. While he may have been anxious, you could have
>> helped more than you did. Nitrous didn't have anything
>> to do with this incident.
>
>> -Karen

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 16th 03, 12:43 PM
On Mon, 15 Sep 2003 18:57:50 GMT, "Dr Steve" > wrote:

>Sounds like the child has learned how to avoid the situation altogether.
>Most kids are smart enough to do that if given the chance.

REPLY:

Exactly. Most kids are twice as smart as two parents put together!


(I used to be one ,,,,, a kid!)_


>It is hard to
>reason past that behavior for very young children. A guess from a long
>distance away is to go to the hospital and get the GA. The child should NOT
>remember any of it.
>
>A general suggestion to all parents is to never try to prepare a child for a
>dental visit. We have the best of intentions, but invariably end up scaring
>the child more by placing new ideas in their heads. Answer all questions as
>briefly, but honestly as possible. Just do not offer ANY information. All
>too often, parents will place too much importance on a single event (like
>visiting the dentist), because it is important to *us*, but we should do the
>opposite. I tell parents to treat the visit with the same level of
>importance (when in front of the kid), as a trip to the supermarket. If we
>tried to explain everything the child would see or experience at the
>supermarket prior to their first trip there (at age 3-4), the kid would be
>scared to death. Think about a reaction to things the child has not seen
>yet by age 3-4, such as automatic doors, HUGE (to the child) metal carts
>that they are forced to ride in, but wobble all over the place, all the
>strangers everywhere, mountains of boxes, a machine which slices meat,
>bright lights, bells going off, and the cash register with its mysterious
>moving belt and chirping register.
>
>Most children do not fear the grocery store because, (1) they have been
>there since they were weeks old, and (2) no one has given them any reason to
>suspect it might be scary. The dental visit should be the same (for the
>kid).
>
>Saying things such as "Don't worry it won't hurt", or "don't be scared", or
>"don't be frightened of the noises", only plants the thought of fear in
>their heads.
>
>I know this advice may be too late for this child. It may not have mattered
>in the first place. The important thing is to get the dental problems
>sorted out quickly, maintain the child's dental health so that it is not an
>issue again, and avoid making the child into a "dentophobic".
>
>The parent will suffer much more from the visit to the hospital for GA than
>the child will. Only the parent will remember it a year later. The
>hospital will have an entire team ready to administer the anesthetic and get
>the treatment done. Don't let the kid live with pain or fear.
>
>It is possible a different dentist may have better luck, but don't count on
>it given the history. If you try another dentist, make sure that dentist
>has the chance to gain the child's trust prior to trying to fix any teeth.
>That often means you get to pay to have the child's teeth cleaned again.
>Often it means you get to pay for a whole series of minor little
>appointments designed solely to gain the child's trust.

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 16th 03, 12:45 PM
Are you kidding me? At my grocery the produce guy gives shots to all
of the customers ......

On Mon, 15 Sep 2003 18:57:50 GMT, "Dr Steve" > wrote:

>Most children do not fear the grocery store because, (1) they have been
>there since they were weeks old, and (2) no one has given them any reason to
>suspect it might be scary.

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 16th 03, 12:45 PM
I just tuned in ... who is Hunter?


Joel

On Mon, 15 Sep 2003 14:27:48 -0500, "Nikki" >
wrote:

>Dr Steve wrote:
>
>> It is possible a different dentist may have better luck, but don't
>> count on it given the history. If you try another dentist, make sure
>> that dentist has the chance to gain the child's trust prior to trying
>> to fix any teeth. That often means you get to pay to have the child's
>> teeth cleaned again. Often it means you get to pay for a whole series
>> of minor little appointments designed solely to gain the child's
>> trust.
>
>I've not responded before since Hunter has not needed dental work and was
>fine with exams and cleaning. One thing I did do was take him when I got my
>teeth cleaned before we went. Like you suggested that visit (as well as his
>the following week) was just another errand on our agenda, no special
>comments were made. We had a family dentist so it was the same guy.
>
>Clearly the OP's child is very anxious (which I image some kids just are, I
>don't think my second son is going to respond quite as well as my first just
>knowing his personality) but if anyone else in her family needs dental work
>(and is not anxious about it) it might benifit him to go along.
>
>I wish her little guy good luck. Cleanings and exams area walk in the part
>compared to actual work I imagine.

--
Joel M. Eichen, .
Philadelphia PA

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Joel M. Eichen D.D.S.
September 16th 03, 12:46 PM
Okay .. why didn't you tell me its Luke's brother?


On Mon, 15 Sep 2003 14:27:48 -0500, "Nikki" >
wrote:

>Nikki
>Mama to Hunter (4) and Luke (2)

--
Joel M. Eichen, .
Philadelphia PA

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Joel M. Eichen D.D.S.
September 16th 03, 12:47 PM
My ex-wife does too!

Not all of them ... just me!


>On Mon, 15 Sep 2003 20:12:21 GMT, dragonlady > wrote:

>I hate dentists.

--
Joel M. Eichen, .
Philadelphia PA

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Joel M. Eichen D.D.S.
September 16th 03, 12:48 PM
On Tue, 16 Sep 2003 06:50:20 GMT, "Roger Schlafly"
> wrote:

>"Dr Steve" > wrote
>> Most children do not fear the grocery store because, (1) they have been
>> there since they were weeks old, and (2) no one has given them any reason
>to
>> suspect it might be scary.
>
>And (3), no one tortures them in the grocery
>

You have not met the Shop-Rite checkout girls ......
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Joel M. Eichen, .
Philadelphia PA

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Joel M. Eichen D.D.S.
September 16th 03, 12:49 PM
And I want to know what the PA means ....?

I am guessing here ...Prince Albert?

On Tue, 16 Sep 2003 01:32:12 +0200, Mxsmanic >
wrote:

>carabelli writes:
>
>> Ka-ching
>
>?

--
Joel M. Eichen, .
Philadelphia PA

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Joel M. Eichen D.D.S.
September 16th 03, 12:51 PM
Let's also point out to parents that untreated malocclusions (crooked
teeth) leads to periodontal disease later in life ~ FACT!


Joel

On Tue, 16 Sep 2003 09:47:08 +0200, Mxsmanic >
wrote:

>carabelli writes:
>
>> Deciduous teeth that are lost prematurely *may* allow for mesial shifting of
>> teeth posterior to the empty site. This *can* impact secondary teeth that
>> would have erupted normally if their space had been preserved. This doen't
>> always occur, but it sure can and more often than not.
>
>Ah, thanks. I was wondering what you were trying to say.
>
>> The Ka-ching was my cash register, I practice orthodontics exclusively.
>
>I see. I've considered braces from time to time, but I've been told by
>dentists that my "jaw is too small" (is that possible?) and that my
>teeth are crowded as a result, and I'm not sure how they could be
>straightened entirely if there just isn't enough space to line them up
>perfectly.

--
Joel M. Eichen, .
Philadelphia PA

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Dr Steve
September 16th 03, 01:06 PM
Do as you say and the child will have a very hard time sitting in the dental
chair. The child deserves the opportunity to developed his/her own
observations and expectations based on their own experiences, NOT the
experiences of their parents 20 years ago.

--
~+--~+--~+--~+--~+--
Stephen Mancuso, D.D.S.
Troy, Michigan, USA

{remove first 3 dots for email}
.................................................. ...

This posting is intended for informational or conversational purposes only.
Always seek the opinion of a licensed dental professional before acting on
the advice or opinion expressed here. Only a dentist who has examined you
in person can diagnose your problems and make decisions which will affect
your health.
.......................
Please ignore j..d...
~~~~``````````#####----

"Roger Schlafly" > wrote in message
. net...
> "Dr Steve" > wrote
> > Most children do not fear the grocery store because, (1) they have been
> > there since they were weeks old, and (2) no one has given them any
reason
> to
> > suspect it might be scary.
>
> And (3), no one tortures them in the grocery
>
> > Saying things such as "Don't worry it won't hurt", or "don't be scared",
> or
> > "don't be frightened of the noises", only plants the thought of fear in
> > their heads.
>
> Better to give the child realistic expectations of what is going to
> happen. If it is going to hurt, then tell the kid it is going to hurt.
>
>

carabelli
September 16th 03, 01:13 PM
"Joel M. Eichen D.D.S." > wrote in message
...
> And I want to know what the PA means ....?

I was declared to be a "Pompous Ass" because I did not realise that RCT and
amalgams are one and the same.

carabelli P.A.

Nikki
September 16th 03, 03:01 PM
Joel M. Eichen D.D.S. wrote:
> I just tuned in ... who is Hunter?

My 4 year old boy :-) Good teeth and good dental patient. Luckily as I
have to admit that he brushes by himself about 50% of the time and lets me
help the other 50%.

--
Nikki
Mama to Hunter (4) and Luke (2)

Cathy Weeks
September 16th 03, 04:45 PM
"Roger Schlafly" > wrote in message >...
> "Dr Steve" > wrote
> > Most children do not fear the grocery store because, (1) they have been
> > there since they were weeks old, and (2) no one has given them any reason
> to
> > suspect it might be scary.
>
> And (3), no one tortures them in the grocery
>
> > Saying things such as "Don't worry it won't hurt", or "don't be scared",
> or
> > "don't be frightened of the noises", only plants the thought of fear in
> > their heads.
>
> Better to give the child realistic expectations of what is going to
> happen. If it is going to hurt, then tell the kid it is going to hurt.

I think you just missed the point of Dr. Steve's post. By telling
them what's going to happen, you often increase a child's fear of the
unknown, thus sabotaging the experience completely.

The problem is that "hurts" is subjective. If you say it's going to
hurt a little bit, a child doesn't really understand what "little bit"
means.

Cathy Weeks
Mommy to Kivi Alexis 12/01

Wendy Marsden
September 16th 03, 07:23 PM
In misc.kids.health Joel M. Eichen D.D.S. > wrote:
> SPECIALIST TIME.

What specialist? The kid started out with a general dentist who referred
him to this pediatric dentist. He was also seen by an oral surgeon but
the oral surgeon said to go to the pediatric dentist for the rest of the
work.

What specialist is there beyond the general dentist, oral surgeon,
pediatric dentist and orthodontist that we've already got on the table?

BTW, my husband just told me he has a teeth cleaning appointment tomorrow
with the dentist we're going to try next with our son. I figure I'll
bring our son to it to just hang out while the work is being done. Does
that make sense to you?

Wendy

Roger Schlafly
September 16th 03, 10:03 PM
"Mxsmanic" > wrote
> > Better to give the child realistic expectations of what is going to
> > happen. If it is going to hurt, then tell the kid it is going to hurt.
> As a general rule, any expectation placed into the mind of young
> children will tend to become exaggerated, with the degree of ...

Sure, if you are in a habit of lying to them about what to expect.
I find that telling them the truth works much better.

> Adults are like this, too, with situations that they've never dealt with
> before. However, since they have considerably more experience, this
> helps to temper their exaggerations in _most_ contexts (but not all).

So do you prefer that a dentist lies to you about how much pain
you are going to get?

Joel M. Eichen D.D.S.
September 16th 03, 11:09 PM
Thanks! Cool name!

On Tue, 16 Sep 2003 09:01:20 -0500, "Nikki" >
wrote:

>Joel M. Eichen D.D.S. wrote:
>> I just tuned in ... who is Hunter?
>
>My 4 year old boy :-) Good teeth and good dental patient. Luckily as I
>have to admit that he brushes by himself about 50% of the time and lets me
>help the other 50%.

--
Joel M. Eichen, .
Philadelphia PA

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<You fill it in>

Joel M. Eichen D.D.S.
September 16th 03, 11:09 PM
We agree!

On Tue, 16 Sep 2003 21:03:22 GMT, "Roger Schlafly"
> wrote:

>"Mxsmanic" > wrote
>> > Better to give the child realistic expectations of what is going to
>> > happen. If it is going to hurt, then tell the kid it is going to hurt.
>> As a general rule, any expectation placed into the mind of young
>> children will tend to become exaggerated, with the degree of ...
>
>Sure, if you are in a habit of lying to them about what to expect.
>I find that telling them the truth works much better.
>
>> Adults are like this, too, with situations that they've never dealt with
>> before. However, since they have considerably more experience, this
>> helps to temper their exaggerations in _most_ contexts (but not all).
>
>So do you prefer that a dentist lies to you about how much pain
>you are going to get?
>

--
Joel M. Eichen, .
Philadelphia PA

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Joel M. Eichen D.D.S.
September 16th 03, 11:10 PM
Pediatric dentist ......


On Tue, 16 Sep 2003 18:23:51 GMT, Wendy Marsden
> wrote:

>In misc.kids.health Joel M. Eichen D.D.S. > wrote:
>> SPECIALIST TIME.
>
>What specialist? The kid started out with a general dentist who referred
>him to this pediatric dentist. He was also seen by an oral surgeon but
>the oral surgeon said to go to the pediatric dentist for the rest of the
>work.
>
>What specialist is there beyond the general dentist, oral surgeon,
>pediatric dentist and orthodontist that we've already got on the table?
>
>BTW, my husband just told me he has a teeth cleaning appointment tomorrow
>with the dentist we're going to try next with our son. I figure I'll
>bring our son to it to just hang out while the work is being done. Does
>that make sense to you?
>
>Wendy

--
Joel M. Eichen, .
Philadelphia PA

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dragonlady
September 16th 03, 11:35 PM
In article >,
Joel M. Eichen D.D.S. > wrote:

> Pediatric dentist ......
>
>

Except that the incident she described was with a pediatric dentist . . .

meh
--
Children won't care how much you know until they know how much you care

Joel M. Eichen D.D.S.
September 16th 03, 11:41 PM
N'udder pediatric dentist .... one more skilled in medications .......


On Tue, 16 Sep 2003 22:35:26 GMT, dragonlady
> wrote:

>In article >,
> Joel M. Eichen D.D.S. > wrote:
>
>> Pediatric dentist ......
>>
>>
>
>Except that the incident she described was with a pediatric dentist . . .
>
>meh

--
Joel M. Eichen, .
Philadelphia PA

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Joel M. Eichen D.D.S.
September 16th 03, 11:43 PM
Line Dancing impairment?

What the heck is that?



Joel

On Tue, 16 Sep 2003 18:41:03 -0400, Joel M. Eichen D.D.S.
> wrote:

>From: (Clinton C Zimmerman)
>Date: 9/16/2003 10:34 AM Pacific Standard Time
>Message-id: >
>
(Jan) wrote in message
>...
>> >Subject: Re: Hg statistics
>> >From: (Clinton C Zimmerman)
>> >Date: 9/15/2003 12:34 PM Pacific Standard Time
>> >Message-id: >
>> >
>> >
>> >
>> >cz
>>
>> 1: Occup Environ Med 1995 Feb;52(2):124-8 Related Articles, Books
>>
>>
>> People with high mercury uptake from their own dental amalgam fillings.
>>
>> Barregard L, Sallsten G, Jarvholm B.
>>
>> Department of Occupational Medicine, Sahlgrenska University Hospital,
>> Goteborg,
>> Sweden.
>>
>> OBJECTIVES--To describe people with high mercury (Hg) uptake from their
>> amalgam
--
Joel M. Eichen, .
Philadelphia PA

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Mxsmanic
September 17th 03, 05:08 AM
Roger Schlafly writes:

> Sure, if you are in a habit of lying to them about what to expect.
> I find that telling them the truth works much better.

Even if you tell the truth, it will be exaggerated in a child's mind.
Adults do the same thing, but not to the same extent.

> So do you prefer that a dentist lies to you about how much pain
> you are going to get?

No, but I'm not prone to exaggeration.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Nikki
September 17th 03, 03:23 PM
Mxsmanic wrote:
> Roger Schlafly writes:
>
>> Sure, if you are in a habit of lying to them about what to expect.
>> I find that telling them the truth works much better.
>
> Even if you tell the truth, it will be exaggerated in a child's mind.
> Adults do the same thing, but not to the same extent.
>
>> So do you prefer that a dentist lies to you about how much pain
>> you are going to get?
>
> No, but I'm not prone to exaggeration.

If the kid doesn't ask, don't offer any information. If they ask then tell
them something specific. Like it might feel like a misquito bite or
something of that nature. That is my tactic at any rate and so far it has
worked well for vaccinations.

Another thing that has worked well for us is to read books about
vaccinations and dental stuff way ahead of our visit, not even related to
our visit. The repeat readings makes it seem more familiar etc. since part
of the apprehension at the dentist has nothing to do with fearing
pain.....kids shouldn't even realize dentist equals pain....but that it is
just something totally new.

--
Nikki
Mama to Hunter (4) and Luke (2)

Joel M. Eichen D.D.S.
September 17th 03, 03:29 PM
Now if the kid is afraid of amalgam poisoning (a current fad amongst
otherwise intelligent people), then he is reading too many nonsense
newsgroups.

PS- Kids can get white fillings too ...... glassionomers are very good
for deciduous teeth ~ Fuji, etc.

Pitch and plug for Carabelli (KS), Jeff (TX), and Charlie (MA),

Be sure to get crooked teeth straightened ~ untreated, it often causes
periodontal disease thirty years later - Joel.

Joel


***********

nonsense follows:

Ironically, all of Jan Drew's pseudoscience HELPS the dentists
financially and often hurts the patients when complications arise!
Ever see the patient who no longer can chew on the recently installed
composites and then needs root canal and crown?

Why not sometimes leave well enough alone?

I refrain from agreeing with the patient's pseudoscience, however, if
someone wants to remove UNSIGHTLY amalgam, is willing to pay for it,
then I am enthusiastic too.

Of course then Jan rolls into "composite compatibility testing" and
"proper protocol," both of which are total unmitigated nonsense!

Now we can make money on that too at the risk of defrauding our
patients!


Joel

On 17 Sep 2003 13:27:31 GMT, (ChuckMSRD) wrote:

>>The sounds of falling amalgam .......
>
>I begin to wonder - why the obsession with amalgam if the ill effects are such
>nonsense? Your obsession reinforces to me that maybe there is something going
>on here.
>As a Nutritionist, when someone tells me how Dr. Barefoot's Coral Calcium cured
>their______ I just smile and say "the science does not really support that
>connection but im glad your feeling better". I dont post 1000 nonsensical
>derisions and attack and impune the person who made the statement.
>
>Chuck



*******

On Wed, 17 Sep 2003 09:23:25 -0500, "Nikki" >
wrote:

>Mxsmanic wrote:
>> Roger Schlafly writes:
>>
>>> Sure, if you are in a habit of lying to them about what to expect.
>>> I find that telling them the truth works much better.
>>
>> Even if you tell the truth, it will be exaggerated in a child's mind.
>> Adults do the same thing, but not to the same extent.
>>
>>> So do you prefer that a dentist lies to you about how much pain
>>> you are going to get?
>>
>> No, but I'm not prone to exaggeration.
>
>If the kid doesn't ask, don't offer any information. If they ask then tell
>them something specific. Like it might feel like a misquito bite or
>something of that nature. That is my tactic at any rate and so far it has
>worked well for vaccinations.
>
>Another thing that has worked well for us is to read books about
>vaccinations and dental stuff way ahead of our visit, not even related to
>our visit. The repeat readings makes it seem more familiar etc. since part
>of the apprehension at the dentist has nothing to do with fearing
>pain.....kids shouldn't even realize dentist equals pain....but that it is
>just something totally new.

--
Joel M. Eichen, .
Philadelphia PA

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Joel M. Eichen D.D.S.
September 17th 03, 11:36 PM
For those with small mouths, kids etc., it helps if the doctor or the
dental assistant knows the "bisecting angle" technique.

It is the one where there is no need for gizmos in your mouth!


Joel

On Thu, 18 Sep 2003 00:40:29 +0200, Mxsmanic >
wrote:

>Nikki writes:
>
>> ...kids shouldn't even realize dentist equals pain....but that it is
>> just something totally new.
>
>Dentist _does not_ equal pain. Even in my childhood, going to the
>dentist was not painful. I didn't like it, but not out of any fear of
>pain, because I never had any. There was the initial shot of
>anesthetic, but that didn't hurt enough to bother me, even at a very
>young age.
>
>Strangely, what scared me most was x-rays, because it required gagging
>on a piece of film in my mouth. I was terrified by having things forced
>down my throat and feeling as though I were about to choke to death.
>I've since been told by some dentists that I was not exceptional in
>being especially afraid of x-rays (true?).

--
Joel M. Eichen, .
Philadelphia PA

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Mxsmanic
September 17th 03, 11:40 PM
Nikki writes:

> ...kids shouldn't even realize dentist equals pain....but that it is
> just something totally new.

Dentist _does not_ equal pain. Even in my childhood, going to the
dentist was not painful. I didn't like it, but not out of any fear of
pain, because I never had any. There was the initial shot of
anesthetic, but that didn't hurt enough to bother me, even at a very
young age.

Strangely, what scared me most was x-rays, because it required gagging
on a piece of film in my mouth. I was terrified by having things forced
down my throat and feeling as though I were about to choke to death.
I've since been told by some dentists that I was not exceptional in
being especially afraid of x-rays (true?).

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Yab
September 18th 03, 12:12 AM
In article >,
says...
> Nikki writes:
>
> > ...kids shouldn't even realize dentist equals pain....but that it is
> > just something totally new.
>
> Dentist _does not_ equal pain.

It does if they try a nerve block that doesn't quite take. That's
happened to me a few times.

Wendy Marsden
September 18th 03, 03:03 AM
In misc.kids.health Yab > wrote:
> says...
>>
>> Dentist _does not_ equal pain.

> It does if they try a nerve block that doesn't quite take. That's
> happened to me a few times.

In my extensive experience I have to tell you that dentist DOES
equal pain. I sometimes have four shots of novacaine before I give up and
just bear the pain along with the dentist's scorn for being so wimpy.

I don't mind the pinch/burn of the novacaine all that much, but I *really*
mind the startling, sharp, coursing-through-me twang when the drill hits a
nerve. And it's going to at some random moment every few seconds.

I don't know if EVERYONE has this problem with novacaine, or if everyone
else just shuts up and bears the feeling of drill on nerve, but I'm not
going to pretend it isn't there.

By the way, the spinal didn't work for my C-section, either. I felt the
knife twice, and the contractions during the surgery, but not much of the
stitching up afterwards besides tugging. At that point I had been in
labor for three days and didn't think a bit more pain was worth
mentioning, but I later found out that other people don't feel surgery.

I was a redhead as a child. I read a blurb suggesting that they don't
process anesthesia the same way as non-red-heads. I suspect this is one
of those things where people who DON'T have this problem don't believe it
when people say they DO have this problem.

Wendy

dragonlady
September 18th 03, 05:24 AM
In article >,
Wendy Marsden > wrote:

> In misc.kids.health Yab > wrote:
> > says...
> >>
> >> Dentist _does not_ equal pain.
>
> > It does if they try a nerve block that doesn't quite take. That's
> > happened to me a few times.
>
> In my extensive experience I have to tell you that dentist DOES
> equal pain. I sometimes have four shots of novacaine before I give up and
> just bear the pain along with the dentist's scorn for being so wimpy.
>
> I don't mind the pinch/burn of the novacaine all that much, but I *really*
> mind the startling, sharp, coursing-through-me twang when the drill hits a
> nerve. And it's going to at some random moment every few seconds.
>
> I don't know if EVERYONE has this problem with novacaine, or if everyone
> else just shuts up and bears the feeling of drill on nerve, but I'm not
> going to pretend it isn't there.
>
> By the way, the spinal didn't work for my C-section, either. I felt the
> knife twice, and the contractions during the surgery, but not much of the
> stitching up afterwards besides tugging. At that point I had been in
> labor for three days and didn't think a bit more pain was worth
> mentioning, but I later found out that other people don't feel surgery.
>
> I was a redhead as a child. I read a blurb suggesting that they don't
> process anesthesia the same way as non-red-heads. I suspect this is one
> of those things where people who DON'T have this problem don't believe it
> when people say they DO have this problem.
>
> Wendy
>

Apparently, my family has a resistance to novacaine. The first time I
needed it, it was in the middle of my back, and the family doctor -- who
was the doctor for several generations of the family -- knew the family
history and after putting in the "normal" amount and waiting the
appropriate amount of time, stuck me with a pin -- and I felt it a LOT.
So he doubled it and waited longer, and the second time I didn't feel it
at all. He just told me to always tell anyone treating me that I need
2X the normal amount, and a longer wait. I have one brother who
apparently never responds to it at all. It is really important for us
to find medical people who believe us!

Unfortunately, after I was already somewhat dental-phobic, I encountered
a dentist who insisted that that was a bunch of crap, that everyone
responds the same, gave me what he thought I needed, and yelled at me
for crying and yelling when he hurt me.

NOW, I would get up and walk out (and refuse to pay). Then, I was young
and put up with it. However, it was more than 10 years before I saw a
dentist again.

meh
--
Children won't care how much you know until they know how much you care

Mxsmanic
September 18th 03, 11:13 AM
Joel M. Eichen D.D.S. writes:

> For those with small mouths, kids etc., it helps if the doctor or the
> dental assistant knows the "bisecting angle" technique.
>
> It is the one where there is no need for gizmos in your mouth!

How does it work? Don't you need a piece of film in the mouth somewhere
in all cases?

The only exception I ever experienced was panoramic shots of the mouth
at the endodontist's office, but I've been told that these are not
detailed enough for evaluation of individual teeth.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Mxsmanic
September 18th 03, 11:13 AM
Yab writes:

> It does if they try a nerve block that doesn't quite take. That's
> happened to me a few times.

Tell them to use more anesthetic before continuing. If they refuse
without a medically sound reason, it's malpractice.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Joel M. Eichen D.D.S.
September 18th 03, 11:29 AM
On Thu, 18 Sep 2003 12:13:00 +0200, Mxsmanic >
wrote:

>Joel M. Eichen D.D.S. writes:
>
>> For those with small mouths, kids etc., it helps if the doctor or the
>> dental assistant knows the "bisecting angle" technique.
>>
>> It is the one where there is no need for gizmos in your mouth!
>
>How does it work? Don't you need a piece of film in the mouth somewhere
>in all cases?

Yes, a piece of film needs to be there, but if carefully placed it
will not gag anyone and will be unnoticed by all. The patient holds it
in place with the finger or thumb in the case of anterior teeth.

The problem comes with the parallel technique (as opposed to the
bisecting-angle technique) because we use an XCP, a plastic thinggie
that goes inside the mouth. The dental assistant says, "bite," and it
h-u-r-t-s-s-s-s-s.

They always call me in with gagging patients and people with small
mouths where XCP will not work. By the way, upper wisdom teeth and
second molars REQUIRE the bisecting angle technique. The mouth is way
too small back there for XCP!

Joel

>
>The only exception I ever experienced was panoramic shots of the mouth
>at the endodontist's office, but I've been told that these are not
>detailed enough for evaluation of individual teeth.

Yup, generally worthless, except for generating income! (TOO strongly
said) They are good for screening for periodontal defects and for
wisdom tooth assessments.


--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
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Joel M. Eichen D.D.S.
September 18th 03, 11:30 AM
..... and if the dentist is not as skilled at nerve block as he should
be!

On Wed, 17 Sep 2003 19:12:35 -0400, Yab > wrote:

>In article >,
says...
>> Nikki writes:
>>
>> > ...kids shouldn't even realize dentist equals pain....but that it is
>> > just something totally new.
>>
>> Dentist _does not_ equal pain.
>
>It does if they try a nerve block that doesn't quite take. That's
>happened to me a few times.

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 18th 03, 11:32 AM
This is an indictment of the dentist, not of you! Sorry for that. Its
our way of "beatin' up" on others .........

Similarly teaching is "beatin' up" on kids!

Mostly the kids are way smarter and way more perceptive then their
teachers!

Joel


Joel

On Thu, 18 Sep 2003 02:03:53 GMT, Wendy Marsden
> wrote:

>In misc.kids.health Yab > wrote:
>> says...
>>>
>>> Dentist _does not_ equal pain.
>
>> It does if they try a nerve block that doesn't quite take. That's
>> happened to me a few times.
>
>In my extensive experience I have to tell you that dentist DOES
>equal pain. I sometimes have four shots of novacaine before I give up and
>just bear the pain along with the dentist's scorn for being so wimpy.
>
>I don't mind the pinch/burn of the novacaine all that much, but I *really*
>mind the startling, sharp, coursing-through-me twang when the drill hits a
>nerve. And it's going to at some random moment every few seconds.
>
>I don't know if EVERYONE has this problem with novacaine, or if everyone
>else just shuts up and bears the feeling of drill on nerve, but I'm not
>going to pretend it isn't there.
>
>By the way, the spinal didn't work for my C-section, either. I felt the
>knife twice, and the contractions during the surgery, but not much of the
>stitching up afterwards besides tugging. At that point I had been in
>labor for three days and didn't think a bit more pain was worth
>mentioning, but I later found out that other people don't feel surgery.
>
>I was a redhead as a child. I read a blurb suggesting that they don't
>process anesthesia the same way as non-red-heads. I suspect this is one
>of those things where people who DON'T have this problem don't believe it
>when people say they DO have this problem.
>
>Wendy

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
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Joel M. Eichen D.D.S.
September 18th 03, 11:33 AM
Nonsense!

The dentist needs a refresher course in anesthesia!

As for redheads, nope. I heard things work on blondes that do not work
on others but I still have my doubts!

Joel

On Thu, 18 Sep 2003 02:03:53 GMT, Wendy Marsden
> wrote:

>In misc.kids.health Yab > wrote:
>> says...
>>>
>>> Dentist _does not_ equal pain.
>
>> It does if they try a nerve block that doesn't quite take. That's
>> happened to me a few times.
>
>In my extensive experience I have to tell you that dentist DOES
>equal pain. I sometimes have four shots of novacaine before I give up and
>just bear the pain along with the dentist's scorn for being so wimpy.
>
>I don't mind the pinch/burn of the novacaine all that much, but I *really*
>mind the startling, sharp, coursing-through-me twang when the drill hits a
>nerve. And it's going to at some random moment every few seconds.
>
>I don't know if EVERYONE has this problem with novacaine, or if everyone
>else just shuts up and bears the feeling of drill on nerve, but I'm not
>going to pretend it isn't there.
>
>By the way, the spinal didn't work for my C-section, either. I felt the
>knife twice, and the contractions during the surgery, but not much of the
>stitching up afterwards besides tugging. At that point I had been in
>labor for three days and didn't think a bit more pain was worth
>mentioning, but I later found out that other people don't feel surgery.
>
>I was a redhead as a child. I read a blurb suggesting that they don't
>process anesthesia the same way as non-red-heads. I suspect this is one
>of those things where people who DON'T have this problem don't believe it
>when people say they DO have this problem.
>
>Wendy

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
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Joel M. Eichen D.D.S.
September 18th 03, 11:34 AM
More importantly is WHERE the xylocaine is placed .....

Joel

On Thu, 18 Sep 2003 04:24:48 GMT, dragonlady
> wrote:

>Apparently, my family has a resistance to novacaine. The first time I
>needed it, it was in the middle of my back, and the family doctor -- who
>was the doctor for several generations of the family -- knew the family
>history and after putting in the "normal" amount and waiting the
>appropriate amount of time, stuck me with a pin -- and I felt it a LOT.
>So he doubled it and waited longer, and the second time I didn't feel it

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Tsu Dho Nimh
September 18th 03, 12:05 PM
Wendy Marsden > wrote:


>In my extensive experience I have to tell you that dentist DOES
>equal pain. I sometimes have four shots of novacaine before I give up and
>just bear the pain along with the dentist's scorn for being so wimpy.

One possibility - your nerve is not in the expected spot, and
they are missing it, or only lightly numbing it.

One clue that they hit the right spot with the novocaine for me
is that the tip of my nose also goes totally numb.

You also might burn it off faster than most people, and the
dentist is outside the window of opportunity.

>I was a redhead as a child. I read a blurb suggesting that they don't
>process anesthesia the same way as non-red-heads.

They don't ... something linked to the pigmentation modifies
breakdown of chemicals in many of them.

Tsu Dho Nimh

--
When businesses invoke the "protection of consumers," it's a lot like
politicians invoking morality and children - grab your wallet and/or
your kid and run for your life.

Joel M. Eichen D.D.S.
September 18th 03, 12:30 PM
Yup, its called "anatomic variation," rather than "the dentist messing
up!"

On Thu, 18 Sep 2003 04:05:28 -0700, Tsu Dho Nimh
> wrote:

>Wendy Marsden > wrote:
>
>
>>In my extensive experience I have to tell you that dentist DOES
>>equal pain. I sometimes have four shots of novacaine before I give up and
>>just bear the pain along with the dentist's scorn for being so wimpy.
>
>One possibility - your nerve is not in the expected spot, and
>they are missing it, or only lightly numbing it.
>
>One clue that they hit the right spot with the novocaine for me
>is that the tip of my nose also goes totally numb.
>
>You also might burn it off faster than most people, and the
>dentist is outside the window of opportunity.
>
>>I was a redhead as a child. I read a blurb suggesting that they don't
>>process anesthesia the same way as non-red-heads.
>
>They don't ... something linked to the pigmentation modifies
>breakdown of chemicals in many of them.
>
>Tsu Dho Nimh

--
Joel M. Eichen, .
Philadelphia PA

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Joel M. Eichen D.D.S.
September 18th 03, 12:31 PM
True!

Some people are xylocaine burners .......

This can be tested for by Dr. Jan Drew at sci.med.dentistry .........




On Thu, 18 Sep 2003 04:05:28 -0700, Tsu Dho Nimh
> wrote:

>You also might burn it off faster than most people, and the
>dentist is outside the window of opportunity.

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Rosalie B.
September 18th 03, 12:59 PM
x-no-archive:yes
dragonlady > wrote:

>In article >,
> Wendy Marsden > wrote:
>
>> In misc.kids.health Yab > wrote:
>> > says...
>> >>
>> >> Dentist _does not_ equal pain.
>>
>> > It does if they try a nerve block that doesn't quite take. That's
>> > happened to me a few times.
>>
>> In my extensive experience I have to tell you that dentist DOES
>> equal pain. I sometimes have four shots of novacaine before I give up and
>> just bear the pain along with the dentist's scorn for being so wimpy.
>>
>> I don't mind the pinch/burn of the novacaine all that much, but I *really*
>> mind the startling, sharp, coursing-through-me twang when the drill hits a
>> nerve. And it's going to at some random moment every few seconds.
>>
>> I don't know if EVERYONE has this problem with novacaine, or if everyone
>> else just shuts up and bears the feeling of drill on nerve, but I'm not
>> going to pretend it isn't there.
>>
>> By the way, the spinal didn't work for my C-section, either. I felt the
>> knife twice, and the contractions during the surgery, but not much of the
>> stitching up afterwards besides tugging. At that point I had been in
>> labor for three days and didn't think a bit more pain was worth
>> mentioning, but I later found out that other people don't feel surgery.
>>
>> I was a redhead as a child. I read a blurb suggesting that they don't
>> process anesthesia the same way as non-red-heads. I suspect this is one
>> of those things where people who DON'T have this problem don't believe it
>> when people say they DO have this problem.
>>

I'm wondering if the resistance to anesthetics extends to other
anesthetics and if that might not be your problem with your child
resisting the dentist. Had you considered that possibility?

>
>Apparently, my family has a resistance to novacaine. The first time I
>needed it, it was in the middle of my back, and the family doctor -- who
>was the doctor for several generations of the family -- knew the family
>history and after putting in the "normal" amount and waiting the
>appropriate amount of time, stuck me with a pin -- and I felt it a LOT.
>So he doubled it and waited longer, and the second time I didn't feel it
>at all. He just told me to always tell anyone treating me that I need
>2X the normal amount, and a longer wait. I have one brother who
>apparently never responds to it at all. It is really important for us
>to find medical people who believe us!
>
<snip for excess quoting of stuff that was both interesting and true>

I'm kind of the opposite - any anesthesia knocks me right out, and it
takes me a long time to come out of it afterwards.

I asked my dh about whether he had novocaine or anesthetic for dental
procedures as a child and he said of course he did. I didn't.

I don't remember ever getting any anesthetic for normal cavity filling
until about 1964 when I was 26 years old. (And that was a new dentist
who had HUGE hands - I felt that he gave me the anesthetic to cover up
that he was clumsy because I felt like I'd gone 3 rounds with the
heavy-weight champ afterwards.)

So drilling DID hurt, but it wasn't so painful that it gave me any
phobias because I apparently don't have especially active pain nerves
in my mouth. I consider this astonishing because I think I'm a wimp
when it comes to pain.

I've had a root canal in a back molar without anesthetic which didn't
hurt at all, although the dentist was a wreck afterwards and insisted
(to finish up on the 2nd visit) that I take anesthetic the next time.
(It gave me a somewhat rosy idea of root canal pain, because I've had
one since that WAS painful even with anesthetic.)

I also had an impacted lower wisdom tooth removed (under general
anesthesia) and when I went to have something done to the packing
(replaced or removed or something - this was in 1958), I had to go to
a different dentist because I'd had the tooth done in spring break and
I was back in school. When the dentist was putting in the packing he
kept asking me if it hurt. When I said no, he said, somewhat
disappointedly, "Most people would be hitting the ceiling by now."

I have to say, that after a long life of interaction with the
medical/dental community I do not believe that even competent well
educated professionals are necessarily always right about their
recommendations and beliefs as to what actions one should do to be
healthy. This cynical attitude started when I helped my dad grade
anatomy practicals when I was 9 or 10 years old.

So for instance, I do not believe that all children's cavities can be
prevented by assiduous care by the parents or the corollary that all
children's cavities are the result of neglect by the parents.


grandma Rosalie

Joel M. Eichen D.D.S.
September 18th 03, 01:03 PM
Those days are long gone! Patients are way wimpy compared to the
self-reliant people of yore!

US has changed GREATLY. I did a bridge for a policemen with excellent
dental coverage. This time, I was salivating, not the patient! At the
very first injection, I was wondering if perhaps he was in the wrong
line of work.

Sometimes street brawls and bullets hurt lots! He was overly sensitive
about dentistry!


Dentistry is about trust and how much your dentist lies to you to
destroy that trust. It is an interesting psychological experience that
approximates the parent/child relationship!

Joel




On Thu, 18 Sep 2003 11:59:07 GMT, Rosalie B.
> wrote:

>I asked my dh about whether he had novocaine or anesthetic for dental
>procedures as a child and he said of course he did. I didn't.
>
>I don't remember ever getting any anesthetic for normal cavity filling
>until about 1964 when I was 26 years old. (And that was a new dentist
>who had HUGE hands - I felt that he gave me the anesthetic to cover up

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 18th 03, 01:04 PM
Different strokes ,, ,different folks ,,,,,,,

This is why dentists SHOULD be sensitive folks ....!!


On Thu, 18 Sep 2003 11:59:07 GMT, Rosalie B.
> wrote:

>So drilling DID hurt, but it wasn't so painful that it gave me any
>phobias because I apparently don't have especially active pain nerves
>in my mouth. I consider this astonishing because I think I'm a wimp
>when it comes to pain.

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
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Joel M. Eichen D.D.S.
September 18th 03, 01:05 PM
Why?

A non-vital tooth requires no xylocaine!


Joel


On Thu, 18 Sep 2003 11:59:07 GMT, Rosalie B.
> wrote:

>I've had a root canal in a back molar without anesthetic which didn't
>hurt at all, although the dentist was a wreck afterwards and insisted
>(to finish up on the 2nd visit) that I take anesthetic the next time.
>(It gave me a somewhat rosy idea of root canal pain, because I've had

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
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Joel M. Eichen D.D.S.
September 18th 03, 01:05 PM
Precisely correct!


On Thu, 18 Sep 2003 11:59:07 GMT, Rosalie B.
> wrote:

>I have to say, that after a long life of interaction with the
>medical/dental community I do not believe that even competent well
>educated professionals are necessarily always right about their
>recommendations and beliefs as to what actions one should do to be

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 18th 03, 01:06 PM
Very wise comments ... THANKS!

By the way, what type of anatomy practical?



Joel

On Thu, 18 Sep 2003 11:59:07 GMT, Rosalie B.
> wrote:

>So for instance, I do not believe that all children's cavities can be
>prevented by assiduous care by the parents or the corollary that all
>children's cavities are the result of neglect by the parents.
>
>
>grandma Rosalie

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

madiba
September 18th 03, 04:24 PM
Joel M. Eichen D.D.S. > wrote:

> More importantly is WHERE the xylocaine is placed .....
>
> Joel

Exactly! Thats the first skill every dentist should be PERFECT at before
he is ever allowed to use a drill.


> On Thu, 18 Sep 2003 04:24:48 GMT, dragonlady
> > wrote:
>
> >Apparently, my family has a resistance to novacaine. The first time I
> >needed it, it was in the middle of my back, and the family doctor -- who
> >was the doctor for several generations of the family -- knew the family
> >history and after putting in the "normal" amount and waiting the
> >appropriate amount of time, stuck me with a pin -- and I felt it a LOT.
> >So he doubled it and waited longer, and the second time I didn't feel it


--
madiba

madiba
September 18th 03, 04:24 PM
Joel M. Eichen D.D.S. > wrote:

> Yup, its called "anatomic variation," rather than "the dentist messing
> up!"
>

I often wondered about that. About 50% of my mandibular blocks took out
the tongue nerve as well, without improving the anaesthetic effect.
Depended on the dentist.




> On Thu, 18 Sep 2003 04:05:28 -0700, Tsu Dho Nimh
> > wrote:
>
> >Wendy Marsden > wrote:
> >
> >
> >>In my extensive experience I have to tell you that dentist DOES
> >>equal pain. I sometimes have four shots of novacaine before I give up and
> >>just bear the pain along with the dentist's scorn for being so wimpy.
> >
> >One possibility - your nerve is not in the expected spot, and
> >they are missing it, or only lightly numbing it.
> >
> >One clue that they hit the right spot with the novocaine for me
> >is that the tip of my nose also goes totally numb.
> >
> >You also might burn it off faster than most people, and the
> >dentist is outside the window of opportunity.
> >
> >>I was a redhead as a child. I read a blurb suggesting that they don't
> >>process anesthesia the same way as non-red-heads.
> >
> >They don't ... something linked to the pigmentation modifies
> >breakdown of chemicals in many of them.
> >
> >Tsu Dho Nimh


--
madiba

Cathy Weeks
September 18th 03, 04:41 PM
Wendy Marsden > wrote in message >...

> I was a redhead as a child. I read a blurb suggesting that they don't
> process anesthesia the same way as non-red-heads. I suspect this is one
> of those things where people who DON'T have this problem don't believe it
> when people say they DO have this problem.

I'm a redhead, and I handle anesthesia pretty normally. My husband,
who is blonde had an experience where he was supposed to be fully out,
but wasn't.

Cathy Weeks
Mommy to Kivi Alexis 12/01

Joel M. Eichen D.D.S.
September 18th 03, 06:34 PM
Unfortunately, we PRACTICE our profession. In my early years I found
myself consulting a pamphlet by Astra, a xylocaine manufacturer. I
learned more and more skills for administering local anesthetic!

The pamphlet had black and whicte photos of where to place the needle,
then the same photo using the needle on a dried specimen of a
mandible. (Not the same person, however!).

In later years, I taught my young associates my technique!

Joel

On Thu, 18 Sep 2003 17:24:50 +0200, (madiba) wrote:

>Joel M. Eichen D.D.S. > wrote:
>
>> More importantly is WHERE the xylocaine is placed .....
>>
>> Joel
>
>Exactly! Thats the first skill every dentist should be PERFECT at before
>he is ever allowed to use a drill.
>
>
>> On Thu, 18 Sep 2003 04:24:48 GMT, dragonlady
>> > wrote:
>>
>> >Apparently, my family has a resistance to novacaine. The first time I
>> >needed it, it was in the middle of my back, and the family doctor -- who
>> >was the doctor for several generations of the family -- knew the family
>> >history and after putting in the "normal" amount and waiting the
>> >appropriate amount of time, stuck me with a pin -- and I felt it a LOT.
>> >So he doubled it and waited longer, and the second time I didn't feel it

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 18th 03, 06:37 PM
Step one:

Inferior alveolar block .... in the back of the mouth.

Step two: Acknowledge from the patient if the LIP itself is numb on
one side.

Step three: Infiltrate around the tooth as well.

The tongue will always be numb if one uses this sequence ... the
important thing is assessing whether or not the LIP is numb too
(without masking signs by infiltrating first!)

1,2,3 works.
1,3,2 may miss the target and confuse the dentist!

Good for parents and kids to understand, even if dentists do not!


Joel

On Thu, 18 Sep 2003 17:24:51 +0200, (madiba) wrote:

>Joel M. Eichen D.D.S. > wrote:
>
>> Yup, its called "anatomic variation," rather than "the dentist messing
>> up!"
>>
>
>I often wondered about that. About 50% of my mandibular blocks took out
>the tongue nerve as well, without improving the anaesthetic effect.
>Depended on the dentist.
>
>
>
>
>> On Thu, 18 Sep 2003 04:05:28 -0700, Tsu Dho Nimh
>> > wrote:
>>
>> >Wendy Marsden > wrote:
>> >
>> >
>> >>In my extensive experience I have to tell you that dentist DOES
>> >>equal pain. I sometimes have four shots of novacaine before I give up and
>> >>just bear the pain along with the dentist's scorn for being so wimpy.
>> >
>> >One possibility - your nerve is not in the expected spot, and
>> >they are missing it, or only lightly numbing it.
>> >
>> >One clue that they hit the right spot with the novocaine for me
>> >is that the tip of my nose also goes totally numb.
>> >
>> >You also might burn it off faster than most people, and the
>> >dentist is outside the window of opportunity.
>> >
>> >>I was a redhead as a child. I read a blurb suggesting that they don't
>> >>process anesthesia the same way as non-red-heads.
>> >
>> >They don't ... something linked to the pigmentation modifies
>> >breakdown of chemicals in many of them.
>> >
>> >Tsu Dho Nimh

--
Joel M. Eichen, .
Philadelphia PA

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Joel M. Eichen D.D.S.
September 18th 03, 06:38 PM
Can't help with that one. We do not do as much OB/GYN as we used to!



>By the way, the spinal didn't work for my C-section, either.

--
Joel M. Eichen, .
Philadelphia PA

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Joel M. Eichen D.D.S.
September 18th 03, 06:39 PM
I think it matters if the women is a blonde ,,,, at least from one
website I saw!

<<humor>>


On 18 Sep 2003 08:41:50 -0700, (Cathy Weeks)
wrote:

>Wendy Marsden > wrote in message >...
>
>> I was a redhead as a child. I read a blurb suggesting that they don't
>> process anesthesia the same way as non-red-heads. I suspect this is one
>> of those things where people who DON'T have this problem don't believe it
>> when people say they DO have this problem.
>
>I'm a redhead, and I handle anesthesia pretty normally. My husband,
>who is blonde had an experience where he was supposed to be fully out,
>but wasn't.
>
>Cathy Weeks
>Mommy to Kivi Alexis 12/01

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
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Joel M. Eichen D.D.S.
September 18th 03, 06:57 PM
Composite is better, more esthetic and might encourage kids to avoid
more tooth decay! Kids are very esthetics conscious these days!

Amalgam is still useful. It is always preferred over ripping out that
same tooth due to budget considerations.You wouldn't know it however,
from all of the hootin' and hollerin' going on at SMD!


Joel


*******


On 18 Sep 2003 16:46:54 GMT, (ChuckMSRD) wrote:

>>She is correct about being so sick!
>
>Your are an insensitive, ignorant ass__ Joel!

REPLY:

Who cares! This is about dentistry, not about Joel!


> The sad thing is that I dont see
>many, if any of your "colleagues" on here chiming in and saying: "Joel, we
>agree with you on the amalgam issue but try to act at least semi-professional,
>compassionate, and on subject". Silence equals agreement quite often.
>
>Chuck

--
Joel M. Eichen, .
Philadelphia PA

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--
Joel M. Eichen, .
Philadelphia PA

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Joel M. Eichen D.D.S.
September 18th 03, 07:04 PM
Each person speaks for himself/herself!

The Nazi movement on the internet forwards posts to one's employer!
Can you imagine that?

That is what Jan Drew does. I am not surprised people are afraid of
her tactics!


On 18 Sep 2003 16:46:54 GMT, (ChuckMSRD) wrote:

>>She is correct about being so sick!
>
>Your are an insensitive, ignorant ass__ Joel! The sad thing is that I dont see
>many, if any of your "colleagues" on here chiming in and saying: "Joel, we
>agree with you on the amalgam issue but try to act at least semi-professional,
>compassionate, and on subject". Silence equals agreement quite often.
>
>Chuck

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>


***********


On Thu, 18 Sep 2003 13:57:35 -0400, Joel M. Eichen D.D.S.
> wrote:

>Composite is better, more esthetic and might encourage kids to avoid
>more tooth decay! Kids are very esthetics conscious these days!
>
>Amalgam is still useful. It is always preferred over ripping out that
>same tooth due to budget considerations.You wouldn't know it however,
>from all of the hootin' and hollerin' going on at SMD!
>
>
>Joel
>
>
>*******
>
>
>On 18 Sep 2003 16:46:54 GMT, (ChuckMSRD) wrote:
>
>>>She is correct about being so sick!
>>
>>Your are an insensitive, ignorant ass__ Joel!
>
>REPLY:
>
>Who cares! This is about dentistry, not about Joel!
>
>
>> The sad thing is that I dont see
>>many, if any of your "colleagues" on here chiming in and saying: "Joel, we
>>agree with you on the amalgam issue but try to act at least semi-professional,
>>compassionate, and on subject". Silence equals agreement quite often.
>>
>>Chuck
>
>--
>Joel M. Eichen, .
>Philadelphia PA
>
>STANDARD DISCLAIMER applies:
><You fill it in>

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
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Mxsmanic
September 18th 03, 09:07 PM
Joel M. Eichen D.D.S. writes:

> Yes, a piece of film needs to be there, but if carefully placed it
> will not gag anyone and will be unnoticed by all. The patient holds it
> in place with the finger or thumb in the case of anterior teeth.

In recent x-rays, I've been asked to hold the film myself in this way,
and it seems to work well (and it isn't bothersome). I didn't realize
it was a different technique. I wish someone had just asked me to do
that when I was little.

> The problem comes with the parallel technique (as opposed to the
> bisecting-angle technique) because we use an XCP, a plastic thinggie
> that goes inside the mouth. The dental assistant says, "bite," and it
> h-u-r-t-s-s-s-s-s.

Yes, it hurts badly! And I would choke for minutes at a time. The
dentist didn't like me (but I didn't like him, either--neither did my
parents, as they eventually stopped going to him for my sister and me).

> Yup, generally worthless, except for generating income! (TOO strongly
> said) They are good for screening for periodontal defects and for
> wisdom tooth assessments.

I had mine for a wisdom-tooth assessment, although the oral surgeon made
some comments about the advisability of braces, too. The resulting
x-ray looked pretty cool, though.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Mxsmanic
September 18th 03, 09:09 PM
Joel M. Eichen D.D.S. writes:

> In later years, I taught my young associates my technique!

My current dentist uses something that looks like a tiny bit of wire
(very thin) at the end of a stainless-steel pen, with some sort of
button that he clicks. It is hardly perceptible during the injection,
and someone he manages to numb only the tooth to be worked on--no more
"fat lips" and biting of the tongue after a visit to the dentist. Even
for the root canal, the adjacent teeth were not numb, but the tooth he
was drilling out was completely dead to the world as he reamed out all
those nerves and stuff. I was quite impressed.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

NOYB
September 18th 03, 10:26 PM
"Joel M. Eichen D.D.S." > wrote in message
...
> Each person speaks for himself/herself!
>
> The Nazi movement on the internet forwards posts to one's employer!
> Can you imagine that?

Yes. She forwarded my post to me. I fired myself and immediately filed a
wrongful termination suit. My attorney thinks I can get millions.

Joel M. Eichen D.D.S.
September 18th 03, 10:33 PM
DAs (dental assistants) and DHs (dental hygienists) may not know the
technique. The other one, the parallel technique with the XCP
contraption inside your mouth is less prone to error, thus accounting
for its widespead usage.

Dentists should know the technique. I teach it to all ~ DAs, DHs,
EFDAs and dentists when they will slow down enough to listen!


Joel

On Thu, 18 Sep 2003 22:07:12 +0200, Mxsmanic >
wrote:

>Joel M. Eichen D.D.S. writes:
>
>> Yes, a piece of film needs to be there, but if carefully placed it
>> will not gag anyone and will be unnoticed by all. The patient holds it
>> in place with the finger or thumb in the case of anterior teeth.
>
>In recent x-rays, I've been asked to hold the film myself in this way,
>and it seems to work well (and it isn't bothersome). I didn't realize
>it was a different technique. I wish someone had just asked me to do
>that when I was little.
>
>> The problem comes with the parallel technique (as opposed to the
>> bisecting-angle technique) because we use an XCP, a plastic thinggie
>> that goes inside the mouth. The dental assistant says, "bite," and it
>> h-u-r-t-s-s-s-s-s.
>
>Yes, it hurts badly! And I would choke for minutes at a time. The
>dentist didn't like me (but I didn't like him, either--neither did my
>parents, as they eventually stopped going to him for my sister and me).
>
>> Yup, generally worthless, except for generating income! (TOO strongly
>> said) They are good for screening for periodontal defects and for
>> wisdom tooth assessments.
>
>I had mine for a wisdom-tooth assessment, although the oral surgeon made
>some comments about the advisability of braces, too. The resulting
>x-ray looked pretty cool, though.

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 18th 03, 10:35 PM
Cool!

That's digital x-ray! Our own Dr. Steve (Mancuso) is our leading
spokesperson for it!

Saves on chemicals, retakes, and protects the environment all at once!



Joel

On Thu, 18 Sep 2003 22:09:44 +0200, Mxsmanic >
wrote:

>Joel M. Eichen D.D.S. writes:
>
>> In later years, I taught my young associates my technique!
>

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Roger Schlafly
September 18th 03, 10:45 PM
"Rosalie B." > wrote
> I don't remember ever getting any anesthetic for normal cavity filling
> until about 1964 when I was 26 years old. (And that was a new dentist
> who had HUGE hands - I felt that he gave me the anesthetic to cover up
> that he was clumsy because I felt like I'd gone 3 rounds with the
> heavy-weight champ afterwards.)

Yes, dentists prefer to give you an anesthetic for their own reasons.

> So drilling DID hurt, but it wasn't so painful that it gave me any
> phobias because I apparently don't have especially active pain nerves
> in my mouth. I consider this astonishing because I think I'm a wimp
> when it comes to pain.

You probably feel as much dental pain as others. You just aren't
getting the psychosomatic dental pain that most patients imagine.

Joel M. Eichen D.D.S.
September 18th 03, 10:48 PM
Good one!

Look how many threats people make. Just today someone wants to forward
to my patients!

Intimidation does not work!

However, actively practicing dentists must exercise caution.


Joel

On Thu, 18 Sep 2003 21:26:39 GMT, "NOYB" > wrote:

>
>"Joel M. Eichen D.D.S." > wrote in message
...
>> Each person speaks for himself/herself!
>>
>> The Nazi movement on the internet forwards posts to one's employer!
>> Can you imagine that?
>
>Yes. She forwarded my post to me. I fired myself and immediately filed a
>wrongful termination suit. My attorney thinks I can get millions.
>
>
>

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 18th 03, 10:57 PM
Yup, the parallel technique is good for patients with big mouths
........... less film waste and less retakes!


Joel

On Fri, 19 Sep 2003 00:05:24 +0200, Mxsmanic >
wrote:

>Joel M. Eichen D.D.S. writes:
>
>> Dentists should know the technique.
>
>That may be the difference. In recent visits, the dentist himself has
>done the x-rays. When I was little, an assistant did them.

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Mxsmanic
September 18th 03, 11:05 PM
Joel M. Eichen D.D.S. writes:

> Dentists should know the technique.

That may be the difference. In recent visits, the dentist himself has
done the x-rays. When I was little, an assistant did them.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

V35B
September 19th 03, 12:27 AM
Acutally Valium is a very safe drug to give a chil. The dosage as a
hypnotic is 3mg/lb. This is an oral dose. There is little risk of any
respiratory depression with this oral dose...

Dentist Pharmacist




"Mxsmanic" > wrote in message
...
> Wendy Marsden writes:
>
> > Why? What is a step in the right direction?
>
> It's strong stuff to give a young child. Indeed, I even have my doubts
> about nitrous oxide. You need the ability to provide positive
> respiratory support and other resuscitation beyond a certain point, and
> most dentist's aren't equipped for that. Anesthesia in children is more
> delicate than in adults.
>
> > What do you suggest?
>
> Find a pediatric dentist that can deal with the child. If none can be
> found, and the dental problems require attention, the child may have to
> be fully sedated (asleep), which requires special support. If multiple
> dentists cannot deal with the child, maybe the child or his parents
> could use some counseling.
>
> --
> Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

V35B
September 19th 03, 12:36 AM
Nitrous Oxide is not potent enough to induce a state of general anesthesia
MAC about 110%


Don't let science get in your way...



"Mxsmanic" > wrote in message
...
> Mary Elliott writes:
>
> > > Besides the doctor or dentist working on you,
> > > there should be an anesthetist constantly monitoring
> > > you until you regain consciousness.
> >
> > You worry too damned much!
>
> Not at all. Any type of general anesthesia requires at least a heart
> and blood-pressure monitor, and constant surveillance, plus equipment
> for emergency resuscitation if required. Careless use of central
> anesthetics like nitrous oxide is quite hazardous.
>
> --
> Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Tony Bad
September 19th 03, 01:46 AM
"NOYB" > wrote in message
hlink.net...
>
> "Joel M. Eichen D.D.S." > wrote in message
> ...
> > Each person speaks for himself/herself!
> >
> > The Nazi movement on the internet forwards posts to one's employer!
> > Can you imagine that?
>
> Yes. She forwarded my post to me. I fired myself and immediately filed a
> wrongful termination suit. My attorney thinks I can get millions.
>
>
I heard your employer is too sharp to fall for that old scam. ;^P

T

Mxsmanic
September 19th 03, 12:43 PM
V35B writes:

> Nitrous Oxide is not potent enough to induce a state
> of general anesthesia ...

That's one of the reasons why it is dangerous for that purpose. Still,
it is a general anesthetic in its mechanism of action (i.e., it's not a
local anesthetic by any means). General anesthetics require greater
caution than local anesthetics.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

V35B
September 19th 03, 01:09 PM
Your logic is incorrect. I am a professor of pharmacology at a Pharmacy
School.


> That's one of the reasons why it is dangerous for that purpose.

It is not dangerous, you cannot be rendered unoncious with it. How can it
be dangerous?



>General anesthetics require greater
> caution than local anesthetics.


You cannot compare the two in this way. They are different classes of drugs
that are used for different purposes....

Joel M. Eichen D.D.S.
September 19th 03, 01:27 PM
There have been accidental deaths from N2O.

One hospital case happened where the plumbers couldn't figure out the
mismatched pipe sizes and cut them off and incorrectly rematched them.

**The mismatch PREVENTS people from mixing up the hoses ~ normally it
is impossible to crank up the N2O/O2 ratio past 80/20. The 20% O2 is
required for life.

After the plumbers did their work the tragedy happened. The docs
thought there were on 100% O2 but it was really 100% N2O.


Tragic.


Joel

On Fri, 19 Sep 2003 13:43:27 +0200, Mxsmanic >
wrote:

>V35B writes:
>
>> Nitrous Oxide is not potent enough to induce a state
>> of general anesthesia ...
>
>That's one of the reasons why it is dangerous for that purpose. Still,
>it is a general anesthetic in its mechanism of action (i.e., it's not a
>local anesthetic by any means). General anesthetics require greater
>caution than local anesthetics.

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 19th 03, 01:28 PM
Please see my post above about mismatching hoses .....



Joel'


On Fri, 19 Sep 2003 12:09:57 GMT, "V35B" > wrote:

>Your logic is incorrect. I am a professor of pharmacology at a Pharmacy
>School.
>
>
>> That's one of the reasons why it is dangerous for that purpose.
>
>It is not dangerous, you cannot be rendered unoncious with it. How can it
>be dangerous?
>
>
>
>>General anesthetics require greater
>> caution than local anesthetics.
>
>
>You cannot compare the two in this way. They are different classes of drugs
>that are used for different purposes....
>
>
>

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 19th 03, 01:58 PM
We agree .......

........say ....... WAIT! Mothers' milk in IV lines ........ isn't that
a new treatment for removing amalgam from your bloodstream? I gotta
check with that erstwhile nursery school teacher, Miss Jan Drew! I'll
be back later ........ right now she is Line Dancing in the park
.......


Joel

On Fri, 19 Sep 2003 13:02:00 GMT, "V35B" > wrote:

>Of course if you place mothers milk in an IV line it can kill you too. The
>point is N20 is arguably safer than local anesthetics, when used within its
>therapeutic realm. No chance of anaphylactic hypersensitivity reaction...
>etc.
>
>The point also is that the two are not interchangable...
>
>
>
>
>
>"Joel M. Eichen D.D.S." > wrote in message
...
>> There have been accidental deaths from N2O.
>>
>> One hospital case happened where the plumbers couldn't figure out the
>> mismatched pipe sizes and cut them off and incorrectly rematched them.
>>
>> **The mismatch PREVENTS people from mixing up the hoses ~ normally it
>> is impossible to crank up the N2O/O2 ratio past 80/20. The 20% O2 is
>> required for life.
>>
>> After the plumbers did their work the tragedy happened. The docs
>> thought there were on 100% O2 but it was really 100% N2O.
>>
>>
>> Tragic.
>>
>>
>> Joel
>>
>> On Fri, 19 Sep 2003 13:43:27 +0200, Mxsmanic >
>> wrote:
>>
>> >V35B writes:
>> >
>> >> Nitrous Oxide is not potent enough to induce a state
>> >> of general anesthesia ...
>> >
>> >That's one of the reasons why it is dangerous for that purpose. Still,
>> >it is a general anesthetic in its mechanism of action (i.e., it's not a
>> >local anesthetic by any means). General anesthetics require greater
>> >caution than local anesthetics.
>>
>> --
>> Joel M. Eichen, .
>> Philadelphia PA
>>
>> STANDARD DISCLAIMER applies:
>> <You fill it in>
>

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

V35B
September 19th 03, 02:02 PM
Of course if you place mothers milk in an IV line it can kill you too. The
point is N20 is arguably safer than local anesthetics, when used within its
therapeutic realm. No chance of anaphylactic hypersensitivity reaction...
etc.

The point also is that the two are not interchangable...





"Joel M. Eichen D.D.S." > wrote in message
...
> There have been accidental deaths from N2O.
>
> One hospital case happened where the plumbers couldn't figure out the
> mismatched pipe sizes and cut them off and incorrectly rematched them.
>
> **The mismatch PREVENTS people from mixing up the hoses ~ normally it
> is impossible to crank up the N2O/O2 ratio past 80/20. The 20% O2 is
> required for life.
>
> After the plumbers did their work the tragedy happened. The docs
> thought there were on 100% O2 but it was really 100% N2O.
>
>
> Tragic.
>
>
> Joel
>
> On Fri, 19 Sep 2003 13:43:27 +0200, Mxsmanic >
> wrote:
>
> >V35B writes:
> >
> >> Nitrous Oxide is not potent enough to induce a state
> >> of general anesthesia ...
> >
> >That's one of the reasons why it is dangerous for that purpose. Still,
> >it is a general anesthetic in its mechanism of action (i.e., it's not a
> >local anesthetic by any means). General anesthetics require greater
> >caution than local anesthetics.
>
> --
> Joel M. Eichen, .
> Philadelphia PA
>
> STANDARD DISCLAIMER applies:
> <You fill it in>

Joel M. Eichen D.D.S.
September 19th 03, 02:17 PM
While we got you here .........

Some people claim they are "allergic" to epinephrine. Of course we
know that the problem when epinephrine/local anesthetic (1:100,000 or
1:50,000) is accidentally injected into a vein it is vasovagal
sympathomimetic reaction, not anaphylactic or allergic reaction.

I say that it is impossible for someone to be "allergic" to
epinephrine. What do you say?


Joel


PS- Here is a checklist for laymen who want to learn more ......



EM guidemap - Syncope

Click on any of the headings or sub-headings to rapidly navigate to
the relevant section of the guidemap

Introduction and general principles

History of present illness

clinical clue table
Risk factors for syncope
Examination

Diagnostic testing

Cardiac monitoring
EKG
Pulse oximetry
Blood testing
Carotid massage
Orthostatic vital signs
Echocardiography
Exercise stress testing
Signal-averaged electrocardiography
Intracardiac electrophysiologic studies
Neurological testing
Medical decision-making
Indications for admission
Continuous ambulatory electrocardiographic monitoring
Long-term event and memory loop recorders
Implantable loop recorders
Tilt table testing
Psychiatric evaluation
Appendix
Causes of syncope
table differentiating syncope from seizure
suggested algorithm for workup of syncope
Introduction and general principles

- syncope is defined as a transient loss of consciousness associated
with a loss of postural tone, and most diseases causing syncope
produce a transient LOC by temporarily decreasing cerebral blood flow

An emergency physician, when faced with a syncope-patient in an ED
setting, should first seek to exclude life-threatening causes of
syncope, which require immediate diagnostic evaluation/treatment +
hospital admission

AMI
PE
aortic dissection
cardiac tamponade
tension pneumothorax
leaking AAA
active internal bleeding
malignant cardiac arrhythmias
ectopic pregnancy
SAH
carotid artery/vertebral artery dissection
air embolism
If there are no overt life-threatening causes of syncope, then an
emergency physician should attempt to identify patients with
situational syncope, vasovagal syncope and benign orthostatic
(postural) syncope - who are candidates for home discharge after any
necessary stabilization treatment in the ED
- young patients (< 45 years), who have a history of a short-lived
syncopal episode with no other associated ongoing symptoms, rarely
have serious causes of syncope if the syncope did not occur during
exertion, and hospital admission and/or an extensive workup is rarely
necessary

- emergency physicians are often faced with the dilemma that the cause
of the syncope is not immediately apparent after a brief clinical
examination, and a decision has to be made whether it is necessary to
admit the patient to hospital

If the cause of the syncope is not readily apparent after initial
clinical evaluation in the ED, then an emergency physician should
attempt to decide whether certain categories of syncope-patients
require admission to hospital

- examples of syncope patients warranting hospitalization include:-

elderly patients > 60 years with no apparent cause of the syncope
sudden syncope occurring in a non-erect patient with no premonitory
symptoms or prodrome
sudden syncope occurring during exertion
sudden syncope in a patient with a family history of syncope or sudden
death
patient has overt evidence of structural heart disease by history or
examination
patient has an abnormal ECG
(* see the medical decision-making section for further details)
- there is no universally accepted approach to the further
inpatient/outpatient workup of patients, whose cause of syncope is not
readily apparent => a suggested algorithm is included in the appendix
section as a general guide

History of the present illness


- critical historical elements include the mode of onset and
progression of event, body position at onset of event, the depth of
altered consciousness, the duration of the syncopal episode and the
rate of recovery of consciousness

(* by paying close attention to the details, an emergency physician
should be able to differentiate syncope from seizures, non-specific
near-syncopal events, non-specific ligheadedness and dysequilibrium
syndromes)

- sudden unheralded syncope at rest, particularly in a non-erect
posture, is ominous - especially if significant injury results =>
suggests a cardiac arrhythmia

- associated palpitations or an irregular heart beat suggests cardiac
syncope secondary to a cardiac arrhythmia

- certain antecedent symptoms lasting > 10 seconds (darkening vision
or tunnel vision or graying vision, lightheadedness, swaying
sensation, nausea, sweating, feeling "hot", face and distal limb
numbness), especially if preceded by a provocative emotional event and
occurring in an upright position suggest vaso-vagal syncope (also
called vasodepressor or reflex or neurocardiogenic syncope)

(* vasovagal syncope is also more likely to happen in overcrowded
social settings where prolonged mandatory standing is a requirement
eg. church, military parades in hot weather)

- antecedent/accompanying chest pain (AMI or PE) or abdominal pain
(ectopic pregnancy) or back pain (ruptured abdominal aortic aneurysm
or dissecting aortic aneurysm) or headache (SAH) suggests serious
pathology

- prominent antecedent/accompanying dyspnea suggests hyperventilation
syndrome, pulmonary embolism or pulmonary hypertension

- accompanying brainstem symptoms (diplopia or blurred vision,
dysarthria, dysphagia, deafness, vertigo, ataxia, limb weakness or
hypoesthesia, face pain or hypoesthesia) suggest vertebro-basilar
artery insufficiency or basilar artery migraine

- the patient’s posture at the time of syncope is very important –
sudden syncope in a non-erect position signifies serious pathology ,
while lightheadedness for 30 - 60 seconds after suddenly
standing/walking and immediately preceding the syncopal episode
suggests underlying orthostatic hypotensive syndromes (autonomic
neuropathy and/or volume depletion and/or drug-induced vasodilatation)

- sudden syncope related to turning or hyperextending the head (eg.
when shaving or while wearing tight constricting neckwear) suggests
carotid sinus syncope

- sudden syncope during strenuous physical activity (exertional
syncope ) suggests potentially serious pathology (HOCM or aortic
stenosis, or atrial myxoma or anomalous coronary artery; or a
malignant arrhythmia eg. torsade des pointes and VT)

- pscyhological triggering events (painful stimuli, sudden bad news)
suggest vasovagal syncope

(* however sudden stress/excitement in patients with long QT syndrome
can trigger torsades des pointes)

- evidence of volume loss may precede syncope (vomiting, diarrhea) or
accompany syncope (hematemesis or melena)

- syncope related to strenuous unilateral upper arm activity suggests
subclavian steal syndrome

- situational syncope is self-diagnostic - cough syncope, micturition
syncope, defecation syncope, hair-grooming syncope, adolescent stretch
syncope, deglutition (swallow) syncope, glossopharyngeal syncope and
"weight-lifter blackouts"

- antecedent "glue-sniffing" or "huffing" suggests a ventricular
arrhythmia and/or hypoxia as the cause of the syncope; sympathomimetic
drug abuse (cocaine or amphetamines) suggest a tachyarhythmia

- recurrent bouts of progressive gradual loss of consciousness over
several minutes while walking or standing + NO sweating + NO pallor +
fixed heart rate suggest chronic dysautonomic syncope

(* patients often also have a history of hypohidrosis, impotence,
blurred vision, urinary difficulties, constipation, nocturnal polyuria
and " coat-hanger" pain [neck and shoulders ache - present only when
standing])

- recent meal ingestion in an elderly patient may suggest
post-prandial hypotensive syncope

- short-lived myoclonic seizures or twitching are compatible with
convulsive syncope, and do not imply a true seizure

(* a true seizure is more likely if an aura and/or convulsions precede
the fall, tongue biting and/or urinary incontinence occurs,
convulsions are generalized and last longer than 30 seconds, prolonged
post-ictal confusion-lethargy occurs => see the table in the appendix
section for further details)


Clinical clue table

Clinical clue Suggests
Sudden syncope at rest when non-erect Cardiac arrhythmia, atrial
myxoma
Sudden syncope on exertion Aortic stenosis, HOCM, atrial myxoma,
malignant cardiac arrhythmia
Preceding "lightheadness" prodrome when erect Vasovagal syncope,
orthostatic hypotension
Preceding palpitations Cardiac arrhythmia
Preceding or accompanying dyspnea Pulmonary embolism, tension
pneumothorax, cardiac tamponade, air embolism
Preceding or accompanying chest pain AMI, PE, cardiac tamponade,
dissecting aneurysm, tension pneumothorax, mitral valve prolapse
Preceding or accompanying back pain Dissecting aortic aneurysm,
leaking AAA
Preceding or accompanying abdominal pain Leaking AAA, ectopic
pregnancy
Occurring when turning head to side, or looking up Carotid sinus
syncope
Occurring when exercising upper arm Subclavian steal syndrome
Occurring during (or immediately after) coughing, laughing, vomiting,
swallowing, urination, defecation, combing hair, stretching
Situational syncope
Occurring after prolonged standing Vasovagal syncope
Occurring after emotional upset Vasovagal syncope, prolonged QT
interval and torsade
Recent illicit drug use Cardiac arrhythmia, air or foreign body
embolism
Recent sudden headache SAH
Recent neurological symptoms Brain stem stroke, vertebro-basilar
artery insufficiency, basilar migraine, carotid or vertebral artery
dissection, dissecting aortic aneurysm
Recent vaginal insufflation Air embolism
Recent black stools GI bleed
Recent fluid loss (diarrhea, vomiting, sweating) Orthostatic
hypotension, Addisonian crisis
Recent meal Postprandial hypotensive syncope
Polypharmacy, recent sialdenafil use Orthostatic syncope
History of fever or myalgia or arthalgia or rash Atrial myxoma,
cardiac tamponade
History of known cardiac ischemia or structural heart disease Cardiac
arrhythmia, pro-arrhythmia drug effect, valve dysfunction
History of mechanical heart valve Thrombosis of valve
Recent history of cancer, prolonged immobilization, leg injury or
surgery Pulmonary embolism
History of autonomic dysfunction (impotence, anhydrosis, sphincter
dysfunction) Orthostatic hypotension secondary to autonomic neuropathy
History of recurrent syncope Cardiac arrhythmia, carotid sinus
syncope, atrial myxoma, aortic stenosis, subclavian steal syndrome,
prolonged QT interval - torsade
Family history of syncope or sudden death HOCM, prolonged QT syndrome
Pacemaker Pacemaker failure


Risk factors for syncope

Underlying causes of orthostatic hypotension

- volume depletion (vomiting, diarrhea, excessive perspiration,
diuretic use)

- blood loss

- adrenal insufficiency

- primary or secondary dysautonomias (multiple sclerosis,
Guillane-Barre syndrome, spinal cord injury, tabes dorsalis,
Parkinsonism, Shy-Drager syndrome, diabetic autonomic neuropathy)

- peripheral neuropathy (chronic alcoholism, diabetes)

- polypharmacy in elderly patients with impaired baroreceptor reflexes

- prolonged recumbency and secondary "cardiac-deconditioning"

Drugs predisposing to syncope

- vasodilators (alpha blockers, beta blockers, ACEI’s, calcium channel
blockers, nitrates, phenothiazines)

- cardio-inhibitor drugs (beta blockers, digoxin)

- psycho-active drugs (anti-convulsants, CNS sedative-depressants,
anti-histamines, anti-depressants, anti-psychotics)

Conditions predisposing to a prolonged QT interval and torsade des
pointes
Acquired causes Enviromental and endocrinological causes Medicinal
and
toxicological causes Congenital causes Neurological causes
Ischemic coronary artery disease Hypothermia Class 1A
antidysrhythmics - quinidine, procainamide, disopyramide
Jervell-Lange-Nielsen syndrome Subarachnoid hemorrhage
Congestive heart failure Bulemia, stringent dieting Class 1C
antidysrhythmics - flecainide, encainide Romano-Ward sydrome
Cerebrovascular occlusive disease
Rheumatic heart disease Hypothyroidism Phenothiazine overdose Refsum
syndrome Traumatic brain injury
Myocarditis Hypokalemia Butyrophenone overdose Mitral valve prolapse
Encephalitis
Hypocalcemia Tetracyclic/tricyclic antidepressant overdose
Hypomagnesemia Organophosphate overdose
Macrolide antibiotics + terfenadine or astemizole or cisapride
Azole antigungals + terfenadine or astemizole or cisapride


Examination


- a selective examination can offer clinical clues as to the etiology
of the syncope

Blood pressure

- difference in blood pressure between left and right upper limbs >
20mmHg is abnormal (suggests dissecting aortic aneurysm or subclavian
steal syndrome)

- difference in blood pressure between upper and lower limbs > 20mmHg
when recumbent is abnormal (suggests a dissecting aortic aneurysm)

Pulse volume

- decreased and delayed upstoke (aortic stenosis/hypertrophic
obstructive cardiomyopathy)

- positive pulsus paradoxus (cardiac tamponade, massive pulmonary
embolism)

- absent pulses (dissection of the aorta, cardiac emboli)

Neck bruits

- suggests great artery stenosis eg. subclavian steal syndrome or
carotid artery dissection

Jugular venous pressure

- increased in heart failure or pulmonary embolism or cardiac
tamponade (positive Kussmaul’s sign)

- 'cannon' a waves suggests AV conduction block

Apex beat

- displaced and forceful (LVH), forceful (RVH)

Heart sounds

- decreased (pericardial tamponade)

- 3rd/4th heart sounds (ventricular failure or LV overload)

- loud second heart sound (pulmonary embolism or pulmonary
hypertension)

- ejection systolic murmurs (aortic stenosis or hypertrophic
cardiomyopathy - increased murmur when standing, decreased when
squatting)

- machinary murmur (air embolism)

- "tumor plop" or diastolic murmur (atrial myxoma)

- varying heart sounds/murmurs (thrombotic occlusion of a prosthetic
valve)

Abdomen

- pulsatile masses (abdominal aneurysm)

- rectal exam for melena or heme-occult positive stools
(gastro-intestinal bleeding)

- absent/decreased femoral pulses (dissection of the aorta)

Neuro exam

- signs of vertebro-basilar artery TIA/CVA or neuropathy or myelopathy
Diagnostic testing


Cardiac monitoring

- immediate and continuous monitoring during the ED evaluation period
is highly recommended

- arrhythmias may be etiologically significant

(* no study has determined the ideal duration of ED cardiac monitoring

ECG

- an abnormal ECG may be etiologically significant, although the
'definitive' diagnostic yield is low (< 5%)

- ECG abnormalities include:-

previous or acute cardiac ischemic changes
signs of pericarditis or electrical alternans (cardiac tamponade)
LVH (hypertension, aortic stenosis, HOCM)
RVH (PE or pulmonary hypertension)
classical/non-specific ECG signs of PE
WPW syndrome
LBBB or bifasicular block (conducting system disease)
bradyarrythmias or tachyarrhythmias
long QT interval
Brugada syndrome (partial RBBB with elevated ST segments in leads V1-3
and peculiar downsloping of the elevated ST segments + inverted T
waves in those leads)
arrhythmogenic right ventricular dysplasia (RBBB, QRS complex > 110
msec in leads V 1-3, inverted T wave or epislon wave
Pulse oximetry
- a low reading may suggest a possible etiology (cyanotic congenital
heart disease, pulmonary embolism, pulmonary hypertension

Blood testing

- not generally useful

- Hb/Hct helpful in establishing baseline in bleeding patients

- glucose and electrolytes have no/little utility

(* hyponatremia + hyperkalemia may rarely suggest Addison's disease;
hypoglycemnia rarely produces syncope without ongoing symptoms of
hypoglycemia)

- serum HCG rarely helpful in reproductive age female patients

(* very rare patient with an ectopic pregnancy presenting as syncope
without any abdominal pain/vaginal bleeding)

Carotid sinus massage

- may be useful in diagnosing carotid sinus syncope in elderly
patients

- first performed on the right side for a minimum of 5 seconds
(preferably 15 seconds) => measure pulse rate and blood pressure =>
wait 120 seconds => repeat test on the left side

- positive response = longer than 3 seconds of asystole, and/or
systolic blood pressure drop of > 50 mmHg when supine

- borderline positive response = slowing of heart rate > 30 - 40%
and/or systolic blood pressure drop of > 30mmHg when supine

- 90% of positive-test patients have the cardio-inhibitory or combined
response, while only 10% have the vaso-depressor response

- up to 10% of elderly patients have carotid sinus hypersensitivity to
some degree, however only < 5 - 20% of these patients have carotid
sinus syndrome (carotid sinus syncope etiologically related to carotid
artery hypersensitivity)

- carotid sinus syncope can only be definitively diagnosed when
syncope or near-syncope occurs during carotid massage

(* carotid sinus massage is contra-indicated in patients with a
history of a CVA, a recent AMI or when a neck bruit is present

Orthostatic vital signs

- the patient should be recumbent for at least 5 minutes prior to
performing the test and the patient should stand for at least 2
minutes

- a positive test is defined as a systolic blood pressure decrease of
> 20 - 30mmHg, a diastolic decrease of >10 - 15mmHg and/or heart rate
increase of greater than 30 bpm when standing

- the test is non-dependable, often inconsistent and has a low
specificity

- a significant drop in blood pressure + fixed heart rate suggests
dysautonomia

- a significant drop in blood pressure + increased heart rate suggests
volume depletion and/or excessive vasodilatation

- an insignificant drop in blood pressure + marked increase in heart
rate suggests postural tachycardia syndrome, which is a heterogenous
entity (history of frequent fainting, symptoms of autonomic
overactivity - palpitations, diaphoresis, tremulousness, visual
blurring, non-anginal chest pain, "spaced-out" feelings, inability to
concentrate, inability to breathe, sensations of impending doom)

Echocardiography

- diagnostic yield low in the absence of historical or physical signs
of organic heart disease

- only definitely indicated in patients with exertion-related syncope,
in all patients who have a prosthetic heart valve, or when the
clinical suspicion of organic heart disease is high (eg. strong
clinical suspicion of obstructive cardiac lesions - HOCM, AS or atrial
myxoma)

-some conservative physicians believe that organic heart disease
cannot be fully excluded prior to performing echocardiography
(unsuspected findings are found in 5 - 10% of unselected patients) and
that echocardiograph should routinely be performed in all patients, or
definitely in patients > 50 years

Exercise-stress testing

- indicated for patients with exertion-related syncope or suspected
CAD

- should always be preceded by echocardiography to first rule-out
cardiac obstructive pathology eg. HOCM, aortic stenosis, atrial myxoma

Signal-averaged electrocardiography

- not usually helpful with many false-positives

- may be useful in selecting patients for electrophysiological studies
when CAD is present and secondary VT suspected

Intracardiac electrophysiologic studies

- expensive, invasive and with low yield

- not indicated in patients with clinically normal hearts and a normal
ECG

- most useful in patients with known organic heart disease (patients
with a history of a MI or CHF - especially if the ejection fraction <
40%) and/or an abnormal ECG

- usefulness is mainly based on the ability of EPS testing to induce
malignant arrhythmias eg. sustained monomorphic ventricular
tachycardia

- induction of non-sustained VT, polymorphic VT and VF during testing
is of no/uncertain clinical usefulness

- less useful for detecting bradyarrhythmias

- sinus node recovery time > 3 seconds may reflect sinus node disease
requiring a pacemaker

- an HV interval exceeding 100 msec or infranodal block induced by
pacing suggest AV nodal disease and a bradycarrhythmic cause of the
syncope

Neurological testing - EEG, CT scan, transcranial/carotid Dopplers

- not indicated unless there is substantial reason to suspect a
seizure or other significant neuropathology
Medical decision-making


An overriding concern and uncertainty about what may happen to the
patient in the near future may cause an emergency physician to
unnecessarily admit too many patients

Patients who can clearly be discharged include those with a classical
presentation of vasovagal syncope (irrespective of age), those with
situational syncope, those with mild, reversible orthostatic syncope
(including polypharmacy syndrome in the elderly patient) and patients
with hysterical conversion syncope

Indications for admission of patients presenting with syncope include:

new clinical evidence of structural heart disease
significant antecedent/associated chest pain or ECG evidence of
cardiac ischemia
history of previous CHF or myocardial ischemia
history of a previous malignant arrhythmia
sudden syncope preceded by and/or associated with palpitations or an
irregular heart beat
significant malignant arrhythmia detected in the ED
high-grade conduction block or high-grade carotid sinus syncope
sudden onset syncope without premonitory symptoms, especially if
occurring when non-erect and associated with injury
exercise-induced syncope (irrespective of age)
syncope associated with moderate/severe orthostatic hypotension
resistant to ED treatment or due to life-threatening pathology eg.
ectopic pregnancy
syncope associated with any significant neurological symptoms/signs
syncope suggestive of pulmonary embolism or pulmonary hypertension
strong family history of sudden syncope/sudden death
syncope in a patient with an abnormal ECG - long QT interval or
Brugada syndrome or WPW syndrome
age > 60 years with no evidence of vasovagal syncope or readily
reversible chronic-or-benign orthostatic causes
syncope due to cardiac tamponade or active internal bleeding
patient taking pro-arrhythmia medications that may potentially cause
malignant arrhythmias eg. quinidine, sotalol, amiodarone
ACEP task force recommendations for admission include:
Admit patients with syncope and any of the following:

1. A history of congestive heart failure or ventricular arrhythmias
2. Associated chest pain or other symptoms compatible with acute
coronary syndrome
3. Evidence of significant congestive heart failure or valvular heart
disease on physical
examination
4. ECG findings of ischemia, arrhythmia, prolonged QT interval, or
bundle branch block

Consider admission for patients with syncope and any of the following:

1. Age older than 60 years
2. History of coronary artery disease or congenital heart disease
3. Family history of unexpected sudden death
4. Exertional syncope in younger patients without an obvious benign
etiology for the
syncope

24-hour Holter (continuous ambulatory electrocardiographic) monitoring

- traditional approach to syncope of unknown etiology with low yield

- 4% true positives (symptoms correlate with arrhythmia) and 15% false
positives (symptoms without any arrhythmia); 14% of patients have an
asymptomatic arrhythmia which may suggest a cause for the syncope
(sinus pauses, non-sustained VT, Mobitz type II block)

- extending the continuous ambulatory electrocardiograhic monitoring
to 72 hours results in a slightly higher yield

- if no symptoms/arrhythmias are detected, arrhythmogenic syncope
cannot be excluded => further testing is required for patients with
recurrent syncope, or if there is a strong clinical suspicion of
malignant cardiac arrythmias eg. known severe structural heart disease
+/- history of recurrent palpitations

Long-term event and memory loop recorders

- provide continuous ambulatory electrocardiographic recordings for
prolonged periods (weeks)

- useful for patients who have recurrent syncope (> 1x/4 weeks)

Implantable loop recoders

- latest development based on a loop-based memory system capable of
providing continuous ambulatory electrocardiographic recording for up
to 18 months

- indicated for patients with recurrent syncope with no definite
organic heart disease

Tilt table testing

- used to confirm neurocardiogenic syncope in a patient, who does not
have a classical history of vaso-vagal (vasodepressor) syncope; has
also been useful in diagnosing neurally-mediated syncope, which
manifests as post-exertional syncope

- used to investigate recurrent syncope in elderly patients with
probable autonomic neuropathy

- some cardiologists reserve tilt testing for patients with
unexplained, recurrent syncope in whom cardiac causes of syncope,
including arrhythmias, have been excluded by echocardiography and
Holter monitoring and EPS
testing

- can also be used to differentiate convulsive syncope from true
seizures

Psychiatric evaluation

- may be indicated in young patients who faint frequently for no
apparent reason, especially when symptoms are suggestive of postural
tachycardia syndrome
Appendix



Causes of syncope

Vasomotor/vascular
Hypovolemia

dehydration
fluid loss
"third" spacing
osmotic/iatrogenic diuresis
Hemorrhage
ruptured abdominal aortic aneurysm
ectopic pregnancy
GIT bleeding
trauma-induced
Vasomotor insufficiency
Postural orthostasis

Vasodepressor (vaso-vagal) syncope

Glossopharyngeal neuralgia

Trigeminal neuralgia

Autonomic/peripheral neuropathy

Subclavian steal syndrome

Anaphylactic shock

Cardiac

Dysrhythmias

tachyarrhythmias
bradyarrhythmias
Carotid sinus hypersensitivity
Pacemaker malfunction

Myocardial ischemia

Dissection of the aorta

Mechanical outflow obstruction or
venous return impedance

aortic stenosis
hypertrophic obstructive cardiomyopathy
pulmonary stenosis
pulmonary embolus
primary pulmonary hypertension
atrial myxoma
prosthetic valve malfunction/thrombosis
pericardial tamponade
tricuspid stenosis
mitral stenosis
retrictive cardiomyopathy
tension pneumothorax
Congenital heart disease
anomalous origin of the left coronary artery
Eisenmenger's syndrome
Tetralogy of Fallot
Situational
cough (post-tussive)
micturition
defecation
swallowing
postprandial
weight-lifters
adolescent stretch
hair grooming
trumpet player's
Metabolic
"hypoglycemia"
addisonian crises
pheochromocytoma
hypothyroidism
Central nervous system
subarachnoid hemorrhage
"seizures"
basilar migraine
posterior circulation TIA's
vertebral artery dissection
carotid artery dissection
Miscellaneous
air embolism
amniotic fluid embolism
foreign body embolism
asphyxia/hypoxia
carbon monoxide poisoning
breath-holding attacks
hyperventilation syndrome
conversion disorder
pro-arrhythmic drugs
polypharmacy
"glue sniffing or huffing"
postural tachycardia syndrome



Differentiating syncope from seizure

Feature Syncope Seizure
Aura Absent Rarely present
Antecedent "dizziness-prodrome" prior to event Sometimes present
Absent
Color at onset of event Sometimes pale Sometimes florid/purple
Jerking movements Infrequent and short-lived (seconds) Common and
longer-lasting (minutes)
Pattern of convulsions Uncoordinated myoclonic jerks and twitches -
after LOC Generalized tonic and/or clonic movements - coincident with
LOC
Upturning of eyes Common Uncommon
Forced conjugate deviation of eyes Absent Common
Tongue biting - lateral Absent Common
Urinary incontinence Rare Common
Duration of event Seconds Minutes
Prolonged disorientation or sleepiness after event Absent-rare
Present-common
Increase in CK enzyme or lactate Absent Present

Suggested algorithm for workup of syncope

Disclaimer : My EM guidemaps reflect my personal approach to
problem-solving/managing clinical cases in an ED setting and they
should not be regarded as the standard of care. They merely represent
the personal opinions of the author and they should only be used in
clinical practice if the reader-user has substantial reason to believe
that the clinical advice contained in the guidemaps is valid and
accurate. The guidemaps are not meant to be "authoritative" and the
reader-user should consult standard medical textbooks and expert
opinion articles/guidelines for more authoritative advice. The
reader-user should particularly confirm all drug doses, their
indications and contra-indications, prior to their use.


On Fri, 19 Sep 2003 13:02:00 GMT, "V35B" > wrote:

>Of course if you place mothers milk in an IV line it can kill you too. The
>point is N20 is arguably safer than local anesthetics, when used within its
>therapeutic realm. No chance of anaphylactic hypersensitivity reaction...
>etc.
>
>The point also is that the two are not interchangable...
>
>
>
>
>
>"Joel M. Eichen D.D.S." > wrote in message
...
>> There have been accidental deaths from N2O.
>>
>> One hospital case happened where the plumbers couldn't figure out the
>> mismatched pipe sizes and cut them off and incorrectly rematched them.
>>
>> **The mismatch PREVENTS people from mixing up the hoses ~ normally it
>> is impossible to crank up the N2O/O2 ratio past 80/20. The 20% O2 is
>> required for life.
>>
>> After the plumbers did their work the tragedy happened. The docs
>> thought there were on 100% O2 but it was really 100% N2O.
>>
>>
>> Tragic.
>>
>>
>> Joel
>>
>> On Fri, 19 Sep 2003 13:43:27 +0200, Mxsmanic >
>> wrote:
>>
>> >V35B writes:
>> >
>> >> Nitrous Oxide is not potent enough to induce a state
>> >> of general anesthesia ...
>> >
>> >That's one of the reasons why it is dangerous for that purpose. Still,
>> >it is a general anesthetic in its mechanism of action (i.e., it's not a
>> >local anesthetic by any means). General anesthetics require greater
>> >caution than local anesthetics.
>>
>> --
>> Joel M. Eichen, .
>> Philadelphia PA
>>
>> STANDARD DISCLAIMER applies:
>> <You fill it in>
>

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Joel M. Eichen D.D.S.
September 19th 03, 02:23 PM
Agreed!

To be more specific, there are actual medical cases where PN
(peripheral neuropathy) exists. Of course that describes a symptom,
not a diagnosis.

The one that readily comes to mind is a sign or sequelae of diabetes.


As for Jan Drew syle PN, meaning she gets her amalgams out and the
next day is cured, that suggests Baloney! In medical terms its called,
"Jansterbalonitis."

I suggest getting out more!


Joel

On Fri, 19 Sep 2003 13:12:10 GMT, "Tony Bad"
> wrote:

>
>"ChuckMSRD" > wrote in message
...
>> >Here come Vaughn sucking up to the dentists, even though he knows Joel is
>> >EXACTLY what you stated.
>>
>> What is up with that Vaughn? For a seemingly intelligent guy to defend or
>> ignore the things that Joel says is pretty comical.
>> ie: "laziness causes PN" no comment but I say "Hg is the second most toxic
>> metal" WAAAAAAAA it is 3.7th most according to OSHA.... Whats the agenda
>here?
>>
>>
>> Chuck
>
>That last question is one you should answer as well. You want to debate the odd
>posting behavior of some here or something more important. You seem to be
>leaning toward the former. As someone else suggested, do a google search on this
>group and you may have a better understanding of the personality dynamics here.
>
>What is your agenda?
>
>T
>

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

dragonlady
September 19th 03, 03:00 PM
In article >,
Joel M. Eichen D.D.S. > wrote:

> There have been accidental deaths from N2O.
>
> One hospital case happened where the plumbers couldn't figure out the
> mismatched pipe sizes and cut them off and incorrectly rematched them.
>
> **The mismatch PREVENTS people from mixing up the hoses ~ normally it
> is impossible to crank up the N2O/O2 ratio past 80/20. The 20% O2 is
> required for life.
>
> After the plumbers did their work the tragedy happened. The docs
> thought there were on 100% O2 but it was really 100% N2O.
>
>
> Tragic.
>
>

Then the N2O didn't kill the patient. The lack of O2 killed the patient.

And yes, the distinction matters.

It's why we have to be careful if we let kids suck the helium out of a
balloon: the helium won't hurt them, but the lack of oxygen if they do
it several times in a row without a "real" breath between may -- and,
since both are gases, they don't feel like they aren't breathing.

meh
--
Children won't care how much you know until they know how much you care

V35B
September 19th 03, 06:39 PM
One cannot be allergic to epinephrine it occurs naturally in the human body.
People tend to get allergy and adverse reaction confused.

Allergy would have to come under the umbrella of on of the 4 types of
hypersensitivity reactions.

Soem one who gets a rapid heartbeat or headache is not showing sgins of an
"allergy"




"Joel M. Eichen D.D.S." > wrote in message
...
> While we got you here .........
>
> Some people claim they are "allergic" to epinephrine. Of course we
> know that the problem when epinephrine/local anesthetic (1:100,000 or
> 1:50,000) is accidentally injected into a vein it is vasovagal
> sympathomimetic reaction, not anaphylactic or allergic reaction.
>
> I say that it is impossible for someone to be "allergic" to
> epinephrine. What do you say?
>
>
> Joel
>
>
> PS- Here is a checklist for laymen who want to learn more ......
>
>
>
> EM guidemap - Syncope
>
> Click on any of the headings or sub-headings to rapidly navigate to
> the relevant section of the guidemap
>
> Introduction and general principles
>
> History of present illness
>
> clinical clue table
> Risk factors for syncope
> Examination
>
> Diagnostic testing
>
> Cardiac monitoring
> EKG
> Pulse oximetry
> Blood testing
> Carotid massage
> Orthostatic vital signs
> Echocardiography
> Exercise stress testing
> Signal-averaged electrocardiography
> Intracardiac electrophysiologic studies
> Neurological testing
> Medical decision-making
> Indications for admission
> Continuous ambulatory electrocardiographic monitoring
> Long-term event and memory loop recorders
> Implantable loop recorders
> Tilt table testing
> Psychiatric evaluation
> Appendix
> Causes of syncope
> table differentiating syncope from seizure
> suggested algorithm for workup of syncope
> Introduction and general principles
>
> - syncope is defined as a transient loss of consciousness associated
> with a loss of postural tone, and most diseases causing syncope
> produce a transient LOC by temporarily decreasing cerebral blood flow
>
> An emergency physician, when faced with a syncope-patient in an ED
> setting, should first seek to exclude life-threatening causes of
> syncope, which require immediate diagnostic evaluation/treatment +
> hospital admission
>
> AMI
> PE
> aortic dissection
> cardiac tamponade
> tension pneumothorax
> leaking AAA
> active internal bleeding
> malignant cardiac arrhythmias
> ectopic pregnancy
> SAH
> carotid artery/vertebral artery dissection
> air embolism
> If there are no overt life-threatening causes of syncope, then an
> emergency physician should attempt to identify patients with
> situational syncope, vasovagal syncope and benign orthostatic
> (postural) syncope - who are candidates for home discharge after any
> necessary stabilization treatment in the ED
> - young patients (< 45 years), who have a history of a short-lived
> syncopal episode with no other associated ongoing symptoms, rarely
> have serious causes of syncope if the syncope did not occur during
> exertion, and hospital admission and/or an extensive workup is rarely
> necessary
>
> - emergency physicians are often faced with the dilemma that the cause
> of the syncope is not immediately apparent after a brief clinical
> examination, and a decision has to be made whether it is necessary to
> admit the patient to hospital
>
> If the cause of the syncope is not readily apparent after initial
> clinical evaluation in the ED, then an emergency physician should
> attempt to decide whether certain categories of syncope-patients
> require admission to hospital
>
> - examples of syncope patients warranting hospitalization include:-
>
> elderly patients > 60 years with no apparent cause of the syncope
> sudden syncope occurring in a non-erect patient with no premonitory
> symptoms or prodrome
> sudden syncope occurring during exertion
> sudden syncope in a patient with a family history of syncope or sudden
> death
> patient has overt evidence of structural heart disease by history or
> examination
> patient has an abnormal ECG
> (* see the medical decision-making section for further details)
> - there is no universally accepted approach to the further
> inpatient/outpatient workup of patients, whose cause of syncope is not
> readily apparent => a suggested algorithm is included in the appendix
> section as a general guide
>
> History of the present illness
>
>
> - critical historical elements include the mode of onset and
> progression of event, body position at onset of event, the depth of
> altered consciousness, the duration of the syncopal episode and the
> rate of recovery of consciousness
>
> (* by paying close attention to the details, an emergency physician
> should be able to differentiate syncope from seizures, non-specific
> near-syncopal events, non-specific ligheadedness and dysequilibrium
> syndromes)
>
> - sudden unheralded syncope at rest, particularly in a non-erect
> posture, is ominous - especially if significant injury results =>
> suggests a cardiac arrhythmia
>
> - associated palpitations or an irregular heart beat suggests cardiac
> syncope secondary to a cardiac arrhythmia
>
> - certain antecedent symptoms lasting > 10 seconds (darkening vision
> or tunnel vision or graying vision, lightheadedness, swaying
> sensation, nausea, sweating, feeling "hot", face and distal limb
> numbness), especially if preceded by a provocative emotional event and
> occurring in an upright position suggest vaso-vagal syncope (also
> called vasodepressor or reflex or neurocardiogenic syncope)
>
> (* vasovagal syncope is also more likely to happen in overcrowded
> social settings where prolonged mandatory standing is a requirement
> eg. church, military parades in hot weather)
>
> - antecedent/accompanying chest pain (AMI or PE) or abdominal pain
> (ectopic pregnancy) or back pain (ruptured abdominal aortic aneurysm
> or dissecting aortic aneurysm) or headache (SAH) suggests serious
> pathology
>
> - prominent antecedent/accompanying dyspnea suggests hyperventilation
> syndrome, pulmonary embolism or pulmonary hypertension
>
> - accompanying brainstem symptoms (diplopia or blurred vision,
> dysarthria, dysphagia, deafness, vertigo, ataxia, limb weakness or
> hypoesthesia, face pain or hypoesthesia) suggest vertebro-basilar
> artery insufficiency or basilar artery migraine
>
> - the patient's posture at the time of syncope is very important -
> sudden syncope in a non-erect position signifies serious pathology ,
> while lightheadedness for 30 - 60 seconds after suddenly
> standing/walking and immediately preceding the syncopal episode
> suggests underlying orthostatic hypotensive syndromes (autonomic
> neuropathy and/or volume depletion and/or drug-induced vasodilatation)
>
> - sudden syncope related to turning or hyperextending the head (eg.
> when shaving or while wearing tight constricting neckwear) suggests
> carotid sinus syncope
>
> - sudden syncope during strenuous physical activity (exertional
> syncope ) suggests potentially serious pathology (HOCM or aortic
> stenosis, or atrial myxoma or anomalous coronary artery; or a
> malignant arrhythmia eg. torsade des pointes and VT)
>
> - pscyhological triggering events (painful stimuli, sudden bad news)
> suggest vasovagal syncope
>
> (* however sudden stress/excitement in patients with long QT syndrome
> can trigger torsades des pointes)
>
> - evidence of volume loss may precede syncope (vomiting, diarrhea) or
> accompany syncope (hematemesis or melena)
>
> - syncope related to strenuous unilateral upper arm activity suggests
> subclavian steal syndrome
>
> - situational syncope is self-diagnostic - cough syncope, micturition
> syncope, defecation syncope, hair-grooming syncope, adolescent stretch
> syncope, deglutition (swallow) syncope, glossopharyngeal syncope and
> "weight-lifter blackouts"
>
> - antecedent "glue-sniffing" or "huffing" suggests a ventricular
> arrhythmia and/or hypoxia as the cause of the syncope; sympathomimetic
> drug abuse (cocaine or amphetamines) suggest a tachyarhythmia
>
> - recurrent bouts of progressive gradual loss of consciousness over
> several minutes while walking or standing + NO sweating + NO pallor +
> fixed heart rate suggest chronic dysautonomic syncope
>
> (* patients often also have a history of hypohidrosis, impotence,
> blurred vision, urinary difficulties, constipation, nocturnal polyuria
> and " coat-hanger" pain [neck and shoulders ache - present only when
> standing])
>
> - recent meal ingestion in an elderly patient may suggest
> post-prandial hypotensive syncope
>
> - short-lived myoclonic seizures or twitching are compatible with
> convulsive syncope, and do not imply a true seizure
>
> (* a true seizure is more likely if an aura and/or convulsions precede
> the fall, tongue biting and/or urinary incontinence occurs,
> convulsions are generalized and last longer than 30 seconds, prolonged
> post-ictal confusion-lethargy occurs => see the table in the appendix
> section for further details)
>
>
> Clinical clue table
>
> Clinical clue Suggests
> Sudden syncope at rest when non-erect Cardiac arrhythmia, atrial
> myxoma
> Sudden syncope on exertion Aortic stenosis, HOCM, atrial myxoma,
> malignant cardiac arrhythmia
> Preceding "lightheadness" prodrome when erect Vasovagal syncope,
> orthostatic hypotension
> Preceding palpitations Cardiac arrhythmia
> Preceding or accompanying dyspnea Pulmonary embolism, tension
> pneumothorax, cardiac tamponade, air embolism
> Preceding or accompanying chest pain AMI, PE, cardiac tamponade,
> dissecting aneurysm, tension pneumothorax, mitral valve prolapse
> Preceding or accompanying back pain Dissecting aortic aneurysm,
> leaking AAA
> Preceding or accompanying abdominal pain Leaking AAA, ectopic
> pregnancy
> Occurring when turning head to side, or looking up Carotid sinus
> syncope
> Occurring when exercising upper arm Subclavian steal syndrome
> Occurring during (or immediately after) coughing, laughing, vomiting,
> swallowing, urination, defecation, combing hair, stretching
> Situational syncope
> Occurring after prolonged standing Vasovagal syncope
> Occurring after emotional upset Vasovagal syncope, prolonged QT
> interval and torsade
> Recent illicit drug use Cardiac arrhythmia, air or foreign body
> embolism
> Recent sudden headache SAH
> Recent neurological symptoms Brain stem stroke, vertebro-basilar
> artery insufficiency, basilar migraine, carotid or vertebral artery
> dissection, dissecting aortic aneurysm
> Recent vaginal insufflation Air embolism
> Recent black stools GI bleed
> Recent fluid loss (diarrhea, vomiting, sweating) Orthostatic
> hypotension, Addisonian crisis
> Recent meal Postprandial hypotensive syncope
> Polypharmacy, recent sialdenafil use Orthostatic syncope
> History of fever or myalgia or arthalgia or rash Atrial myxoma,
> cardiac tamponade
> History of known cardiac ischemia or structural heart disease Cardiac
> arrhythmia, pro-arrhythmia drug effect, valve dysfunction
> History of mechanical heart valve Thrombosis of valve
> Recent history of cancer, prolonged immobilization, leg injury or
> surgery Pulmonary embolism
> History of autonomic dysfunction (impotence, anhydrosis, sphincter
> dysfunction) Orthostatic hypotension secondary to autonomic neuropathy
> History of recurrent syncope Cardiac arrhythmia, carotid sinus
> syncope, atrial myxoma, aortic stenosis, subclavian steal syndrome,
> prolonged QT interval - torsade
> Family history of syncope or sudden death HOCM, prolonged QT syndrome
> Pacemaker Pacemaker failure
>
>
> Risk factors for syncope
>
> Underlying causes of orthostatic hypotension
>
> - volume depletion (vomiting, diarrhea, excessive perspiration,
> diuretic use)
>
> - blood loss
>
> - adrenal insufficiency
>
> - primary or secondary dysautonomias (multiple sclerosis,
> Guillane-Barre syndrome, spinal cord injury, tabes dorsalis,
> Parkinsonism, Shy-Drager syndrome, diabetic autonomic neuropathy)
>
> - peripheral neuropathy (chronic alcoholism, diabetes)
>
> - polypharmacy in elderly patients with impaired baroreceptor reflexes
>
> - prolonged recumbency and secondary "cardiac-deconditioning"
>
> Drugs predisposing to syncope
>
> - vasodilators (alpha blockers, beta blockers, ACEI's, calcium channel
> blockers, nitrates, phenothiazines)
>
> - cardio-inhibitor drugs (beta blockers, digoxin)
>
> - psycho-active drugs (anti-convulsants, CNS sedative-depressants,
> anti-histamines, anti-depressants, anti-psychotics)
>
> Conditions predisposing to a prolonged QT interval and torsade des
> pointes
> Acquired causes Enviromental and endocrinological causes Medicinal
> and
> toxicological causes Congenital causes Neurological causes
> Ischemic coronary artery disease Hypothermia Class 1A
> antidysrhythmics - quinidine, procainamide, disopyramide
> Jervell-Lange-Nielsen syndrome Subarachnoid hemorrhage
> Congestive heart failure Bulemia, stringent dieting Class 1C
> antidysrhythmics - flecainide, encainide Romano-Ward sydrome
> Cerebrovascular occlusive disease
> Rheumatic heart disease Hypothyroidism Phenothiazine overdose Refsum
> syndrome Traumatic brain injury
> Myocarditis Hypokalemia Butyrophenone overdose Mitral valve prolapse
> Encephalitis
> Hypocalcemia Tetracyclic/tricyclic antidepressant overdose
> Hypomagnesemia Organophosphate overdose
> Macrolide antibiotics + terfenadine or astemizole or cisapride
> Azole antigungals + terfenadine or astemizole or cisapride
>
>
> Examination
>
>
> - a selective examination can offer clinical clues as to the etiology
> of the syncope
>
> Blood pressure
>
> - difference in blood pressure between left and right upper limbs >
> 20mmHg is abnormal (suggests dissecting aortic aneurysm or subclavian
> steal syndrome)
>
> - difference in blood pressure between upper and lower limbs > 20mmHg
> when recumbent is abnormal (suggests a dissecting aortic aneurysm)
>
> Pulse volume
>
> - decreased and delayed upstoke (aortic stenosis/hypertrophic
> obstructive cardiomyopathy)
>
> - positive pulsus paradoxus (cardiac tamponade, massive pulmonary
> embolism)
>
> - absent pulses (dissection of the aorta, cardiac emboli)
>
> Neck bruits
>
> - suggests great artery stenosis eg. subclavian steal syndrome or
> carotid artery dissection
>
> Jugular venous pressure
>
> - increased in heart failure or pulmonary embolism or cardiac
> tamponade (positive Kussmaul's sign)
>
> - 'cannon' a waves suggests AV conduction block
>
> Apex beat
>
> - displaced and forceful (LVH), forceful (RVH)
>
> Heart sounds
>
> - decreased (pericardial tamponade)
>
> - 3rd/4th heart sounds (ventricular failure or LV overload)
>
> - loud second heart sound (pulmonary embolism or pulmonary
> hypertension)
>
> - ejection systolic murmurs (aortic stenosis or hypertrophic
> cardiomyopathy - increased murmur when standing, decreased when
> squatting)
>
> - machinary murmur (air embolism)
>
> - "tumor plop" or diastolic murmur (atrial myxoma)
>
> - varying heart sounds/murmurs (thrombotic occlusion of a prosthetic
> valve)
>
> Abdomen
>
> - pulsatile masses (abdominal aneurysm)
>
> - rectal exam for melena or heme-occult positive stools
> (gastro-intestinal bleeding)
>
> - absent/decreased femoral pulses (dissection of the aorta)
>
> Neuro exam
>
> - signs of vertebro-basilar artery TIA/CVA or neuropathy or myelopathy
> Diagnostic testing
>
>
> Cardiac monitoring
>
> - immediate and continuous monitoring during the ED evaluation period
> is highly recommended
>
> - arrhythmias may be etiologically significant
>
> (* no study has determined the ideal duration of ED cardiac monitoring
>
> ECG
>
> - an abnormal ECG may be etiologically significant, although the
> 'definitive' diagnostic yield is low (< 5%)
>
> - ECG abnormalities include:-
>
> previous or acute cardiac ischemic changes
> signs of pericarditis or electrical alternans (cardiac tamponade)
> LVH (hypertension, aortic stenosis, HOCM)
> RVH (PE or pulmonary hypertension)
> classical/non-specific ECG signs of PE
> WPW syndrome
> LBBB or bifasicular block (conducting system disease)
> bradyarrythmias or tachyarrhythmias
> long QT interval
> Brugada syndrome (partial RBBB with elevated ST segments in leads V1-3
> and peculiar downsloping of the elevated ST segments + inverted T
> waves in those leads)
> arrhythmogenic right ventricular dysplasia (RBBB, QRS complex > 110
> msec in leads V 1-3, inverted T wave or epislon wave
> Pulse oximetry
> - a low reading may suggest a possible etiology (cyanotic congenital
> heart disease, pulmonary embolism, pulmonary hypertension
>
> Blood testing
>
> - not generally useful
>
> - Hb/Hct helpful in establishing baseline in bleeding patients
>
> - glucose and electrolytes have no/little utility
>
> (* hyponatremia + hyperkalemia may rarely suggest Addison's disease;
> hypoglycemnia rarely produces syncope without ongoing symptoms of
> hypoglycemia)
>
> - serum HCG rarely helpful in reproductive age female patients
>
> (* very rare patient with an ectopic pregnancy presenting as syncope
> without any abdominal pain/vaginal bleeding)
>
> Carotid sinus massage
>
> - may be useful in diagnosing carotid sinus syncope in elderly
> patients
>
> - first performed on the right side for a minimum of 5 seconds
> (preferably 15 seconds) => measure pulse rate and blood pressure =>
> wait 120 seconds => repeat test on the left side
>
> - positive response = longer than 3 seconds of asystole, and/or
> systolic blood pressure drop of > 50 mmHg when supine
>
> - borderline positive response = slowing of heart rate > 30 - 40%
> and/or systolic blood pressure drop of > 30mmHg when supine
>
> - 90% of positive-test patients have the cardio-inhibitory or combined
> response, while only 10% have the vaso-depressor response
>
> - up to 10% of elderly patients have carotid sinus hypersensitivity to
> some degree, however only < 5 - 20% of these patients have carotid
> sinus syndrome (carotid sinus syncope etiologically related to carotid
> artery hypersensitivity)
>
> - carotid sinus syncope can only be definitively diagnosed when
> syncope or near-syncope occurs during carotid massage
>
> (* carotid sinus massage is contra-indicated in patients with a
> history of a CVA, a recent AMI or when a neck bruit is present
>
> Orthostatic vital signs
>
> - the patient should be recumbent for at least 5 minutes prior to
> performing the test and the patient should stand for at least 2
> minutes
>
> - a positive test is defined as a systolic blood pressure decrease of
> > 20 - 30mmHg, a diastolic decrease of >10 - 15mmHg and/or heart rate
> increase of greater than 30 bpm when standing
>
> - the test is non-dependable, often inconsistent and has a low
> specificity
>
> - a significant drop in blood pressure + fixed heart rate suggests
> dysautonomia
>
> - a significant drop in blood pressure + increased heart rate suggests
> volume depletion and/or excessive vasodilatation
>
> - an insignificant drop in blood pressure + marked increase in heart
> rate suggests postural tachycardia syndrome, which is a heterogenous
> entity (history of frequent fainting, symptoms of autonomic
> overactivity - palpitations, diaphoresis, tremulousness, visual
> blurring, non-anginal chest pain, "spaced-out" feelings, inability to
> concentrate, inability to breathe, sensations of impending doom)
>
> Echocardiography
>
> - diagnostic yield low in the absence of historical or physical signs
> of organic heart disease
>
> - only definitely indicated in patients with exertion-related syncope,
> in all patients who have a prosthetic heart valve, or when the
> clinical suspicion of organic heart disease is high (eg. strong
> clinical suspicion of obstructive cardiac lesions - HOCM, AS or atrial
> myxoma)
>
> -some conservative physicians believe that organic heart disease
> cannot be fully excluded prior to performing echocardiography
> (unsuspected findings are found in 5 - 10% of unselected patients) and
> that echocardiograph should routinely be performed in all patients, or
> definitely in patients > 50 years
>
> Exercise-stress testing
>
> - indicated for patients with exertion-related syncope or suspected
> CAD
>
> - should always be preceded by echocardiography to first rule-out
> cardiac obstructive pathology eg. HOCM, aortic stenosis, atrial myxoma
>
> Signal-averaged electrocardiography
>
> - not usually helpful with many false-positives
>
> - may be useful in selecting patients for electrophysiological studies
> when CAD is present and secondary VT suspected
>
> Intracardiac electrophysiologic studies
>
> - expensive, invasive and with low yield
>
> - not indicated in patients with clinically normal hearts and a normal
> ECG
>
> - most useful in patients with known organic heart disease (patients
> with a history of a MI or CHF - especially if the ejection fraction <
> 40%) and/or an abnormal ECG
>
> - usefulness is mainly based on the ability of EPS testing to induce
> malignant arrhythmias eg. sustained monomorphic ventricular
> tachycardia
>
> - induction of non-sustained VT, polymorphic VT and VF during testing
> is of no/uncertain clinical usefulness
>
> - less useful for detecting bradyarrhythmias
>
> - sinus node recovery time > 3 seconds may reflect sinus node disease
> requiring a pacemaker
>
> - an HV interval exceeding 100 msec or infranodal block induced by
> pacing suggest AV nodal disease and a bradycarrhythmic cause of the
> syncope
>
> Neurological testing - EEG, CT scan, transcranial/carotid Dopplers
>
> - not indicated unless there is substantial reason to suspect a
> seizure or other significant neuropathology
> Medical decision-making
>
>
> An overriding concern and uncertainty about what may happen to the
> patient in the near future may cause an emergency physician to
> unnecessarily admit too many patients
>
> Patients who can clearly be discharged include those with a classical
> presentation of vasovagal syncope (irrespective of age), those with
> situational syncope, those with mild, reversible orthostatic syncope
> (including polypharmacy syndrome in the elderly patient) and patients
> with hysterical conversion syncope
>
> Indications for admission of patients presenting with syncope include:
>
> new clinical evidence of structural heart disease
> significant antecedent/associated chest pain or ECG evidence of
> cardiac ischemia
> history of previous CHF or myocardial ischemia
> history of a previous malignant arrhythmia
> sudden syncope preceded by and/or associated with palpitations or an
> irregular heart beat
> significant malignant arrhythmia detected in the ED
> high-grade conduction block or high-grade carotid sinus syncope
> sudden onset syncope without premonitory symptoms, especially if
> occurring when non-erect and associated with injury
> exercise-induced syncope (irrespective of age)
> syncope associated with moderate/severe orthostatic hypotension
> resistant to ED treatment or due to life-threatening pathology eg.
> ectopic pregnancy
> syncope associated with any significant neurological symptoms/signs
> syncope suggestive of pulmonary embolism or pulmonary hypertension
> strong family history of sudden syncope/sudden death
> syncope in a patient with an abnormal ECG - long QT interval or
> Brugada syndrome or WPW syndrome
> age > 60 years with no evidence of vasovagal syncope or readily
> reversible chronic-or-benign orthostatic causes
> syncope due to cardiac tamponade or active internal bleeding
> patient taking pro-arrhythmia medications that may potentially cause
> malignant arrhythmias eg. quinidine, sotalol, amiodarone
> ACEP task force recommendations for admission include:
> Admit patients with syncope and any of the following:
>
> 1. A history of congestive heart failure or ventricular arrhythmias
> 2. Associated chest pain or other symptoms compatible with acute
> coronary syndrome
> 3. Evidence of significant congestive heart failure or valvular heart
> disease on physical
> examination
> 4. ECG findings of ischemia, arrhythmia, prolonged QT interval, or
> bundle branch block
>
> Consider admission for patients with syncope and any of the following:
>
> 1. Age older than 60 years
> 2. History of coronary artery disease or congenital heart disease
> 3. Family history of unexpected sudden death
> 4. Exertional syncope in younger patients without an obvious benign
> etiology for the
> syncope
>
> 24-hour Holter (continuous ambulatory electrocardiographic) monitoring
>
> - traditional approach to syncope of unknown etiology with low yield
>
> - 4% true positives (symptoms correlate with arrhythmia) and 15% false
> positives (symptoms without any arrhythmia); 14% of patients have an
> asymptomatic arrhythmia which may suggest a cause for the syncope
> (sinus pauses, non-sustained VT, Mobitz type II block)
>
> - extending the continuous ambulatory electrocardiograhic monitoring
> to 72 hours results in a slightly higher yield
>
> - if no symptoms/arrhythmias are detected, arrhythmogenic syncope
> cannot be excluded => further testing is required for patients with
> recurrent syncope, or if there is a strong clinical suspicion of
> malignant cardiac arrythmias eg. known severe structural heart disease
> +/- history of recurrent palpitations
>
> Long-term event and memory loop recorders
>
> - provide continuous ambulatory electrocardiographic recordings for
> prolonged periods (weeks)
>
> - useful for patients who have recurrent syncope (> 1x/4 weeks)
>
> Implantable loop recoders
>
> - latest development based on a loop-based memory system capable of
> providing continuous ambulatory electrocardiographic recording for up
> to 18 months
>
> - indicated for patients with recurrent syncope with no definite
> organic heart disease
>
> Tilt table testing
>
> - used to confirm neurocardiogenic syncope in a patient, who does not
> have a classical history of vaso-vagal (vasodepressor) syncope; has
> also been useful in diagnosing neurally-mediated syncope, which
> manifests as post-exertional syncope
>
> - used to investigate recurrent syncope in elderly patients with
> probable autonomic neuropathy
>
> - some cardiologists reserve tilt testing for patients with
> unexplained, recurrent syncope in whom cardiac causes of syncope,
> including arrhythmias, have been excluded by echocardiography and
> Holter monitoring and EPS
> testing
>
> - can also be used to differentiate convulsive syncope from true
> seizures
>
> Psychiatric evaluation
>
> - may be indicated in young patients who faint frequently for no
> apparent reason, especially when symptoms are suggestive of postural
> tachycardia syndrome
> Appendix
>
>
>
> Causes of syncope
>
> Vasomotor/vascular
> Hypovolemia
>
> dehydration
> fluid loss
> "third" spacing
> osmotic/iatrogenic diuresis
> Hemorrhage
> ruptured abdominal aortic aneurysm
> ectopic pregnancy
> GIT bleeding
> trauma-induced
> Vasomotor insufficiency
> Postural orthostasis
>
> Vasodepressor (vaso-vagal) syncope
>
> Glossopharyngeal neuralgia
>
> Trigeminal neuralgia
>
> Autonomic/peripheral neuropathy
>
> Subclavian steal syndrome
>
> Anaphylactic shock
>
> Cardiac
>
> Dysrhythmias
>
> tachyarrhythmias
> bradyarrhythmias
> Carotid sinus hypersensitivity
> Pacemaker malfunction
>
> Myocardial ischemia
>
> Dissection of the aorta
>
> Mechanical outflow obstruction or
> venous return impedance
>
> aortic stenosis
> hypertrophic obstructive cardiomyopathy
> pulmonary stenosis
> pulmonary embolus
> primary pulmonary hypertension
> atrial myxoma
> prosthetic valve malfunction/thrombosis
> pericardial tamponade
> tricuspid stenosis
> mitral stenosis
> retrictive cardiomyopathy
> tension pneumothorax
> Congenital heart disease
> anomalous origin of the left coronary artery
> Eisenmenger's syndrome
> Tetralogy of Fallot
> Situational
> cough (post-tussive)
> micturition
> defecation
> swallowing
> postprandial
> weight-lifters
> adolescent stretch
> hair grooming
> trumpet player's
> Metabolic
> "hypoglycemia"
> addisonian crises
> pheochromocytoma
> hypothyroidism
> Central nervous system
> subarachnoid hemorrhage
> "seizures"
> basilar migraine
> posterior circulation TIA's
> vertebral artery dissection
> carotid artery dissection
> Miscellaneous
> air embolism
> amniotic fluid embolism
> foreign body embolism
> asphyxia/hypoxia
> carbon monoxide poisoning
> breath-holding attacks
> hyperventilation syndrome
> conversion disorder
> pro-arrhythmic drugs
> polypharmacy
> "glue sniffing or huffing"
> postural tachycardia syndrome
>
>
>
> Differentiating syncope from seizure
>
> Feature Syncope Seizure
> Aura Absent Rarely present
> Antecedent "dizziness-prodrome" prior to event Sometimes present
> Absent
> Color at onset of event Sometimes pale Sometimes florid/purple
> Jerking movements Infrequent and short-lived (seconds) Common and
> longer-lasting (minutes)
> Pattern of convulsions Uncoordinated myoclonic jerks and twitches -
> after LOC Generalized tonic and/or clonic movements - coincident with
> LOC
> Upturning of eyes Common Uncommon
> Forced conjugate deviation of eyes Absent Common
> Tongue biting - lateral Absent Common
> Urinary incontinence Rare Common
> Duration of event Seconds Minutes
> Prolonged disorientation or sleepiness after event Absent-rare
> Present-common
> Increase in CK enzyme or lactate Absent Present
>
> Suggested algorithm for workup of syncope
>
> Disclaimer : My EM guidemaps reflect my personal approach to
> problem-solving/managing clinical cases in an ED setting and they
> should not be regarded as the standard of care. They merely represent
> the personal opinions of the author and they should only be used in
> clinical practice if the reader-user has substantial reason to believe
> that the clinical advice contained in the guidemaps is valid and
> accurate. The guidemaps are not meant to be "authoritative" and the
> reader-user should consult standard medical textbooks and expert
> opinion articles/guidelines for more authoritative advice. The
> reader-user should particularly confirm all drug doses, their
> indications and contra-indications, prior to their use.
>
>
> On Fri, 19 Sep 2003 13:02:00 GMT, "V35B" > wrote:
>
> >Of course if you place mothers milk in an IV line it can kill you too.
The
> >point is N20 is arguably safer than local anesthetics, when used within
its
> >therapeutic realm. No chance of anaphylactic hypersensitivity
reaction...
> >etc.
> >
> >The point also is that the two are not interchangable...
> >
> >
> >
> >
> >
> >"Joel M. Eichen D.D.S." > wrote in message
> ...
> >> There have been accidental deaths from N2O.
> >>
> >> One hospital case happened where the plumbers couldn't figure out the
> >> mismatched pipe sizes and cut them off and incorrectly rematched them.
> >>
> >> **The mismatch PREVENTS people from mixing up the hoses ~ normally it
> >> is impossible to crank up the N2O/O2 ratio past 80/20. The 20% O2 is
> >> required for life.
> >>
> >> After the plumbers did their work the tragedy happened. The docs
> >> thought there were on 100% O2 but it was really 100% N2O.
> >>
> >>
> >> Tragic.
> >>
> >>
> >> Joel
> >>
> >> On Fri, 19 Sep 2003 13:43:27 +0200, Mxsmanic >
> >> wrote:
> >>
> >> >V35B writes:
> >> >
> >> >> Nitrous Oxide is not potent enough to induce a state
> >> >> of general anesthesia ...
> >> >
> >> >That's one of the reasons why it is dangerous for that purpose.
Still,
> >> >it is a general anesthetic in its mechanism of action (i.e., it's not
a
> >> >local anesthetic by any means). General anesthetics require greater
> >> >caution than local anesthetics.
> >>
> >> --
> >> Joel M. Eichen, .
> >> Philadelphia PA
> >>
> >> STANDARD DISCLAIMER applies:
> >> <You fill it in>
> >
>
> --
> Joel M. Eichen, .
> Philadelphia PA
>
> STANDARD DISCLAIMER applies:
> <You fill it in>

Joel M. Eichen D.D.S.
September 19th 03, 07:16 PM
Quite correct! I should have stated it as such!

THANKS!


Joel


On Fri, 19 Sep 2003 14:00:46 GMT, dragonlady
> wrote:

>In article >,
> Joel M. Eichen D.D.S. > wrote:
>
>> There have been accidental deaths from N2O.
>>
>> One hospital case happened where the plumbers couldn't figure out the
>> mismatched pipe sizes and cut them off and incorrectly rematched them.
>>
>> **The mismatch PREVENTS people from mixing up the hoses ~ normally it
>> is impossible to crank up the N2O/O2 ratio past 80/20. The 20% O2 is
>> required for life.
>>
>> After the plumbers did their work the tragedy happened. The docs
>> thought there were on 100% O2 but it was really 100% N2O.
>>
>>
>> Tragic.
>>
>>
>
>Then the N2O didn't kill the patient. The lack of O2 killed the patient.
>
>And yes, the distinction matters.
>
>It's why we have to be careful if we let kids suck the helium out of a
>balloon: the helium won't hurt them, but the lack of oxygen if they do
>it several times in a row without a "real" breath between may -- and,
>since both are gases, they don't feel like they aren't breathing.
>
>meh

--
Joel M. Eichen, .
Philadelphia PA

STANDARD DISCLAIMER applies:
<You fill it in>

Mxsmanic
September 20th 03, 12:19 AM
V35B writes:

> It is not dangerous, you cannot be rendered unoncious with it.

It's dangerous to administer enough of it to produce unconsciousness and
full anesthesia.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Mxsmanic
September 20th 03, 12:23 AM
dragonlady writes:

> ... and, since both are gases, they don't feel
> like they aren't breathing.

The main danger is that they are still blowing off CO2. It is CO2 that
stimulates the breathing reflex; as long as you are removing it from the
blood, you won't notice that you aren't getting any oxygen. You'll just
pass out and die.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

madiba
September 20th 03, 11:24 AM
Joel M. Eichen D.D.S. > wrote:

> Cool!
>
> That's digital x-ray! Our own Dr. Steve (Mancuso) is our leading
> spokesperson for it!
>
> Saves on chemicals, retakes, and protects the environment all at once!
>
>
>
> Joel
>
> On Thu, 18 Sep 2003 22:09:44 +0200, Mxsmanic >
> wrote:

<unfortunately snipped>
In Google I saw your post Mxsmanic and I'm pretty sure your dentist
gives a PDLA or peridontal ligament anaesthetic. Special injector that
clicks, the 'needle' gets pushed along the tooth until it reaches the
bone and the lidocaine is then injected slowly under high pressure.
Seems it works well for you, I'd like to find a dentist that uses it
too.


--
madiba

Joel M. Eichen D.D.S.
September 20th 03, 11:37 AM
All N2O devices are fool-proof under normal circumstances. It is not
possible to administer more than 80/20 ratio ~ N2O/O2.

O2 is 16% in ambient air.


On Sat, 20 Sep 2003 01:19:13 +0200, Mxsmanic >
wrote:

>V35B writes:
>
>> It is not dangerous, you cannot be rendered unoncious with it.
>
>It's dangerous to administer enough of it to produce unconsciousness and
>full anesthesia.

--
Joel M. Eichen, .
Philadelphia PA

DISCLAIMER FOLLOWS:

*********

Dental health-related material
is provided for information purposes
only and does not necessarily
represent endorsement by or an official
position of the SciMedDentistry gang
or any other agency either actual
or fictioous.

Advice on the treatment or care
of an individual patient should
be obtained through consultation
with a dentist who has examined
that patient or is familiar with
that patient's dental history.

STANDARD DISCLAIMER

Joel M. Eichen D.D.S.
September 20th 03, 11:37 AM
Sorry, this is not correct.

Anesthesia is defined differently.

On Sat, 20 Sep 2003 01:19:13 +0200, Mxsmanic >
wrote:

>It's dangerous to administer enough of it to produce unconsciousness and
>full anesthesia.

--
Joel M. Eichen, .
Philadelphia PA

DISCLAIMER FOLLOWS:

*********

Dental health-related material
is provided for information purposes
only and does not necessarily
represent endorsement by or an official
position of the SciMedDentistry gang
or any other agency either actual
or fictioous.

Advice on the treatment or care
of an individual patient should
be obtained through consultation
with a dentist who has examined
that patient or is familiar with
that patient's dental history.

STANDARD DISCLAIMER

Yab
September 20th 03, 12:07 PM
In article >, says...
> In misc.kids.health Yab > wrote:
> > says...
> >>
> >> Dentist _does not_ equal pain.
>
> > It does if they try a nerve block that doesn't quite take. That's
> > happened to me a few times.
>
> In my extensive experience I have to tell you that dentist DOES
> equal pain. I sometimes have four shots of novacaine before I give up and
> just bear the pain along with the dentist's scorn for being so wimpy.
>
> I don't mind the pinch/burn of the novacaine all that much, but I *really*
> mind the startling, sharp, coursing-through-me twang when the drill hits a
> nerve. And it's going to at some random moment every few seconds.
>
> I don't know if EVERYONE has this problem with novacaine, or if everyone
> else just shuts up and bears the feeling of drill on nerve, but I'm not
> going to pretend it isn't there.

That's what happens when the nerve block (which they often try for lower
teeth) doesn't take.

When that happens, I make the dentist administer more anesthetic until
the pain is stopped. When the procedure is over, I get up and walk out
and never return. I'm sure crap like this was common in, say, the 1800s
but now it's 2003, for chrissakes; there's NO excuse for not being able
to anesthetize a damn tooth unless the dentist is incompetent.

Yab
September 20th 03, 12:09 PM
In article >,
says...
> Joel M. Eichen D.D.S. writes:
>
> > In later years, I taught my young associates my technique!
>
> My current dentist uses something that looks like a tiny bit of wire
> (very thin) at the end of a stainless-steel pen, with some sort of
> button that he clicks. It is hardly perceptible during the injection,
> and someone he manages to numb only the tooth to be worked on--no more
> "fat lips" and biting of the tongue after a visit to the dentist. Even
> for the root canal, the adjacent teeth were not numb, but the tooth he
> was drilling out was completely dead to the world as he reamed out all
> those nerves and stuff. I was quite impressed.

That tooth that he did the root canal on was probably "dead" inside
anyway, and he could have reamed it out without administering any
anesthetic at all.

Yab
September 20th 03, 12:13 PM
In article >,
says...
> Yab writes:
>
> > It does if they try a nerve block that doesn't quite take. That's
> > happened to me a few times.
>
> Tell them to use more anesthetic before continuing. If they refuse
> without a medically sound reason, it's malpractice.

IMO, proceeding to drill without first ensuring that the tooth is
sufficiently anesthetized is malpractice.

Joel M. Eichen D.D.S.
September 20th 03, 12:36 PM
You wrote:

>That tooth that he did the root canal on was probably "dead" inside
>anyway, and he could have reamed it out without administering any
>anesthetic at all.

REPLY:

Yup! Correct. By the way did you know that Jan Drew is correct? There
are Alien Autopsies in Nevada and amalgam therefore must be completely
poisonous! [Her logic, not mine!]


Joel

*****


Document extends secrecy on Area 51 in southern Nevada

09/19/2003




CARSON CITY, Nev. (AP) -- Invoking national security, President Bush
has renewed an exemption allowing the Air Force to keep mum about
top-secret operations at a southern Nevada base.
Bush's memorandum said it was of "paramount interest" to exempt the
Groom Lake base about 90 miles north of Las Vegas from disclosing
classified information.

Also known as Area 51, the mysterious base sits on a dry lake bed and
is heavily patrolled. The area is in a no-fly zone.

The secrecy has fueled speculation about UFOs, aliens and other
strange occurrences around Area 51. Residents of the nearby town of
Rachel say the UFO talk began years ago when a Nevada Test Site worker
claimed he saw alien ships there.



President Clinton first issued the base's exemption in 1995 in
response to two lawsuits filed by injured workers seeking information
about the military's environmental practices at the site. It has been
renewed yearly.

In renewing the order Tuesday, Bush cited the suits brought by injured
workers and the widows of two workers who alleged in 1994 that their
husbands were exposed to hazardous and toxic materials at Groom Lake.

Attorney Jonathan Turley, who represents the families, said the
presidential directive keeps secret documents and testimony that he
believes would link Area 51 to the men's deaths.

"It is baffling to see the government continue to cover up what went
on at Area 51," said Turley, a George Washington University law
professor. Bush's memo exempts the Air Force from following federal,
state or local solid waste and hazardous waste laws if classified
information would be disclosed.

The government has acknowledged the existence of the installation but
has not disclosed what it does there, further fueling the UFO lore.

The state got in the act in 1996, officially naming a 98-mile stretch
of state Route 375, which runs through Rachel, the Extraterrestrial
Highway and erecting green highway signs with images of spaceships


Jump to top of story


On Sat, 20 Sep 2003 07:09:58 -0400, Yab > wrote:

>In article >,
says...
>> Joel M. Eichen D.D.S. writes:
>>
>> > In later years, I taught my young associates my technique!
>>
>> My current dentist uses something that looks like a tiny bit of wire
>> (very thin) at the end of a stainless-steel pen, with some sort of
>> button that he clicks. It is hardly perceptible during the injection,
>> and someone he manages to numb only the tooth to be worked on--no more
>> "fat lips" and biting of the tongue after a visit to the dentist. Even
>> for the root canal, the adjacent teeth were not numb, but the tooth he
>> was drilling out was completely dead to the world as he reamed out all
>> those nerves and stuff. I was quite impressed.
>
>That tooth that he did the root canal on was probably "dead" inside
>anyway, and he could have reamed it out without administering any
>anesthetic at all.

--
Joel M. Eichen, .
Philadelphia PA

DISCLAIMER FOLLOWS:

*********

Dental health-related material
is provided for information purposes
only and does not necessarily
represent endorsement by or an official
position of the SciMedDentistry gang
or any other agency either actual
or fictioous.

Advice on the treatment or care
of an individual patient should
be obtained through consultation
with a dentist who has examined
that patient or is familiar with
that patient's dental history.

STANDARD DISCLAIMER

Joel M. Eichen D.D.S.
September 20th 03, 12:41 PM
You wrote:

> I'm sure crap like this was common in, say, the 1800s
>but now it's 2003, for chrissakes; there's NO excuse for not being able
>to anesthetize a damn tooth unless the dentist is incompetent.


REPLY:

Yup, because there was no xylocaine in the 1800s ........ Procaine
(Novocaine) was developed in 1905 by Hoechst Pharmaceuticals .....

1859 Niemann and Lossen isolated cocaine from the cocoa plant and the
rest is history! But you are correct about not accepting "less than
effective" local anesthesia! Its doable.


Joel


On Sat, 20 Sep 2003 07:07:46 -0400, Yab > wrote:

>In article >, says...
>> In misc.kids.health Yab > wrote:
>> > says...
>> >>
>> >> Dentist _does not_ equal pain.
>>
>> > It does if they try a nerve block that doesn't quite take. That's
>> > happened to me a few times.
>>
>> In my extensive experience I have to tell you that dentist DOES
>> equal pain. I sometimes have four shots of novacaine before I give up and
>> just bear the pain along with the dentist's scorn for being so wimpy.
>>
>> I don't mind the pinch/burn of the novacaine all that much, but I *really*
>> mind the startling, sharp, coursing-through-me twang when the drill hits a
>> nerve. And it's going to at some random moment every few seconds.
>>
>> I don't know if EVERYONE has this problem with novacaine, or if everyone
>> else just shuts up and bears the feeling of drill on nerve, but I'm not
>> going to pretend it isn't there.
>
>That's what happens when the nerve block (which they often try for lower
>teeth) doesn't take.
>
>When that happens, I make the dentist administer more anesthetic until
>the pain is stopped. When the procedure is over, I get up and walk out
>and never return. I'm sure crap like this was common in, say, the 1800s
>but now it's 2003, for chrissakes; there's NO excuse for not being able
>to anesthetize a damn tooth unless the dentist is incompetent.

--
Joel M. Eichen, .
Philadelphia PA

DISCLAIMER FOLLOWS:

*********

Dental health-related material
is provided for information purposes
only and does not necessarily
represent endorsement by or an official
position of the SciMedDentistry gang
or any other agency either actual
or fictioous.

Advice on the treatment or care
of an individual patient should
be obtained through consultation
with a dentist who has examined
that patient or is familiar with
that patient's dental history.

STANDARD DISCLAIMER

Joel M. Eichen D.D.S.
September 20th 03, 12:42 PM
Nope, but we get your message anyway!

Malpractice has a legal definition and that ain't it!


Joel

On Sat, 20 Sep 2003 07:13:46 -0400, Yab > wrote:

>In article >,
says...
>> Yab writes:
>>
>> > It does if they try a nerve block that doesn't quite take. That's
>> > happened to me a few times.
>>
>> Tell them to use more anesthetic before continuing. If they refuse
>> without a medically sound reason, it's malpractice.
>
>IMO, proceeding to drill without first ensuring that the tooth is
>sufficiently anesthetized is malpractice.

--
Joel M. Eichen, .
Philadelphia PA

DISCLAIMER FOLLOWS:

*********

Dental health-related material
is provided for information purposes
only and does not necessarily
represent endorsement by or an official
position of the SciMedDentistry gang
or any other agency either actual
or fictioous.

Advice on the treatment or care
of an individual patient should
be obtained through consultation
with a dentist who has examined
that patient or is familiar with
that patient's dental history.

STANDARD DISCLAIMER

V35B
September 20th 03, 03:45 PM
Wrong!

IF the nerve invilved has been subjected to an increasing level of stimulus
(nociception) say from a tooth with irreversible pulpitis, The nerve
transmission may be of such a magnitude that it will exceed the ability of
the anesthetic to block transmission along it.


> but now it's 2003, for chrissakes; there's NO excuse for not being able
> to anesthetize a damn tooth unless the dentist is incompetent.

From what experience do you speak??

madiba
September 20th 03, 03:49 PM
Yab > wrote:

> In article >,
> says...
> > Joel M. Eichen D.D.S. writes:
> >
> > > In later years, I taught my young associates my technique!
> >
> > My current dentist uses something that looks like a tiny bit of wire
> > (very thin) at the end of a stainless-steel pen, with some sort of
> > button that he clicks. It is hardly perceptible during the injection,
> > and someone he manages to numb only the tooth to be worked on--no more
> > "fat lips" and biting of the tongue after a visit to the dentist. Even
> > for the root canal, the adjacent teeth were not numb, but the tooth he
> > was drilling out was completely dead to the world as he reamed out all
> > those nerves and stuff. I was quite impressed.
>
> That tooth that he did the root canal on was probably "dead" inside
> anyway, and he could have reamed it out without administering any
> anesthetic at all.

No, he used PerioDontal Ligament Anaesthesia PDLA. Sounds like a good
idea.. Anyone else experienced it?
Here's a link
www.ronvig.com/sider/paroject.html

--
madiba

Joel M. Eichen D.D.S.
September 20th 03, 05:05 PM
Inject into the PDL until the tissue blanches ......

On Sat, 20 Sep 2003 14:45:20 GMT, "V35B" > wrote:

>Wrong!
>
>IF the nerve invilved has been subjected to an increasing level of stimulus
>(nociception) say from a tooth with irreversible pulpitis, The nerve
>transmission may be of such a magnitude that it will exceed the ability of
>the anesthetic to block transmission along it.
>
>
>> but now it's 2003, for chrissakes; there's NO excuse for not being able
>> to anesthetize a damn tooth unless the dentist is incompetent.
>
>From what experience do you speak??
>
>
>

--
Joel M. Eichen, .
Philadelphia PA

DISCLAIMER FOLLOWS:

*********

Dental health-related material
is provided for information purposes
only and does not necessarily
represent endorsement by or an official
position of the SciMedDentistry gang
or any other agency either actual
or fictioous.

Advice on the treatment or care
of an individual patient should
be obtained through consultation
with a dentist who has examined
that patient or is familiar with
that patient's dental history.

STANDARD DISCLAIMER

Mark & Steven Bornfeld DDS
September 20th 03, 05:45 PM
V35B wrote:

> Wrong!
>
> IF the nerve invilved has been subjected to an increasing level of stimulus
> (nociception) say from a tooth with irreversible pulpitis, The nerve
> transmission may be of such a magnitude that it will exceed the ability of
> the anesthetic to block transmission along it.

Listened to a lecture a few months ago by a surgeon who spoke about
evolving theories of pain perception. There is a lot of new info out there,
and while all of it does not seem to be settled science, I remember a few
factoids.
Specifically, local nociceptive stimuli can produce neuroactive chemicals
(kinins, etc.) that act locally. But they also promote stimulation of CENTRAL
nociceptors, so that stimuli that previously would be under the pain threshold
are sufficient to to cause pain.
This is evidence in support of the (empirical) finding that giving a
patient an analgesic before the anesthesia wears off is more effective than
waiting for the analgesic to be taken as needed.

Steve

>
>
> > but now it's 2003, for chrissakes; there's NO excuse for not being able
> > to anesthetize a damn tooth unless the dentist is incompetent.
>
> From what experience do you speak??

--
Mark & Steven Bornfeld DDS
Brooklyn, NY
718-258-5001
http://www.dentaltwins.com

Mxsmanic
September 20th 03, 09:40 PM
Yab writes:

> That tooth that he did the root canal on was probably
> "dead" inside anyway, and he could have reamed it out
> without administering any anesthetic at all.

Oh no, it was very much alive--and I was seeing stars with the constant,
agonizing pain it was causing me until he made that first injection.
What a relief it was! Of course, by the time the anesthetic wore off,
he _had_ reamed it out, and it didn't hurt at all. And it never hurt
again.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Mxsmanic
September 20th 03, 09:45 PM
madiba writes:

> No, he used PerioDontal Ligament Anaesthesia PDLA. Sounds like a good
> idea.. Anyone else experienced it?
> Here's a link
> www.ronvig.com/sider/paroject.html

That gadget looks a lot like the thing he used, and the instructions
sound a lot like what he did (although I couldn't see where he was
injecting). It worked superbly, easily the most effective and
convenient dental anesthesia I've ever had. What I liked was that the
bad tooth was so completely numb--he could have split it with a hammer
without me feeling it--and yet even adjacent teeth were not numbed at
all.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Mxsmanic
September 20th 03, 09:47 PM
V35B writes:

> IF the nerve invilved has been subjected to an increasing
> level of stimulus (nociception) say from a tooth with
> irreversible pulpitis, The nerve transmission may be of
> such a magnitude that it will exceed the ability of
> the anesthetic to block transmission along it.

My tooth was hurting so much that I could not sleep in the two days
preceding my first root canal visit. I couldn't do much of anything
except try to somehow sooth the tooth. And yet as soon as the dentist
did whatever magic anesthesia he used (PDLA, I guess), the pain was
_completely_ gone. And he did not baby that tooth as he cleaned it out.
I heard it, but I never felt a thing.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

madiba
September 20th 03, 10:10 PM
V35B > wrote:

> Your logic is incorrect. I am a professor of pharmacology at a Pharmacy
> School.
>
>
> > That's one of the reasons why it is dangerous for that purpose.
>
> It is not dangerous, you cannot be rendered unoncious with it. How can it
> be dangerous?
What a dumb statement from a so-called prof. of pharmacology!

--
madiba

madiba
September 20th 03, 10:10 PM
Yab > wrote:

> When the procedure is over, I get up and walk out
> and never return. I'm sure crap like this was common in, say, the 1800s
> but now it's 2003, for chrissakes; there's NO excuse for not being able
> to anesthetize a damn tooth unless the dentist is incompetent.
I agree wholeheartedly!
Never again will I accept painful treatment.

--
madiba

Joel M. Eichen D.D.S.
September 20th 03, 11:36 PM
Sorry, the Prof is correct!

On Sat, 20 Sep 2003 23:10:07 +0200, (madiba) wrote:

>V35B > wrote:
>
>> Your logic is incorrect. I am a professor of pharmacology at a Pharmacy
>> School.
>>
>>
>> > That's one of the reasons why it is dangerous for that purpose.
>>
>> It is not dangerous, you cannot be rendered unoncious with it. How can it
>> be dangerous?
>What a dumb statement from a so-called prof. of pharmacology!

--
Joel M. Eichen, .
Philadelphia PA

DISCLAIMER FOLLOWS:

*********

Dental health-related material
is provided for information purposes
only and does not necessarily
represent endorsement by or an official
position of the SciMedDentistry gang
or any other agency either actual
or fictioous.

Advice on the treatment or care
of an individual patient should
be obtained through consultation
with a dentist who has examined
that patient or is familiar with
that patient's dental history.

STANDARD DISCLAIMER

Joel M. Eichen D.D.S.
September 20th 03, 11:37 PM
OK, then you are out of the S&M club!

On Sat, 20 Sep 2003 23:10:16 +0200, (madiba) wrote:

>Yab > wrote:
>
>> When the procedure is over, I get up and walk out
>> and never return. I'm sure crap like this was common in, say, the 1800s
>> but now it's 2003, for chrissakes; there's NO excuse for not being able
>> to anesthetize a damn tooth unless the dentist is incompetent.
>I agree wholeheartedly!
>Never again will I accept painful treatment.

--
Joel M. Eichen, .
Philadelphia PA

DISCLAIMER FOLLOWS:

*********

Dental health-related material
is provided for information purposes
only and does not necessarily
represent endorsement by or an official
position of the SciMedDentistry gang
or any other agency either actual
or fictioous.

Advice on the treatment or care
of an individual patient should
be obtained through consultation
with a dentist who has examined
that patient or is familiar with
that patient's dental history.

STANDARD DISCLAIMER

madiba
September 21st 03, 12:47 AM
Joel M. Eichen D.D.S. > wrote:

> Sorry, the Prof is correct!
He is not!
You just need to raise the % of N20 and you go KO..
If you look at the history of dentistry (which is linked to the history
of anaesthesia) the pioneer's patients used to breath NiOx straight out
of a bag and were completely unconcious.
> On Sat, 20 Sep 2003 23:10:07 +0200, (madiba) wrote:
>
> >V35B > wrote:
> >
> >> Your logic is incorrect. I am a professor of pharmacology at a Pharmacy
> >> School.
> >>
> >>
> >> > That's one of the reasons why it is dangerous for that purpose.
> >>
> >> It is not dangerous, you cannot be rendered unoncious with it. How can it
> >> be dangerous?
> >What a dumb statement from a so-called prof. of pharmacology!

--
madiba

v35b
September 21st 03, 01:26 AM
Madiba,

Get an anesthesia book and read about MAC min alveolar concentration of
anesthetics. Then let me know what you think....



BTW We don't administer N2O with Glad Bags

We use an anesthesia machine......







"madiba" > wrote in message
...
> Joel M. Eichen D.D.S. > wrote:
>
> > Sorry, the Prof is correct!
> He is not!
> You just need to raise the % of N20 and you go KO..
> If you look at the history of dentistry (which is linked to the history
> of anaesthesia) the pioneer's patients used to breath NiOx straight out
> of a bag and were completely unconcious.
> > On Sat, 20 Sep 2003 23:10:07 +0200, (madiba) wrote:
> >
> > >V35B > wrote:
> > >
> > >> Your logic is incorrect. I am a professor of pharmacology at a
Pharmacy
> > >> School.
> > >>
> > >>
> > >> > That's one of the reasons why it is dangerous for that purpose.
> > >>
> > >> It is not dangerous, you cannot be rendered unoncious with it. How
can it
> > >> be dangerous?
> > >What a dumb statement from a so-called prof. of pharmacology!
>
> --
> madiba

Mxsmanic
September 21st 03, 01:26 AM
Joel M. Eichen D.D.S. writes:

> Sorry, the Prof is correct!

You can certainly be rendered unconscious with nitrous oxide. You just
can't be rendered _safely_ unconscious with it.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Joel M. Eichen D.D.S.
September 21st 03, 02:07 PM
General anesthesia does does not equal KO!

There are levels of analgesia where you are totally unconscious but
clearly that is not general anesthesia!

On Sun, 21 Sep 2003 01:47:42 +0200, (madiba) wrote:

>Joel M. Eichen D.D.S. > wrote:
>
>> Sorry, the Prof is correct!
>He is not!
>You just need to raise the % of N20 and you go KO..
>If you look at the history of dentistry (which is linked to the history
>of anaesthesia) the pioneer's patients used to breath NiOx straight out
>of a bag and were completely unconcious.
>> On Sat, 20 Sep 2003 23:10:07 +0200, (madiba) wrote:
>>
>> >V35B > wrote:
>> >
>> >> Your logic is incorrect. I am a professor of pharmacology at a Pharmacy
>> >> School.
>> >>
>> >>
>> >> > That's one of the reasons why it is dangerous for that purpose.
>> >>
>> >> It is not dangerous, you cannot be rendered unoncious with it. How can it
>> >> be dangerous?
>> >What a dumb statement from a so-called prof. of pharmacology!

--
Joel M. Eichen, .
Philadelphia PA

DISCLAIMER FOLLOWS:

*********

Dental health-related material
is provided for information purposes
only and does not necessarily
represent endorsement by or an official
position of the SciMedDentistry gang
or any other agency either actual
or fictioous.

Advice on the treatment or care
of an individual patient should
be obtained through consultation
with a dentist who has examined
that patient or is familiar with
that patient's dental history.

STANDARD DISCLAIMER

Joel M. Eichen D.D.S.
September 21st 03, 02:08 PM
That is not general anesthesia. One could not remove an appendix with
nitrous oxide!

It might be desirable if possible as N2O is far safer than drugs used
for GA.

On Sun, 21 Sep 2003 02:26:10 +0200, Mxsmanic >
wrote:

>Joel M. Eichen D.D.S. writes:
>
>> Sorry, the Prof is correct!
>
>You can certainly be rendered unconscious with nitrous oxide. You just
>can't be rendered _safely_ unconscious with it.

--
Joel M. Eichen, .
Philadelphia PA

DISCLAIMER FOLLOWS:

*********

Dental health-related material
is provided for information purposes
only and does not necessarily
represent endorsement by or an official
position of the SciMedDentistry gang
or any other agency either actual
or fictioous.

Advice on the treatment or care
of an individual patient should
be obtained through consultation
with a dentist who has examined
that patient or is familiar with
that patient's dental history.

STANDARD DISCLAIMER

Steven Bornfeld
September 21st 03, 08:08 PM
Joel M. Eichen D.D.S. wrote:
> That is not general anesthesia. One could not remove an appendix with
> nitrous oxide!
>
> It might be desirable if possible as N2O is far safer than drugs used
> for GA.
>
> On Sun, 21 Sep 2003 02:26:10 +0200, Mxsmanic >
> wrote:

Belive it or not, as late as 1977 I was in the OR (on my anesthesia
rotation at my residency) on a case using ethyl ether for anesthesia.
As you probably remember it is relatively non-toxic, but slow induction
and lots of nausea. Oh, and don't light a match.
Anyway, enough gets into the adipose tissue that for 24 hrs. the
patient (on a large public ward) was blowing off so much the whole place
stank of ether. It was really a strange piece of apparatus, too--like a
large copper kettle, as I recall.

Steve (from the days of the giants)


>
>
>>Joel M. Eichen D.D.S. writes:
>>
>>
>>>Sorry, the Prof is correct!
>>
>>You can certainly be rendered unconscious with nitrous oxide. You just
>>can't be rendered _safely_ unconscious with it.
>
>

Mxsmanic
September 22nd 03, 01:48 AM
Steven Bornfeld writes:

> Belive it or not, as late as 1977 I was in the OR (on my anesthesia
> rotation at my residency) on a case using ethyl ether for anesthesia.

Really? I thought it had been more or less abandoned by the 1970s. Any
particular reason for using it in this case?

> Anyway, enough gets into the adipose tissue that for 24 hrs. the
> patient (on a large public ward) was blowing off so much the whole place
> stank of ether.

I hope he wasn't a smoker!

I rather like the smell of ether. My mother hates it, as she was given
ether for some minor surgeries in her youth and she associates it with
severe nausea. I don't think I've ever been given it. I recall
smelling something odd through a mask when I had my tonsils out, but I
was very young, and I don't remember exactly what it smelled like. When
I had nitrous oxide for my wisdom teeth, it smelled strangely familiar,
but then again, so does ether.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Steven Bornfeld
September 22nd 03, 02:46 AM
Mxsmanic wrote:
> Steven Bornfeld writes:
>
>
>>Belive it or not, as late as 1977 I was in the OR (on my anesthesia
>>rotation at my residency) on a case using ethyl ether for anesthesia.
>
>
> Really? I thought it had been more or less abandoned by the 1970s. Any
> particular reason for using it in this case?

If there was, I didn't know. It was a teaching hospital, perhaps that
the attendings felt the residents still should have the experience.
OTOH, perhaps there was a problem with liver function. Most of the
patients were getting halothane or ethrane. IIRC, almost all the
patients, regardless of what the primary anesthetic agent, were getting
nitrous oxide through their endotracheal tube. Usually used an
ultrashort acting barbiturate for induction.

Steve

>
>
>>Anyway, enough gets into the adipose tissue that for 24 hrs. the
>>patient (on a large public ward) was blowing off so much the whole place
>>stank of ether.
>
>
> I hope he wasn't a smoker!
>
> I rather like the smell of ether. My mother hates it, as she was given
> ether for some minor surgeries in her youth and she associates it with
> severe nausea. I don't think I've ever been given it. I recall
> smelling something odd through a mask when I had my tonsils out, but I
> was very young, and I don't remember exactly what it smelled like. When
> I had nitrous oxide for my wisdom teeth, it smelled strangely familiar,
> but then again, so does ether.
>

Wendy
September 28th 03, 02:16 AM
In misc.kids.health Joel M. Eichen D.D.S. > wrote:
> N'udder pediatric dentist .... one more skilled in medications .......

Okay, here's the follow-up.

I found another dentist - a gentle, calm man whose work is highly
recommended - treats my best friend's children (their father is a dentist
but can't ever seem to get to his own kids since he's on active duty).

We went in to observe a cleaning. All fun and games. Then we went in
for an examination. No problems. I asked the dentist if he would
feel comfortable prescribing valium before the restoration work. The
dentist said no, he doesn't have any experience with it. (He doesn't use
nitrous oxide, either.) But his manner is so kind and gentle and
respectful and he explains things well. He was just what I was hoping
for.

So we went in for restoration work on the easiest tooth to reach. My son
cringed at the Q-tip with topical analgesic and we had to coax him to put
it in his mouth. Then he cried because it was burning in his mouth (the
warm tingly feeling.) We continued to coax him with toys and games and
stuff. The dentist went to give him the novacaine shot and my son
screamed bloody murder. The dentist stuck with it (literally) for a few
seconds but gave up with only half the shot administered. My son
continued to scream like a banshee in a high-pitched terror sort of way
and leaped into my arms like a monkey falling from a tree. The dentist
started writing out referral slips to other pediatric dentists.

I calmed the kid down, calmed the dentist down, and convinced them both to
try again now that his tooth was numb. I also left the room. I heard the
sobs from down the hall. Apparently all the dentist did was put a mirror
in his mouth. The dentist was calm, respectful, kind and honest.

But he threw us out, too. Oh, he was nice about it. He even called his
referral (a pediatric dentist 50 miles away) and discussed my son's case
with her. She called and left a message saying she'd like to try.

My best friend's husband (the dentist) and my son's pediatrician also have
given me referrals to a man who retired in June. I keep pointing out that
he isn't there anymore and they keep insisting that the guy who bought his
practice is probably just as nice because they worked together for
the last year. (It's an hour's drive each way and no one honestly knows
anything about the new guy.)

We have now been to 10 different dental visits in the past four months,
including three dentists and one oral surgeon and three different aborted
attempts to do the required restoration work.

I have absolutely no reason to think that either of the other two
pediatric dentists will have any more success with this child in a chair
than we've had so far.

Should I pursue this further? I still think valium would work. But I
discussed it with his pediatrician and two different dentists and no
one will prescribe it. God knows I'm not in favor of sedating the kid in
normal situations, but this extreme fearfulness needs to be addressed.

We've had an offer to do the work under GA in a hospital (from the
pediatric dentist I don't like who uses NO for teeth cleanings).
It won't happen until January. I really don't like the idea, though.

Is GA the way to go? Or do I keep driving him to more and more aborted
dentist appointments as if this is my bizarre new hobby? (Any second now
I'm going to be accused of Munchhausen's by Proxy with this kid.) It's
now taking most of a work day to get him to the dentist's and back (and I
have both a business to run and two other children who need me, too.)

(Just a bit of history for the people who didn't see earlier posts: my
kid had a traumatic hospitalization associated with near-fatal
perforated intestines and peritonitis at age 2.11 and presented with five
cavities out of the blue at age 3.11, in May. One was pulled by an oral
surgeon, the other four need to be restored, though God knows how.)

Wendy, who really, really, really hates going to the dentist

V35B
September 28th 03, 03:15 AM
This is an instance where teh dentists need to take some continuing
education. Valium works. Valium is very safe in children. 0.3mg per
pound so a 50 pound child would get 15mg. This is a hypnotic dose not a
sedative dose so it seems high, but its not.... This together with N2O
works almost all of the time.

Where do you live?



Wendy wrote:
> In misc.kids.health Joel M. Eichen D.D.S. > wrote:
>
>>N'udder pediatric dentist .... one more skilled in medications .......
>
>
> Okay, here's the follow-up.
>
> I found another dentist - a gentle, calm man whose work is highly
> recommended - treats my best friend's children (their father is a dentist
> but can't ever seem to get to his own kids since he's on active duty).
>
> We went in to observe a cleaning. All fun and games. Then we went in
> for an examination. No problems. I asked the dentist if he would
> feel comfortable prescribing valium before the restoration work. The
> dentist said no, he doesn't have any experience with it. (He doesn't use
> nitrous oxide, either.) But his manner is so kind and gentle and
> respectful and he explains things well. He was just what I was hoping
> for.
>
> So we went in for restoration work on the easiest tooth to reach. My son
> cringed at the Q-tip with topical analgesic and we had to coax him to put
> it in his mouth. Then he cried because it was burning in his mouth (the
> warm tingly feeling.) We continued to coax him with toys and games and
> stuff. The dentist went to give him the novacaine shot and my son
> screamed bloody murder. The dentist stuck with it (literally) for a few
> seconds but gave up with only half the shot administered. My son
> continued to scream like a banshee in a high-pitched terror sort of way
> and leaped into my arms like a monkey falling from a tree. The dentist
> started writing out referral slips to other pediatric dentists.
>
> I calmed the kid down, calmed the dentist down, and convinced them both to
> try again now that his tooth was numb. I also left the room. I heard the
> sobs from down the hall. Apparently all the dentist did was put a mirror
> in his mouth. The dentist was calm, respectful, kind and honest.
>
> But he threw us out, too. Oh, he was nice about it. He even called his
> referral (a pediatric dentist 50 miles away) and discussed my son's case
> with her. She called and left a message saying she'd like to try.
>
> My best friend's husband (the dentist) and my son's pediatrician also have
> given me referrals to a man who retired in June. I keep pointing out that
> he isn't there anymore and they keep insisting that the guy who bought his
> practice is probably just as nice because they worked together for
> the last year. (It's an hour's drive each way and no one honestly knows
> anything about the new guy.)
>
> We have now been to 10 different dental visits in the past four months,
> including three dentists and one oral surgeon and three different aborted
> attempts to do the required restoration work.
>
> I have absolutely no reason to think that either of the other two
> pediatric dentists will have any more success with this child in a chair
> than we've had so far.
>
> Should I pursue this further? I still think valium would work. But I
> discussed it with his pediatrician and two different dentists and no
> one will prescribe it. God knows I'm not in favor of sedating the kid in
> normal situations, but this extreme fearfulness needs to be addressed.
>
> We've had an offer to do the work under GA in a hospital (from the
> pediatric dentist I don't like who uses NO for teeth cleanings).
> It won't happen until January. I really don't like the idea, though.
>
> Is GA the way to go? Or do I keep driving him to more and more aborted
> dentist appointments as if this is my bizarre new hobby? (Any second now
> I'm going to be accused of Munchhausen's by Proxy with this kid.) It's
> now taking most of a work day to get him to the dentist's and back (and I
> have both a business to run and two other children who need me, too.)
>
> (Just a bit of history for the people who didn't see earlier posts: my
> kid had a traumatic hospitalization associated with near-fatal
> perforated intestines and peritonitis at age 2.11 and presented with five
> cavities out of the blue at age 3.11, in May. One was pulled by an oral
> surgeon, the other four need to be restored, though God knows how.)
>
> Wendy, who really, really, really hates going to the dentist

Dr. Steve
September 28th 03, 03:51 AM
Wendy,

I have seen Valium work well in kids and I have seen it work in an opposite
fashion and get the kid more worked up than usual.

All you are doing is training the kid to be a rotten dental patient. Take
the kid to the hospital and get the work done under GA. The child will
never remember a thing. It will be done and life will go on. If you keep
up the aborted dental appointments, the child will just learn to fear all
health professionals even more. It is past the time to give up and go the
other way.

--
=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+
Stephen Mancuso, D.D.S.
..
~`~`~`~`~`~`~`~`~`~`~`~`~`~`~`~`
Remove all but the last dot to email me


"Wendy" > wrote in message
...
> In misc.kids.health Joel M. Eichen D.D.S. > wrote:
> > N'udder pediatric dentist .... one more skilled in medications .......
>
> Okay, here's the follow-up.
>
> I found another dentist - a gentle, calm man whose work is highly
> recommended - treats my best friend's children (their father is a dentist
> but can't ever seem to get to his own kids since he's on active duty).
>
> We went in to observe a cleaning. All fun and games. Then we went in
> for an examination. No problems. I asked the dentist if he would
> feel comfortable prescribing valium before the restoration work. The
> dentist said no, he doesn't have any experience with it. (He doesn't use
> nitrous oxide, either.) But his manner is so kind and gentle and
> respectful and he explains things well. He was just what I was hoping
> for.
>
> So we went in for restoration work on the easiest tooth to reach. My son
> cringed at the Q-tip with topical analgesic and we had to coax him to put
> it in his mouth. Then he cried because it was burning in his mouth (the
> warm tingly feeling.) We continued to coax him with toys and games and
> stuff. The dentist went to give him the novacaine shot and my son
> screamed bloody murder. The dentist stuck with it (literally) for a few
> seconds but gave up with only half the shot administered. My son
> continued to scream like a banshee in a high-pitched terror sort of way
> and leaped into my arms like a monkey falling from a tree. The dentist
> started writing out referral slips to other pediatric dentists.
>
> I calmed the kid down, calmed the dentist down, and convinced them both to
> try again now that his tooth was numb. I also left the room. I heard the
> sobs from down the hall. Apparently all the dentist did was put a mirror
> in his mouth. The dentist was calm, respectful, kind and honest.
>
> But he threw us out, too. Oh, he was nice about it. He even called his
> referral (a pediatric dentist 50 miles away) and discussed my son's case
> with her. She called and left a message saying she'd like to try.
>
> My best friend's husband (the dentist) and my son's pediatrician also have
> given me referrals to a man who retired in June. I keep pointing out that
> he isn't there anymore and they keep insisting that the guy who bought his
> practice is probably just as nice because they worked together for
> the last year. (It's an hour's drive each way and no one honestly knows
> anything about the new guy.)
>
> We have now been to 10 different dental visits in the past four months,
> including three dentists and one oral surgeon and three different aborted
> attempts to do the required restoration work.
>
> I have absolutely no reason to think that either of the other two
> pediatric dentists will have any more success with this child in a chair
> than we've had so far.
>
> Should I pursue this further? I still think valium would work. But I
> discussed it with his pediatrician and two different dentists and no
> one will prescribe it. God knows I'm not in favor of sedating the kid in
> normal situations, but this extreme fearfulness needs to be addressed.
>
> We've had an offer to do the work under GA in a hospital (from the
> pediatric dentist I don't like who uses NO for teeth cleanings).
> It won't happen until January. I really don't like the idea, though.
>
> Is GA the way to go? Or do I keep driving him to more and more aborted
> dentist appointments as if this is my bizarre new hobby? (Any second now
> I'm going to be accused of Munchhausen's by Proxy with this kid.) It's
> now taking most of a work day to get him to the dentist's and back (and I
> have both a business to run and two other children who need me, too.)
>
> (Just a bit of history for the people who didn't see earlier posts: my
> kid had a traumatic hospitalization associated with near-fatal
> perforated intestines and peritonitis at age 2.11 and presented with five
> cavities out of the blue at age 3.11, in May. One was pulled by an oral
> surgeon, the other four need to be restored, though God knows how.)
>
> Wendy, who really, really, really hates going to the dentist

Wendy
September 28th 03, 04:28 AM
In misc.kids V35B > wrote:
> This is an instance where the dentists need to take some continuing
> education. Valium works. Valium is very safe in children. 0.3mg per
> pound so a 50 pound child would get 15mg. This is a hypnotic dose not a
> sedative dose so it seems high, but its not.... This together with N2O
> works almost all of the time.

The oral surgeon had us give our 28 pound child 4 mg of valium before the
extraction and used NO during the extraction. There were no problems.
But oral surgeons are different than dentists. I've not been able to
get either a dentist or his pediatrician to prescribe it. The dentist who
uses NO quite sensibly didn't want to have him so sedated that he might go
into respiratory distress (which I agreed with, I just wanted him to NOT
use the NO and use the valium instead, which he refused to do.)

The dentist we went to afterwards just said he never uses it and didn't
disagree that it would be useful (especially after the kid totally lost
it) he just doesn't feel comfortable using it himself. He'd just rather
turf a new patient who is that traumatized. I don't blame him.

> Where do you live?

New England, 90 miles from New Haven, 100 miles from Boston, and 200 miles
from New York City. Normally I like living in the boondocks.

Wendy

V35B
September 28th 03, 04:42 AM
Teh reason htat it has the opposite effectis that the does was not high
enough, IE the inhibitory mechanisms where inhibited.

A higher dose and concurrent use of N2O would work,,,,





Dr. Steve wrote:

> Wendy,
>
> I have seen Valium work well in kids and I have seen it work in an opposite
> fashion and get the kid more worked up than usual.
>
> All you are doing is training the kid to be a rotten dental patient. Take
> the kid to the hospital and get the work done under GA. The child will
> never remember a thing. It will be done and life will go on. If you keep
> up the aborted dental appointments, the child will just learn to fear all
> health professionals even more. It is past the time to give up and go the
> other way.
>

V35B
September 28th 03, 04:49 AM
My spelling is deplorable.....






V35B wrote:

> Teh reason htat it has the opposite effectis that the does was not high
> enough, IE the inhibitory mechanisms where inhibited.
>
> A higher dose and concurrent use of N2O would work,,,,
>
>
>
>
>
> Dr. Steve wrote:
>
>> Wendy,
>>
>> I have seen Valium work well in kids and I have seen it work in an
>> opposite
>> fashion and get the kid more worked up than usual.
>>
>> All you are doing is training the kid to be a rotten dental patient.
>> Take
>> the kid to the hospital and get the work done under GA. The child will
>> never remember a thing. It will be done and life will go on. If you
>> keep
>> up the aborted dental appointments, the child will just learn to fear all
>> health professionals even more. It is past the time to give up and go
>> the
>> other way.
>>
>

Mxsmanic
September 28th 03, 04:53 AM
Wendy writes:

> Should I pursue this further?

You should pursue psychological counseling for your child. I suppose
gneeral anesthetic is an option in this case (although it is likely to
be extraordinarily expensive and awkward), but that isn't going to help
the general problem. The fact that you've gone through so many dentists
without success demonstrates that it isn't the dentists.

> I still think valium would work. But I discussed it with his
> pediatrician and two different dentists and no one will prescribe
> it.

I don't blame them. It treats only a symptom, not the disease.

> God knows I'm not in favor of sedating the kid in
> normal situations, but this extreme fearfulness needs
> to be addressed.

You don't address it by knocking him out. He needs to see a
psychologist, or possibly a psychiatrist (who might indeed be willing to
prescribe drugs).

> We've had an offer to do the work under GA in a hospital (from the
> pediatric dentist I don't like who uses NO for teeth cleanings).
> It won't happen until January. I really don't like the idea, though.

There's always a risk to GA, and in minor surgery (and thus all the more
so in mere dental treatments), the risk of GA is higher than any other
risk.

> Is GA the way to go? Or do I keep driving him to more and more aborted
> dentist appointments as if this is my bizarre new hobby?

You should be driving him to the psychologist's office instead.

> Any second now I'm going to be accused of Munchhausen's
> by Proxy with this kid.

If this extreme response is limited to dental visits and he has no
dental history to explain it directory, then one tends to wonder how he
has been conditioned by his parents, particularly if one of them has a
morbid fear of dentists.

> Just a bit of history for the people who didn't see earlier posts: my
> kid had a traumatic hospitalization associated with near-fatal
> perforated intestines and peritonitis at age 2.11 and presented with five
> cavities out of the blue at age 3.11, in May. One was pulled by an oral
> surgeon, the other four need to be restored, though God knows how.

I nearly died of pneumonia at an age slightly younger than your son (I
_still_ remember lying in that crib with a net over it!), but that did
not seem to prevent me from seeing the dentist. Although they both seem
like doctors to kids, they are not quite the same. I was a difficult
dental patient, but our pediatric dentist wasn't that good, either
(neither I nor my sister could stand him). I wasn't nearly as difficult
as your son sounds, though--I got very scared and nervous but I
tolerated the injection and still behaved well once that (and any
x-rays) were out of the way.

> Wendy, who really, really, really hates going to the dentist

Apparently your son senses that.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Mxsmanic
September 28th 03, 04:55 AM
Wendy writes:

> ... I just wanted him to NOT use the NO and use the
> valium instead, which he refused to do.

The effects of nitrous oxide subside rapidly when the gas is withdrawn.
A poor or extreme reaction to valium would require active therapy to
counteract, so I can understand the dentist's reluctance.

> He'd just rather turf a new patient who is that
> traumatized. I don't blame him.

But your son hasn't been traumatized by a dentist, and I'm not at all
convinced that his medical experience in the past would transfer to the
dentist's office. I'd guess that something else is giving him this
intense fear of dentists.

By the way, how did you come to be so afraid of dentists yourself?

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Mxsmanic
September 28th 03, 04:57 AM
V35B writes:

> A higher dose and concurrent use of N2O would work,,,,

.... right into respiratory arrest. Hard to handle in a dentist's
office.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

dragonlady
September 28th 03, 05:05 AM
In article >,
Mxsmanic > wrote:

> Wendy writes:
>
> > Should I pursue this further?
>
> You should pursue psychological counseling for your child. I suppose
> gneeral anesthetic is an option in this case (although it is likely to
> be extraordinarily expensive and awkward), but that isn't going to help
> the general problem. The fact that you've gone through so many dentists
> without success demonstrates that it isn't the dentists.

I'm not sure that's called for, although a few visits with someone who
specializes in dealing with children's fears couldn't hurt.

I don't oppose using mental health professionals; I haven't seen
anything else that indicates this child is difficult about anything
except this.

However, her primary concern is getting the teeth treated, and not doing
so until psychological counseling gets him over his fear doesn't sound
like a real good idea.

>
> > I still think valium would work. But I discussed it with his
> > pediatrician and two different dentists and no one will prescribe
> > it.
>
> I don't blame them. It treats only a symptom, not the disease.

But sometimes the symptoms need to be treated, too. For a time, I
struggled with horrible tension headaches. Once we figured out that's
what they were, I was sent for some counseling. Fortunately, in the
meantime the doctor gave me strong enough pain pills to knock out the
headaches -- we both knew that was only treating the symptom, and I had
to find a way to face and deal with some stress in my life -- but he
didn't insist on NOT treating the headaches!

>
> > God knows I'm not in favor of sedating the kid in
> > normal situations, but this extreme fearfulness needs
> > to be addressed.
>
> You don't address it by knocking him out. He needs to see a
> psychologist, or possibly a psychiatrist (who might indeed be willing to
> prescribe drugs).
>
> > We've had an offer to do the work under GA in a hospital (from the
> > pediatric dentist I don't like who uses NO for teeth cleanings).
> > It won't happen until January. I really don't like the idea, though.
>
> There's always a risk to GA, and in minor surgery (and thus all the more
> so in mere dental treatments), the risk of GA is higher than any other
> risk.
>
> > Is GA the way to go? Or do I keep driving him to more and more aborted
> > dentist appointments as if this is my bizarre new hobby?
>
> You should be driving him to the psychologist's office instead.
>
> > Any second now I'm going to be accused of Munchhausen's
> > by Proxy with this kid.
>
> If this extreme response is limited to dental visits and he has no
> dental history to explain it directory, then one tends to wonder how he
> has been conditioned by his parents, particularly if one of them has a
> morbid fear of dentists.

That's a little harsh, and in this case most likely inaccurate. He does
have some history that would explain his fear, but even if he didn't
there does not need to be conditioning by a parent for a child to
develop fears!

I had two kids develop phobic responses to things that bothered neither
their other parent nor me -- one to bugs (of any sort; lots of fun in
Wisconsin and Massachusetts!) and one to dogs. There did not seem to be
any preceeding event to trigger their reactions.

Kids sometimes develop extreme fear reactions to things; to assume that
a parent has somehow conditioned the child to be afraid is a way of
assigning blame where it doesn't belong: kids are perfectly capable of
developing irrational and extreme fears without their parents' help!


> > Wendy, who really, really, really hates going to the dentist
>
> Apparently your son senses that.

I'm pretty sure she means since this problem came up; it doesn't sound
like it's been a lot of fun for her OR for her son.

meh

meh
--
Children won't care how much you know until they know how much you care

V35B
September 28th 03, 10:49 AM
Sorry but your are most incorrect.

0.3mg per pound is no where near the threshold for respiratory arrest.
Valium has a wide therepetic index. You have a fear for this drug
because you are obviously ignorant of its action. All the better you
shouldn't use it on your patients.





Mxsmanic wrote:

> V35B writes:
>
>
>>A higher dose and concurrent use of N2O would work,,,,
>
>
> ... right into respiratory arrest. Hard to handle in a dentist's
> office.
>

Wendy
September 28th 03, 06:52 PM
In misc.kids Mxsmanic > wrote:
> Wendy writes:

>> Should I pursue this further?

> You should pursue psychological counseling for your child. I suppose
> gneeral anesthetic is an option in this case (although it is likely to
> be extraordinarily expensive and awkward), but that isn't going to help
> the general problem. The fact that you've gone through so many dentists
> without success demonstrates that it isn't the dentists.

My son is starting to freak over mere sensation at this point. It is
definitely psychologically related. He is fearful of rain falling on him,
he is terrified of bandaids pulling against his skin when he clothes touch
him, and he hates the feel of anything against his skin like Q-tips of
analgesic or a dental mirror against his cheeks. Yes, psychological
counseling sounds appropriate.

>> Wendy, who really, really, really hates going to the dentist

> Apparently your son senses that.

This isn't apparent to me. It's only the attempts at restoration that
have caused problems, and the sensory thing is excelerating
it. He didn't freak out until he had the NO. He complained of
having to breath in the funny smelling/feeling thing. He behaved quite
well with X-rays, cleanings and exams. He is compliant in the chair right
up until something feels funny. It's not the dentist he fears, it's the
unusual sensation.

Besides, he does this with his father, too. And I don't *fear* going to
the dentist, I just find it painful and annoyingly necessary. I haven't
shared any pain stories with my son and I have brought him repeatedly to
people I trusted and had no fears for his safety. In fact, I keep wishing
the dentists would stick with it and work with him rather than keep
turfing him!

Wendy

Wendy
September 28th 03, 07:04 PM
In misc.kids Dr. Steve > wrote:
> Wendy,

> I have seen Valium work well in kids and I have seen it work in an opposite
> fashion and get the kid more worked up than usual.

I've seen paradoxical effects on several drugs in my kids. I just thought
it was worth a try because of the high anxiety level AND I've seen it work
in this very same kid before.

> All you are doing is training the kid to be a rotten dental patient. Take
> the kid to the hospital and get the work done under GA. The child will
> never remember a thing. It will be done and life will go on. If you keep
> up the aborted dental appointments, the child will just learn to fear all
> health professionals even more. It is past the time to give up and go the
> other way.

I agree. I feel guilty about not taking the referrals that three trusted
professionals took the time to call and pre-screen for me. But I can't
help but think it would be wasted time unless we do the pre-appt sedative.

But I disagree that he fears health professionals. He's fine with health
professionals. He fears pain. His anxiety level about pain is off the
charts. It's spread from pain to mere sensation.

But I did call the pediatric dentist who does hospital dentistry and asked
him to schedule the procedure for January. Why January? They're already
scheduling months out and by putting it in January instead of December I
can save hundreds if not thousands of dollars because a.) we've used up
his dental insurance cap this year and b.) I can put money in a Medical
Reimbursement Plan to pay for it in pre-tax dollars. It also allows
the GA to serve as a backup while I pursue the sedative/new dentist option.

I'm worried that this monetary concern will be considered abuse (the
pediatric dentist is the one who doesn't trust me). I didn't tell them I
was shopping him around at other dentists. (Isn't it funny how lack of
trust engenders lack of trustworthyness?)

-- Wendy

Mxsmanic
September 28th 03, 10:04 PM
Wendy writes:

> He is fearful of rain falling on him, he is terrified
> of bandaids pulling against his skin when he clothes touch
> him, and he hates the feel of anything against his skin
> like Q-tips of analgesic or a dental mirror against his
> cheeks. Yes, psychological counseling sounds appropriate.

It sounds like a serious problem, unless there is some physiological
basis for his hypersensitivity, but that is unlikely.

> It's not the dentist he fears, it's the unusual sensation.

How long has he been this way?

Most small children are wary of unfamiliar sensations, even non-painful
ones (whence the occasionally fear or crying at the barber shop or when
having nails trimmed, etc.). Your son sounds like he has carried this
to a neurotic extreme.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Dr. Steve
September 28th 03, 10:54 PM
Wendy,

A parent's fear of dentistry is almost always transferred to the child. The
child watches and listens much more than we (as parents) realize. I will
say that I have NEVER seen a frightened child who did NOT also have
frightened parents. You obviously don't trust the opinions you have
received and moved on to try another office to see if they will do it *your*
way. That sign of mis-trust gets felt by the child. If you don't trust the
dentist and what he/she says, the child will not trust either.

Waiting until January (remember I have not examined this child) may or may
not make the problems worse. I hope you are not post-poning due to fear,
because that will transfer to the child, too. I hope you do not experience
any quilt if waiting 4 more months to get the teeth fixed results in dental
pain, impaired dental growth or development, speech impairment, poor
nutrition due to poor chewing, poor sleep due to pain, etc. I hope the
money you save is worth it to the child. Medical bills never come when we
are prepared for them. That is why we have banks and finance companies.

Get the child's teeth fixed in a fashion that cannot traumatize him further.
Then, find a way to deal with the multiple phobias in your own time,
(hopefully rather quickly).

--
=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+
Stephen Mancuso, D.D.S.
..
~`~`~`~`~`~`~`~`~`~`~`~`~`~`~`~`
Remove all but the last dot to email me


"Wendy" > wrote in message
...
> In misc.kids Dr. Steve > wrote:
> > Wendy,
>
> > I have seen Valium work well in kids and I have seen it work in an
opposite
> > fashion and get the kid more worked up than usual.
>
> I've seen paradoxical effects on several drugs in my kids. I just thought
> it was worth a try because of the high anxiety level AND I've seen it work
> in this very same kid before.
>
> > All you are doing is training the kid to be a rotten dental patient.
Take
> > the kid to the hospital and get the work done under GA. The child will
> > never remember a thing. It will be done and life will go on. If you
keep
> > up the aborted dental appointments, the child will just learn to fear
all
> > health professionals even more. It is past the time to give up and go
the
> > other way.
>
> I agree. I feel guilty about not taking the referrals that three trusted
> professionals took the time to call and pre-screen for me. But I can't
> help but think it would be wasted time unless we do the pre-appt sedative.
>
> But I disagree that he fears health professionals. He's fine with health
> professionals. He fears pain. His anxiety level about pain is off the
> charts. It's spread from pain to mere sensation.
>
> But I did call the pediatric dentist who does hospital dentistry and asked
> him to schedule the procedure for January. Why January? They're already
> scheduling months out and by putting it in January instead of December I
> can save hundreds if not thousands of dollars because a.) we've used up
> his dental insurance cap this year and b.) I can put money in a Medical
> Reimbursement Plan to pay for it in pre-tax dollars. It also allows
> the GA to serve as a backup while I pursue the sedative/new dentist
option.
>
> I'm worried that this monetary concern will be considered abuse (the
> pediatric dentist is the one who doesn't trust me). I didn't tell them I
> was shopping him around at other dentists. (Isn't it funny how lack of
> trust engenders lack of trustworthyness?)
>
> -- Wendy

Wendy
September 29th 03, 12:56 AM
In misc.kids dragonlady > wrote:

> That's a little harsh, and in this case most likely inaccurate. He does
> have some history that would explain his fear, but even if he didn't
> there does not need to be conditioning by a parent for a child to
> develop fears!

In May of 2002 he required emergency surgery for perforated intestines and
peritonitis. This involved three hours of surgery during which
they pulled all his intestines out of his body and went through
them inch by inch. Following the surgery on the ward I cried plaintively
for them to help my son with his pain. I was ignored as a hysterical
mother. He went 12 hours post surgery without morphine until a family
member who's an R.N. showed up and taught me the right language: "Give
him 1 mg of morphine NOW!"

We continued to struggle to get him meds the entire time. He was
frequently in severe pain. Most of the nurses thought he had had
laparoscopic surgery. The rest of them had some puritan reason for not
letting him have morphine. Even when the doctor put him on scheduled
morphine (because they weren't responding to my requests) they still
skipped doses. I frequently had to ask them three times. Once I fell
asleep and they deliberately skipped his 2 am dose. I woke at 6 to find
him in a rictis of pain.

Right before he left a new resident came in and yanked out a drainage tube
that was stitched in place. It was ghastly and painful beyond belief.

Shortly after we got out of the hospital we went for a haircut and the
barber sprayed water on his head and he totally freaked out. He hasn't
allowed us to get his head wet ever since. (Hair washing is very
traumatic at our house.) I don't get the connection, but he's got one.

I have no particular reason to think that the trauma he underwent left him
unscarred. Nor would I call his avoidance of pain "irrational". The kid
has handled more pain in his young life than I hope you ever see.

I don't think giving him anti-anxiety meds before a procedure is such a
bad idea.

Wendy

madiba
September 29th 03, 04:43 PM
V35B > wrote:

> Sorry but your are most incorrect.
>
> 0.3mg per pound is no where near the threshold for respiratory arrest.
> Valium has a wide therepetic index. You have a fear for this drug
> because you are obviously ignorant of its action. All the better you
> shouldn't use it on your patients.
>
Oh shuddup V35B, few posts back you were prescribing 3mg/lb.
Make up your mind, professor. Your hair-brained pharmacology is ok in a
vet clinic or in Bucharest, in the west you go to jail for putting kids
to sleep forever..
Generally for sedating (they don't need to sleep) kids 1-6 years of age
a dose of 1 -6-mg/DAY is enough, older kids 2-10mg/day.
I (and Mxsmanic I think) are aware of the problems of Valium as opposed
to other benzodiazepines.. Respiratory arrest IS a problem, I would
personally never use it in kids outside an OP-room unless a real
indication is there (for example an epileptic fit).
>
>
> Mxsmanic wrote:
>
> > V35B writes:
> >
> >
> >>A higher dose and concurrent use of N2O would work,,,,
> >
> >
> > ... right into respiratory arrest. Hard to handle in a dentist's
> > office.
> >

--
madiba

Hillary Israeli
September 29th 03, 05:41 PM
In >,
madiba > wrote:

*V35B > wrote:
*
*> Sorry but your are most incorrect.
*>
*> 0.3mg per pound is no where near the threshold for respiratory arrest.
*> Valium has a wide therepetic index. You have a fear for this drug
*> because you are obviously ignorant of its action. All the better you
*> shouldn't use it on your patients.
*>
*Oh shuddup V35B, few posts back you were prescribing 3mg/lb.
*Make up your mind, professor. Your hair-brained pharmacology is ok in a
*vet clinic or in Bucharest, in the west you go to jail for putting kids
*to sleep forever..

Neither hair-brained nor hare-brained pharmacology is ok in a vet clinic,
actually. Just in case anyone is paying attention here.

--
hillary israeli vmd http://www.hillary.net
"uber vaccae in quattuor partes divisum est."
not-so-newly minted veterinarian-at-large :)

V35B
September 29th 03, 05:48 PM
Wrong. The reccommendation is 0.3mg per pound. No matter what you
think, this is the current thinking. And, as another poster noted this
is a safe dose.

OF course there is not sense in arguing with someone like yourself.....


You obviously lack experience and knowledge in this area.

Do yourself and the patient a favor and refer any patients that need
sedation out to someone who can handle it.....

madiba wrote:
> V35B > wrote:
>
>
>>Sorry but your are most incorrect.
>>
>>0.3mg per pound is no where near the threshold for respiratory arrest.
>>Valium has a wide therepetic index. You have a fear for this drug
>>because you are obviously ignorant of its action. All the better you
>>shouldn't use it on your patients.
>>
>
> Oh shuddup V35B, few posts back you were prescribing 3mg/lb.
> Make up your mind, professor. Your hair-brained pharmacology is ok in a
> vet clinic or in Bucharest, in the west you go to jail for putting kids
> to sleep forever..
> Generally for sedating (they don't need to sleep) kids 1-6 years of age
> a dose of 1 -6-mg/DAY is enough, older kids 2-10mg/day.
> I (and Mxsmanic I think) are aware of the problems of Valium as opposed
> to other benzodiazepines.. Respiratory arrest IS a problem, I would
> personally never use it in kids outside an OP-room unless a real
> indication is there (for example an epileptic fit).
>
>>
>>Mxsmanic wrote:
>>
>>
>>>V35B writes:
>>>
>>>
>>>
>>>>A higher dose and concurrent use of N2O would work,,,,
>>>
>>>
>>>... right into respiratory arrest. Hard to handle in a dentist's
>>>office.
>>>
>
>

Joel M. Eichen D.D.S.
September 29th 03, 10:42 PM
Yup, thanks!

One could say those dudes are barking up the wrong tree .....


Joel


On Mon, 29 Sep 2003 16:41:52 +0000 (UTC), (Hillary
Israeli) wrote:

>In >,
>madiba > wrote:
>
>*V35B > wrote:
>*
>*> Sorry but your are most incorrect.
>*>
>*> 0.3mg per pound is no where near the threshold for respiratory arrest.
>*> Valium has a wide therepetic index. You have a fear for this drug
>*> because you are obviously ignorant of its action. All the better you
>*> shouldn't use it on your patients.
>*>
>*Oh shuddup V35B, few posts back you were prescribing 3mg/lb.
>*Make up your mind, professor. Your hair-brained pharmacology is ok in a
>*vet clinic or in Bucharest, in the west you go to jail for putting kids
>*to sleep forever..
>
>Neither hair-brained nor hare-brained pharmacology is ok in a vet clinic,
>actually. Just in case anyone is paying attention here.

--
Joel M. Eichen, .
Philadelphia PA

DISCLAIMER FOLLOWS:

*********

Dental health-related material
is provided for information purposes
only and does not necessarily
represent endorsement by or an official
position of the SciMedDentistry gang
or any other official agency either
actual or fictitious or Steve Mancuso.

Advice on the treatment or care
of an individual patient should
be obtained through consultation
with a dentist who has examined
that patient or is familiar with
that patient's dental history.

STANDARD DISCLAIMER

Tsam
September 30th 03, 12:33 AM
In article >,
says...
> Wendy,
>
> A parent's fear of dentistry is almost always transferred to the child.

Heh. I remember the first time I heard about "drilling" teeth, at about
age four or so. This was extremely unsettling, because my dad was a
carpenter and the only drill I was familiar at the time with was a power
drill. So I had this mental image of a big, muscled, sweaty guy
wielding a big ass Black&Decker with a footlong half-inch-diameter twist
bit... OPEN WIDE, BOY.

(You laugh, but thirty years later an oral surgeon whipped out a set of
bits used for drilling holes for implants, and damned if the largest one
didn't look eerily similar to some of the smaller bits that dear old dad
used to use in the woodshop. Yikes. Crank up that nitrous a bit more,
doc, you're scaring me.)

Rosalie B.
September 30th 03, 02:10 AM
Tsam > wrote:

>In article >,
says...
>> Wendy,
>>
>> A parent's fear of dentistry is almost always transferred to the child.

I've been following this thread kind of casually. Neither my husband nor I
are afraid of the dentist. But out of 4 children, one (now grown) child
who is a bit phobic. So whose fault is that? I'd bet on the dentist(s).

Not everything is the parent's fault.

grandma Rosalie

Mxsmanic
September 30th 03, 02:21 AM
Tsam writes:

> You laugh, but thirty years later an oral surgeon whipped out a set of
> bits used for drilling holes for implants, and damned if the largest one
> didn't look eerily similar to some of the smaller bits that dear old dad
> used to use in the woodshop.

Bone is a lot harder than wood. Ask a brain surgeon for a peek into his
toolbox sometime.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Dr. Steve
September 30th 03, 03:43 AM
Sure a crummy dentist can make a kid afraid of dentistry. But, a parent who
is frightened of dentistry tends to *usually* extend that fear right into
the child. Now I have seen some very thoughtful frightened parents who
worked very hard not teach their children to be frightened of dentistry.
But, most parents just never notice all the negative remarks they make and
the various faces they make which the kids see and hear.

--
=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+
Stephen Mancuso, D.D.S.
..
~`~`~`~`~`~`~`~`~`~`~`~`~`~`~`~`
Remove all but the last dot to email me


"Rosalie B." > wrote in message
...
> Tsam > wrote:
>
> >In article >,
> says...
> >> Wendy,
> >>
> >> A parent's fear of dentistry is almost always transferred to the child.
>
> I've been following this thread kind of casually. Neither my husband nor
I
> are afraid of the dentist. But out of 4 children, one (now grown) child
> who is a bit phobic. So whose fault is that? I'd bet on the dentist(s).
>
> Not everything is the parent's fault.
>
> grandma Rosalie

carabelli
September 30th 03, 03:59 AM
"Dr. Steve" > wrote in message
.com...
> Sure a crummy dentist can make a kid afraid of dentistry. But, a parent
who
> is frightened of dentistry tends to *usually* extend that fear right into
> the child. Now I have seen some very thoughtful frightened parents who
> worked very hard not teach their children to be frightened of dentistry.
> But, most parents just never notice all the negative remarks they make and
> the various faces they make which the kids see and hear.

Steve - how's the asst situation now? Been there done that.

I think a lot of parents do try (to the best of their ability) however they
don't know how to approach it. It ends up being doubly frustrating for them
and by the time they get home guess who is the bad guy?

This weekend while watching the Chiefs (or maybe it was the KU-MU game which
I am sure Steve Fawks taped for me) I saw an ad for some major company (I
forget who - with good reason) with some guy screaming in a dental chair.
Of course it had nothing to do with their product, just an attention
grabber. This stuff does nothing but drive the very ones that need it, away
from the general dentist.

I understand it is an advertising grabber and an easy laugh in a sitcom but
watch closely. It's out there on the tube far too often and reinforces
preconceptions reflecting old dentistry and old attitudes that do not apply
in a modern dental office. I wonder if these people realise the problems
people could easily have resolved if they were not projecting their own
fears or ignorance.

If it hurts find another dentist. It shouldn't

carabelli

Mxsmanic
September 30th 03, 09:42 AM
carabelli writes:

> If it hurts find another dentist. It shouldn't

It's worrisome to me that people still fear dentists today. Anesthesia
has been around for generations, and dentistry when properly practiced
is essentially painless. Why are so many people still afraid of pain?
Just how many dentists are there out there who still don't know how to
administer anesthesia properly?

My current dentist is painless. So were all my previous dentists. Even
the pediatric dentist who worked on me when I was little was painless; I
didn't care for him and I hated going to the dentist, but it wasn't
really because of pain (it was mainly because of x-rays and his
chairside manner, mainly).

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Joel M. Eichen D.D.S.
September 30th 03, 09:52 AM
On Tue, 30 Sep 2003 10:42:18 +0200, Mxsmanic >
wrote:

>carabelli writes:
>
>> If it hurts find another dentist. It shouldn't
>
>It's worrisome to me that people still fear dentists today. Anesthesia
>has been around for generations, and dentistry when properly practiced
>is essentially painless. Why are so many people still afraid of pain?
>Just how many dentists are there out there who still don't know how to
>administer anesthesia properly?

REPLY:

Lots of dentists, based on many reports here and elsewhere. The main
problem as I see it is respect. All of us, patients and doctors need
to respect ourselves more and therefore stand up for ourselves more.

If it hurts, that is an internal perception. Someone saying, "this
isn't going to hurt a bit," is playing a psychological game that has
lasting impressions. Its also dishonest.

How many times during the course of a day do people lie to each of us
with a nice smile on their faces? This is why we 'gots what we gots,'
in my opinion.


Joel


>
>My current dentist is painless. So were all my previous dentists. Even
>the pediatric dentist who worked on me when I was little was painless; I
>didn't care for him and I hated going to the dentist, but it wasn't
>really because of pain (it was mainly because of x-rays and his
>chairside manner, mainly).

--
Joel M. Eichen, .
Philadelphia PA

DISCLAIMER FOLLOWS:

*********

Dental health-related material
is provided for information purposes
only and does not necessarily
represent endorsement by or an official
position of the SciMedDentistry gang
or any other official agency either
actual or fictitious or Steve Mancuso.

Advice on the treatment or care
of an individual patient should
be obtained through consultation
with a dentist who has examined
that patient or is familiar with
that patient's dental history.

STANDARD DISCLAIMER

Joel M. Eichen D.D.S.
September 30th 03, 09:54 AM
On Tue, 30 Sep 2003 03:21:48 +0200, Mxsmanic >
wrote:

>Tsam writes:
>
>> You laugh, but thirty years later an oral surgeon whipped out a set of
>> bits used for drilling holes for implants, and damned if the largest one
>> didn't look eerily similar to some of the smaller bits that dear old dad
>> used to use in the woodshop.
>
>Bone is a lot harder than wood. Ask a brain surgeon for a peek into his
>toolbox sometime.

Not necessarily. There is a cortical plate covering a spongier type of
bone. Bone is filled with blood vessels, etc.


Joel



--
Joel M. Eichen, .
Philadelphia PA

DISCLAIMER FOLLOWS:

*********

Dental health-related material
is provided for information purposes
only and does not necessarily
represent endorsement by or an official
position of the SciMedDentistry gang
or any other official agency either
actual or fictitious or Steve Mancuso.

Advice on the treatment or care
of an individual patient should
be obtained through consultation
with a dentist who has examined
that patient or is familiar with
that patient's dental history.

STANDARD DISCLAIMER

Hillary Israeli
September 30th 03, 12:47 PM
In >,
Mxsmanic > wrote:

*carabelli writes:
*
*> If it hurts find another dentist. It shouldn't
*
*It's worrisome to me that people still fear dentists today. Anesthesia
*has been around for generations, and dentistry when properly practiced
*is essentially painless. Why are so many people still afraid of pain?
*Just how many dentists are there out there who still don't know how to
*administer anesthesia properly?

I didn't have any fear of dentists as a kid. My dentist, a kindly old man
who was also my grandmother's dentist when she came to this country, and
my mom's dentist all through growing up etc, seemingly never heard of
anesthesia and certainly never practiced it on me. I had a couple of teeth
pulled in his office, and a LOT of fillings, and honestly while I do
remember that one infected deciduous tooth was VERY painful, none of the
other procedures were, and I had no fear of the man. Then I went to
college and got a new dentist who found a cavity and approached my mouth
with a big honkin' needle. I was taken aback and asked what on earth he
was doing. He said he was going to numb me up. He was shocked I'd never
had that before, since I had so many fillings. I let him, but man that
shot hurt like a son of a b*tch, and now I am afraid of dentists a little
bit. FWIW.


--
hillary israeli vmd http://www.hillary.net
"uber vaccae in quattuor partes divisum est."
not-so-newly minted veterinarian-at-large :)

Mxsmanic
September 30th 03, 01:10 PM
Joel M. Eichen D.D.S. writes:

> Not necessarily. There is a cortical plate covering a spongier type of
> bone. Bone is filled with blood vessels, etc.

Well, you still have to drill through the plate.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Dr Steve
September 30th 03, 02:07 PM
Hi Dan,

I am training a new DA right now. Hired this young lady off the street (no
dental experience). Dynamite gal ! She only needs to be shown things once.
learns instantly, has a great attitude, smiles a lot, is happy all day long,
and is looking for more things to learn all day long. She is already asking
about how to get certified. <VBG>

--
~+--~+--~+--~+--~+--
Stephen Mancuso, D.D.S.
Troy, Michigan, USA
DrSteve Q Mancusodds.com
{change the center letter to "at" (and drop two spaces) for email}
.................................................. ...

This posting is intended for informational or conversational purposes only.
Always seek the opinion of a licensed dental professional before acting on
the advice or opinion expressed here. Only a dentist who has examined you
in person can diagnose your problems and make decisions which will affect
your health.
.......................
Please ignore j..d...
~~~~``````````#####----

"carabelli" > wrote in message
...
>
> "Dr. Steve" > wrote in message
> .com...
> > Sure a crummy dentist can make a kid afraid of dentistry. But, a parent
> who
> > is frightened of dentistry tends to *usually* extend that fear right
into
> > the child. Now I have seen some very thoughtful frightened parents who
> > worked very hard not teach their children to be frightened of dentistry.
> > But, most parents just never notice all the negative remarks they make
and
> > the various faces they make which the kids see and hear.
>
> Steve - how's the asst situation now? Been there done that.
>
> I think a lot of parents do try (to the best of their ability) however
they
> don't know how to approach it. It ends up being doubly frustrating for
them
> and by the time they get home guess who is the bad guy?
>
> This weekend while watching the Chiefs (or maybe it was the KU-MU game
which
> I am sure Steve Fawks taped for me) I saw an ad for some major company (I
> forget who - with good reason) with some guy screaming in a dental chair.
> Of course it had nothing to do with their product, just an attention
> grabber. This stuff does nothing but drive the very ones that need it,
away
> from the general dentist.
>
> I understand it is an advertising grabber and an easy laugh in a sitcom
but
> watch closely. It's out there on the tube far too often and reinforces
> preconceptions reflecting old dentistry and old attitudes that do not
apply
> in a modern dental office. I wonder if these people realise the problems
> people could easily have resolved if they were not projecting their own
> fears or ignorance.
>
> If it hurts find another dentist. It shouldn't
>
> carabelli
>
>
>

Dr Steve
September 30th 03, 02:17 PM
I don't know how many times I have seen parents describe the entire dental
experience to a young child, trying to make it sound as gentle and innocent
as possible. They tell the kid "it won't hurt" when we stick the sharp
metal instruments in their mouth. "It won't hurt" when they put that hard
thing in your mouth to get x-ray pictures. "Just close your eyes" if that
huge bright light is too powerful. The kid listens between the lines and
figures the parent is bringing these things up because the parent is
frightened and the kid becomes scared. Or, the kid just hears the "sharp',
"hard", "powerfully bright" part, and gets scared.

Kids do best when the parents say ZERO about the dental office before
bringing the kid in, and if they never make a big deal out how the kid did
at the office. Keep it low key and normal.

Often, the parents mess the kids up before we ever get to see them, and the
parents were trying their best to help.

Kids do best when they are a "blank slate" the first time we see them. At
most, sneak a Barney video or read a child's book which has a kid going to
the dentist, in the middle of a bunch of there ones so the kid does not
perceive it as anything special.

~+--~+--~+--~+--~+--
Stephen Mancuso, D.D.S.
Troy, Michigan, USA
DrSteve Q Mancusodds.com
{change the center letter to "at" (and drop two spaces) for email}
.................................................. ...

This posting is intended for informational or conversational purposes only.
Always seek the opinion of a licensed dental professional before acting on
the advice or opinion expressed here. Only a dentist who has examined you
in person can diagnose your problems and make decisions which will affect
your health.
.......................
Please ignore j..d...
~~~~``````````#####----

"carabelli" > wrote in message
...
>
> "Dr. Steve" > wrote in message
> .com...
> > Sure a crummy dentist can make a kid afraid of dentistry. But, a parent
> who
> > is frightened of dentistry tends to *usually* extend that fear right
into
> > the child. Now I have seen some very thoughtful frightened parents who
> > worked very hard not teach their children to be frightened of dentistry.
> > But, most parents just never notice all the negative remarks they make
and
> > the various faces they make which the kids see and hear.
>
> Steve - how's the asst situation now? Been there done that.
>
> I think a lot of parents do try (to the best of their ability) however
they
> don't know how to approach it. It ends up being doubly frustrating for
them
> and by the time they get home guess who is the bad guy?
>
> This weekend while watching the Chiefs (or maybe it was the KU-MU game
which
> I am sure Steve Fawks taped for me) I saw an ad for some major company (I
> forget who - with good reason) with some guy screaming in a dental chair.
> Of course it had nothing to do with their product, just an attention
> grabber. This stuff does nothing but drive the very ones that need it,
away
> from the general dentist.
>
> I understand it is an advertising grabber and an easy laugh in a sitcom
but
> watch closely. It's out there on the tube far too often and reinforces
> preconceptions reflecting old dentistry and old attitudes that do not
apply
> in a modern dental office. I wonder if these people realise the problems
> people could easily have resolved if they were not projecting their own
> fears or ignorance.
>
> If it hurts find another dentist. It shouldn't
>
> carabelli
>
>
>

Dr Steve
September 30th 03, 02:23 PM
Pain is a relative thing. It can not be measured or described. It is also
directly proportional to emotional state.

So, those patients who are afraid of dentistry, are notoriously difficult to
get fully numb. They get their system worked up to a point that sometimes
NO amount of local anesthetic will work. Couple that with them coming in to
the office after years of neglect with a swollen face that needs attention
NOW. Afterwards, they will think this dentist does not know how to give
anesthetic. Ideally, the dentist would give medications and bring the
patient back, but sometimes, that is just not a very good choice. Also,
some patients will hide their anxiety well enough that the dentist thinks
they are numb and get part-way into a RCT, only to discover the patient is
still feeling it. The dentist can put the anesthetic directly into the RCT
and get the tooth completely numb at that point despite the emotional state,
but the patient will feel pain while the anesthetic is injected inside the
tooth.

Add to the mix that there are probably some dentists who are not very good
at using anesthetic, but judging by what I have seen in school and after, I
think that is a VERY minor part of the equation.

--
~+--~+--~+--~+--~+--
Stephen Mancuso, D.D.S.
Troy, Michigan, USA
DrSteve Q Mancusodds.com
{change the center letter to "at" (and drop two spaces) for email}
.................................................. ...

This posting is intended for informational or conversational purposes only.
Always seek the opinion of a licensed dental professional before acting on
the advice or opinion expressed here. Only a dentist who has examined you
in person can diagnose your problems and make decisions which will affect
your health.
.......................
Please ignore j..d...
~~~~``````````#####----

"Mxsmanic" > wrote in message
...
> carabelli writes:
>
> > If it hurts find another dentist. It shouldn't
>
> It's worrisome to me that people still fear dentists today. Anesthesia
> has been around for generations, and dentistry when properly practiced
> is essentially painless. Why are so many people still afraid of pain?
> Just how many dentists are there out there who still don't know how to
> administer anesthesia properly?
>
> My current dentist is painless. So were all my previous dentists. Even
> the pediatric dentist who worked on me when I was little was painless; I
> didn't care for him and I hated going to the dentist, but it wasn't
> really because of pain (it was mainly because of x-rays and his
> chairside manner, mainly).
>
> --
> Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

madiba
September 30th 03, 02:50 PM
Wendy > wrote:

> In misc.kids dragonlady > wrote:
>
> > That's a little harsh, and in this case most likely inaccurate. He does
> > have some history that would explain his fear, but even if he didn't
> > there does not need to be conditioning by a parent for a child to
> > develop fears!
>
> In May of 2002 he required emergency surgery for perforated intestines and
> peritonitis. This involved three hours of surgery during which
> they pulled all his intestines out of his body and went through
> them inch by inch. Following the surgery on the ward I cried plaintively
> for them to help my son with his pain. I was ignored as a hysterical
> mother. He went 12 hours post surgery without morphine until a family
> member who's an R.N. showed up and taught me the right language: "Give
> him 1 mg of morphine NOW!"
>
> We continued to struggle to get him meds the entire time. He was
> frequently in severe pain. Most of the nurses thought he had had
> laparoscopic surgery. The rest of them had some puritan reason for not
> letting him have morphine. Even when the doctor put him on scheduled
> morphine (because they weren't responding to my requests) they still
> skipped doses. I frequently had to ask them three times. Once I fell
> asleep and they deliberately skipped his 2 am dose. I woke at 6 to find
> him in a rictis of pain.
>
> Right before he left a new resident came in and yanked out a drainage tube
> that was stitched in place. It was ghastly and painful beyond belief.
>
> Shortly after we got out of the hospital we went for a haircut and the
> barber sprayed water on his head and he totally freaked out. He hasn't
> allowed us to get his head wet ever since. (Hair washing is very
> traumatic at our house.) I don't get the connection, but he's got one.
>
> I have no particular reason to think that the trauma he underwent left him
> unscarred. Nor would I call his avoidance of pain "irrational". The kid
> has handled more pain in his young life than I hope you ever see.
>
> I don't think giving him anti-anxiety meds before a procedure is such a
> bad idea.
After having heard the whole story, you're probably right. But there are
plenty of tranquillisers out there besides Valium.
I get the feeling the morphine trips in hospital sensitised him. Careful
when he reaches his teens..

--
madiba

Scott Seidman
September 30th 03, 03:06 PM
"Dr Steve" > wrote in
.com:

> Add to the mix that there are probably some dentists who are not very
> good at using anesthetic, but judging by what I have seen in school
> and after, I think that is a VERY minor part of the equation.

An old friend of mine is an anesthesiologist with a private pain practice,
so he carries his own malpractice. He's developed a dental anesthesia
practice, where he travels with full gear, including emergency gear and
crash cart, to dentists' offices for bigger procedures. He's an
anesthesiologist, so he knows all the agents and methods like the back of
his hand, and he stays current. He uses agents that dentists might not
even know about, when its the best tool for the job at hand.

The patients love it. The dentists love it. He swears the dentists hand
him money, and still act like he's doing them the absolute biggest favor in
the whole world.

Scott

Joel M. Eichen D.D.S.
September 30th 03, 07:46 PM
I am sorry, I tuned in late. What newsgroup is this?

On Tue, 30 Sep 2003 13:07:56 GMT, "Dr Steve" > wrote:

>Hi Dan,
>
>I am training a new DA right now.

--
Joel M. Eichen, .
Philadelphia PA

DISCLAIMER FOLLOWS:

*********

Dental health-related material
is provided for information purposes
only and does not necessarily
represent endorsement by or an official
position of the SciMedDentistry gang
or any other official agency either
actual or fictitious or Steve Mancuso.

Advice on the treatment or care
of an individual patient should
be obtained through consultation
with a dentist who has examined
that patient or is familiar with
that patient's dental history.

STANDARD DISCLAIMER

madiba
September 30th 03, 09:32 PM
Dr Steve > wrote:

> Hi Dan,
>
> I am training a new DA right now. Hired this young lady off the street (no
> dental experience). Dynamite gal ! She only needs to be shown things once.
> learns instantly, has a great attitude, smiles a lot, is happy all day long,
> and is looking for more things to learn all day long. She is already asking
> about how to get certified. <VBG>

Oops, I think this was supposed to be an email.. <VBG>
--
madiba

Dr Steve
September 30th 03, 09:58 PM
Actually wanted to share my good news with some of my good friends in SMD.
Some of us are actually face-to-face friends.

--
~+--~+--~+--~+--~+--
Stephen Mancuso, D.D.S.
Troy, Michigan, USA
DrSteve Q Mancusodds.com
{change the center letter to "at" (and drop two spaces) for email}
.................................................. ...

This posting is intended for informational or conversational purposes only.
Always seek the opinion of a licensed dental professional before acting on
the advice or opinion expressed here. Only a dentist who has examined you
in person can diagnose your problems and make decisions which will affect
your health.
.......................
Please ignore j..d...
~~~~``````````#####----

"madiba" > wrote in message
...
> Dr Steve > wrote:
>
> > Hi Dan,
> >
> > I am training a new DA right now. Hired this young lady off the street
(no
> > dental experience). Dynamite gal ! She only needs to be shown things
once.
> > learns instantly, has a great attitude, smiles a lot, is happy all day
long,
> > and is looking for more things to learn all day long. She is already
asking
> > about how to get certified. <VBG>
>
> Oops, I think this was supposed to be an email.. <VBG>
> --
> madiba

Wendy
September 30th 03, 10:30 PM
In misc.kids Dr Steve > wrote:
> Pain is a relative thing. It can not be measured or described. It is also
> directly proportional to emotional state.

> So, those patients who are afraid of dentistry, are notoriously difficult to
> get fully numb. They get their system worked up to a point that sometimes
> NO amount of local anesthetic will work.

I think you've confused correlation and causality. I don't like dentistry
specifically BECAUSE I am unresponsive to novacaine. And because of that
I am especially conscientious about my dental care: I get regular
cleanings, brush twice a day and floss: BECAUSE I don't want to have to
have any more painful cavities filled.

My kids get regular cleanings and exams, orthodontic care, brush & floss &
rinse with flouride rinse and took flouride supplements when they were
little. My two older kids have a combined age of 26 and one cavity
between 'em. (My third is the one in the OP.)

I just don't think that "fear of pain" translates into "lousy dental
patient".

Wendy

Mxsmanic
September 30th 03, 10:33 PM
Scott Seidman writes:

> He's developed a dental anesthesia practice, where he
> travels with full gear, including emergency gear and
> crash cart, to dentists' offices for bigger procedures.

The one thing I'm curious about here is: Don't most forms of GA involve
an inhaled anesthetic agent? And if so, doesn't that interfere with the
dental work? I mean, usually you intubate a patient for GA with
inhalants, but I don't see how you can do that for dental work without
crowding out the dentist. So how is it done?

In the case of my wisdom extractions, I insisted on being asleep (I
cannot tolerate extractions while awake--almost went that way once, had
to stop urgently as the procedure began). The oral surgeon attached an
EKG and a mask, and administered nitrous oxide. As soon as he saw
ptosis, he injected me with something that I suspect was sodium
methohexital, which put me to sleep. When I woke up, I noted that my
jaw was somewhat numb, so I assume he administered a lot of local
anesthetic after I was out, and I presume that the local anesthetic was
actually what prevented pain, the Brevital and nitrous oxide alone being
insufficient for this.

> The patients love it. The dentists love it. He swears
> the dentists hand him money, and still act like he's doing
> them the absolute biggest favor in the whole world.

It sounds like an excellent deal to me, the only disadvantages being the
expense and the increased risk (plus the mystery described above, but
maybe someone can explain that).

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Mxsmanic
September 30th 03, 10:37 PM
Dr Steve writes:

> Or, the kid just hears the "sharp', "hard", "powerfully
> bright" part, and gets scared.

I think it is heard like this:

"Well, you'll just sit in this nice chair, and then the dentist will use
something that will PINCH a little bit, jdf yaeri sdfu zpoer SHARP, jfi
.... bryyz, ereyu iuzer HARD sh a euirs! Ruy ziuo s BRIGHT sudfyz STING
shdfy zzer DRILL sdfyzer sui qiudsf hh ezr HURT sdf jhze. Fyzo iurs?"

Kids are like the NSA, searching for keywords in text. The "trigger"
list includes things like hurt, pinch, sting, hard, mask, drill, tools,
and so on.



--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Mark & Steven Bornfeld DDS
September 30th 03, 10:38 PM
Mxsmanic wrote:

> Scott Seidman writes:
>
> > He's developed a dental anesthesia practice, where he
> > travels with full gear, including emergency gear and
> > crash cart, to dentists' offices for bigger procedures.
>
> The one thing I'm curious about here is: Don't most forms of GA involve
> an inhaled anesthetic agent? And if so, doesn't that interfere with the
> dental work? I mean, usually you intubate a patient for GA with
> inhalants, but I don't see how you can do that for dental work without
> crowding out the dentist. So how is it done?
>
> In the case of my wisdom extractions, I insisted on being asleep (I
> cannot tolerate extractions while awake--almost went that way once, had
> to stop urgently as the procedure began). The oral surgeon attached an
> EKG and a mask, and administered nitrous oxide. As soon as he saw
> ptosis, he injected me with something that I suspect was sodium
> methohexital, which put me to sleep. When I woke up, I noted that my
> jaw was somewhat numb, so I assume he administered a lot of local
> anesthetic after I was out, and I presume that the local anesthetic was
> actually what prevented pain, the Brevital and nitrous oxide alone being
> insufficient for this.

Actually, a local is always used, even if general anesthetic agents are
as well. This eliminates any involuntary reaction to pain (say, reflexive
movement) which can happen even when unconscious.
Most oral surgeons I know use an ultrashort acting barbiturate for
induction. The nitrous potentiates this, but it is the IV barbiturate that
is really the general anesthetic agent. Back in the stone ages when I was a
resident, real short procedures did not get intubated--an airway way placed
though. Cases in the OR got nasotracheal intubation, and an inhalation
agent--usually halothane or ethrane.

Steve

>
>
> > The patients love it. The dentists love it. He swears
> > the dentists hand him money, and still act like he's doing
> > them the absolute biggest favor in the whole world.
>
> It sounds like an excellent deal to me, the only disadvantages being the
> expense and the increased risk (plus the mystery described above, but
> maybe someone can explain that).
>
> --
> Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

--
Mark & Steven Bornfeld DDS
Brooklyn, NY
718-258-5001
http://www.dentaltwins.com

Mxsmanic
September 30th 03, 10:38 PM
madiba writes:

> I get the feeling the morphine trips in hospital sensitised him. Careful
> when he reaches his teens..

In what way would he be sensitized?

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Wendy
September 30th 03, 10:40 PM
In misc.kids madiba > wrote:
>> I don't think giving him anti-anxiety meds before a procedure is such a
>> bad idea.

> After having heard the whole story, you're probably right. But there are
> plenty of tranquillisers out there besides Valium.

Valium is all I know and I haven't even been able to get that for
him. The first dentist didn't work on kids who needed that much
work. The second dentist wouldn't use valium because he used NO. The
third dentist didn't use sedatives at all and didn't want to. We're
headed for the fourth dentist and I tried to prescreen her on the phone to
discover if she'd prescribe a sedative before I make the 1/2 day journey
to her office for his 11th visit to the dentist in 4 months, but her
assistant just said she has in the past. I'm taking that as a hopeful
sign.

Is there any other sedative I should discuss with her?

By the way, I had a long talk with his pediatrician's nurse today, who
recommended yet a 5th dentist, but no solution to the anxiety. In fact,
he's slightly anemic and they want to draw more blood in a retest. I said
the hell with that, let's just assume he IS anemic and not bother testing
him again. (I'm slightly anemic and so are both of my other children - we
just are low normal in our family.) I cannot believe that these people
want to do yet another stick on this child without a damn good reason!

> I get the feeling the morphine trips in hospital sensitised him. Careful
> when he reaches his teens..

Sigh. Okay, what's THIS new danger?

Wendy, who needs a new hobby

Joel M. Eichen D.D.S.
September 30th 03, 11:02 PM
One comment: Change your description to .....
xylocaine (our standby) for novocaine (last used in 1945!).

Joel

On 30 Sep 2003 17:30:53 -0400, Wendy >
wrote:

>In misc.kids Dr Steve > wrote:
>> Pain is a relative thing. It can not be measured or described. It is also
>> directly proportional to emotional state.
>
>> So, those patients who are afraid of dentistry, are notoriously difficult to
>> get fully numb. They get their system worked up to a point that sometimes
>> NO amount of local anesthetic will work.
>
>I think you've confused correlation and causality. I don't like dentistry
>specifically BECAUSE I am unresponsive to novacaine. And because of that
>I am especially conscientious about my dental care: I get regular
>cleanings, brush twice a day and floss: BECAUSE I don't want to have to
>have any more painful cavities filled.
>
>My kids get regular cleanings and exams, orthodontic care, brush & floss &
>rinse with flouride rinse and took flouride supplements when they were
>little. My two older kids have a combined age of 26 and one cavity
>between 'em. (My third is the one in the OP.)
>
>I just don't think that "fear of pain" translates into "lousy dental
>patient".
>
>Wendy

--
Joel M. Eichen, .
Philadelphia PA

DISCLAIMER FOLLOWS:

*********

Dental health-related material
is provided for information purposes
only and does not necessarily
represent endorsement by or an official
position of the SciMedDentistry gang
or any other official agency either
actual or fictitious or Steve Mancuso.

Advice on the treatment or care
of an individual patient should
be obtained through consultation
with a dentist who has examined
that patient or is familiar with
that patient's dental history.

STANDARD DISCLAIMER

Dr Steve
October 1st 03, 12:36 AM
Oh please don't misunderstand me. I meant that comment in a general fashion
as part of a greater discussion, not about you.

--
~+--~+--~+--~+--~+--
Stephen Mancuso, D.D.S.
Troy, Michigan, USA
DrSteve Q Mancusodds.com
{change the center letter to "at" (and drop two spaces) for email}
.................................................. ...

This posting is intended for informational or conversational purposes only.
Always seek the opinion of a licensed dental professional before acting on
the advice or opinion expressed here. Only a dentist who has examined you
in person can diagnose your problems and make decisions which will affect
your health.
.......................
Please ignore j..d...
~~~~``````````#####----

"Wendy" > wrote in message
...
> In misc.kids Dr Steve > wrote:
> > Pain is a relative thing. It can not be measured or described. It is
also
> > directly proportional to emotional state.
>
> > So, those patients who are afraid of dentistry, are notoriously
difficult to
> > get fully numb. They get their system worked up to a point that
sometimes
> > NO amount of local anesthetic will work.
>
> I think you've confused correlation and causality. I don't like dentistry
> specifically BECAUSE I am unresponsive to novacaine. And because of that
> I am especially conscientious about my dental care: I get regular
> cleanings, brush twice a day and floss: BECAUSE I don't want to have to
> have any more painful cavities filled.
>
> My kids get regular cleanings and exams, orthodontic care, brush & floss &
> rinse with flouride rinse and took flouride supplements when they were
> little. My two older kids have a combined age of 26 and one cavity
> between 'em. (My third is the one in the OP.)
>
> I just don't think that "fear of pain" translates into "lousy dental
> patient".
>
> Wendy

Dr Steve
October 1st 03, 12:37 AM
agreed

--
~+--~+--~+--~+--~+--
Stephen Mancuso, D.D.S.
Troy, Michigan, USA
DrSteve Q Mancusodds.com
{change the center letter to "at" (and drop two spaces) for email}
.................................................. ...

This posting is intended for informational or conversational purposes only.
Always seek the opinion of a licensed dental professional before acting on
the advice or opinion expressed here. Only a dentist who has examined you
in person can diagnose your problems and make decisions which will affect
your health.
.......................
Please ignore j..d...
~~~~``````````#####----

"Mxsmanic" > wrote in message
...
> Dr Steve writes:
>
> > Or, the kid just hears the "sharp', "hard", "powerfully
> > bright" part, and gets scared.
>
> I think it is heard like this:
>
> "Well, you'll just sit in this nice chair, and then the dentist will use
> something that will PINCH a little bit, jdf yaeri sdfu zpoer SHARP, jfi
> ... bryyz, ereyu iuzer HARD sh a euirs! Ruy ziuo s BRIGHT sudfyz STING
> shdfy zzer DRILL sdfyzer sui qiudsf hh ezr HURT sdf jhze. Fyzo iurs?"
>
> Kids are like the NSA, searching for keywords in text. The "trigger"
> list includes things like hurt, pinch, sting, hard, mask, drill, tools,
> and so on.
>
>
>
> --
> Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Dr Steve
October 1st 03, 12:39 AM
~~~GA in a hospital~~~

--
~+--~+--~+--~+--~+--
Stephen Mancuso, D.D.S.
Troy, Michigan, USA
DrSteve Q Mancusodds.com
{change the center letter to "at" (and drop two spaces) for email}
.................................................. ...

This posting is intended for informational or conversational purposes only.
Always seek the opinion of a licensed dental professional before acting on
the advice or opinion expressed here. Only a dentist who has examined you
in person can diagnose your problems and make decisions which will affect
your health.
.......................
Please ignore j..d...
~~~~``````````#####----

"Wendy" > wrote in message
...
> In misc.kids madiba > wrote:
> >> I don't think giving him anti-anxiety meds before a procedure is such a
> >> bad idea.
>
> > After having heard the whole story, you're probably right. But there are
> > plenty of tranquillisers out there besides Valium.
>
> Valium is all I know and I haven't even been able to get that for
> him. The first dentist didn't work on kids who needed that much
> work. The second dentist wouldn't use valium because he used NO. The
> third dentist didn't use sedatives at all and didn't want to. We're
> headed for the fourth dentist and I tried to prescreen her on the phone to
> discover if she'd prescribe a sedative before I make the 1/2 day journey
> to her office for his 11th visit to the dentist in 4 months, but her
> assistant just said she has in the past. I'm taking that as a hopeful
> sign.
>
> Is there any other sedative I should discuss with her?
>
> By the way, I had a long talk with his pediatrician's nurse today, who
> recommended yet a 5th dentist, but no solution to the anxiety. In fact,
> he's slightly anemic and they want to draw more blood in a retest. I said
> the hell with that, let's just assume he IS anemic and not bother testing
> him again. (I'm slightly anemic and so are both of my other children - we
> just are low normal in our family.) I cannot believe that these people
> want to do yet another stick on this child without a damn good reason!
>
> > I get the feeling the morphine trips in hospital sensitised him. Careful
> > when he reaches his teens..
>
> Sigh. Okay, what's THIS new danger?
>
> Wendy, who needs a new hobby

Mxsmanic
October 1st 03, 12:43 AM
Mark & Steven Bornfeld DDS writes:

> Most oral surgeons I know use an ultrashort acting barbiturate for
> induction. The nitrous potentiates this, but it is the IV barbiturate that
> is really the general anesthetic agent.

I'd guess that the nitrous oxide made me woozy in about 30 seconds, and
I think I was out for only about 20 minutes under the barbiturate (I
think he told me it was Brevital, but I'm not sure).

> Cases in the OR got nasotracheal intubation, and an inhalation
> agent--usually halothane or ethrane.

I didn't even know you could intubate someone through the nose. It
sounds difficult to do. Even intubation through the mouth is said to be
pesky enough that an anesthesiologist is often called in just to do
that.

I assume, then, that this nasotracheal intubation leaves the mouth
unencumbered while keeping a sealed path to the lungs for the
anesthesia?

Another thing I noticed about the wisdom extraction was: no post-op
nausea. I had a simple IV induction for a hernia operation, and
whatever he used (inhalant of some kind, I presume) left me sick for 24
hours. I was worried about the extraction for this reason, but other
than an odd sort of fatigue (I felt fatigued, but when I tried to lay
down to sleep, I didn't fall asleep), I experienced no aftereffects,
which was fine with me.

Indeed, had I known that removing bony impacted wisdom teeth four at a
time could be such a breeze, I wouldn't have endured the discomfort of
those teeth for so long.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Steven Bornfeld
October 1st 03, 03:23 AM
Mxsmanic wrote:
> Mark & Steven Bornfeld DDS writes:
>
>
>>Most oral surgeons I know use an ultrashort acting barbiturate for
>>induction. The nitrous potentiates this, but it is the IV barbiturate that
>>is really the general anesthetic agent.
>
>
> I'd guess that the nitrous oxide made me woozy in about 30 seconds, and
> I think I was out for only about 20 minutes under the barbiturate (I
> think he told me it was Brevital, but I'm not sure).

That's what was used "in the day"--it may still be the drug of choice
for the OMFS.

>
>
>>Cases in the OR got nasotracheal intubation, and an inhalation
>>agent--usually halothane or ethrane.
>
>
> I didn't even know you could intubate someone through the nose. It
> sounds difficult to do. Even intubation through the mouth is said to be
> pesky enough that an anesthesiologist is often called in just to do
> that.

I had a month rotation in anesthesia. My first try on an endotracheal
intubation I did neatly down the esophagus. They let me bag the guy and
inflate the stomach before they told me. Nice.
Like anything else, the good anesthesiologists make it look easy.

>
> I assume, then, that this nasotracheal intubation leaves the mouth
> unencumbered while keeping a sealed path to the lungs for the
> anesthesia?

Yes.

>
> Another thing I noticed about the wisdom extraction was: no post-op
> nausea. I had a simple IV induction for a hernia operation, and
> whatever he used (inhalant of some kind, I presume) left me sick for 24
> hours. I was worried about the extraction for this reason, but other
> than an odd sort of fatigue (I felt fatigued, but when I tried to lay
> down to sleep, I didn't fall asleep), I experienced no aftereffects,
> which was fine with me.

I think nausea isn't too common, still anyone getting GA MUST have an
empty stomach before surgery.

>
> Indeed, had I known that removing bony impacted wisdom teeth four at a
> time could be such a breeze, I wouldn't have endured the discomfort of
> those teeth for so long.

Glad for you it went easily. Frequently it does. Except when it doesn't.

Steve

>

Rosalie B.
October 1st 03, 12:35 PM
Wendy > wrote:
<snip>
>. (I'm slightly anemic and so are both of my other children - we
>just are low normal in our family.) I cannot believe that these people
>want to do yet another stick on this child without a damn good reason!
>
I must stay that I was always borderline anemic too, and dd#1 was also when
she was a toddler. She had lots of needlesticks and didn't ever complain
about it. I had lots and lots of needles as a child, because the treatment
for asthma then was shots 3x a week, which my dad gave me for years. I
think it hurt him more than me. He really hated to do it.

I hate that commercial about how heartwrenching it is for a 3 yo to cry
about needlesticks. I just think that is so lame. If you have the choice
of testing your blood or dying, you test the blood.

I do agree that there's no real reason to check Wendy's child again for
that. I am also of the opinion that doctors do not really know how to
treat anemia - nothing they ever gave me helped - iron pills and even a
complete hysterectomy did not do it. And I think dd got better on her own
in spite of what they did rather than because of it.

My ds's first child had leukemia and was in the hospital a lot before he
died and they put a thing in his chest to deliver drugs and chemo. He
never complained about that but he hated to have his temperature taken in
his ear. We couldn't figure out why that was such a problem for him
because it's really pretty non-invasive.


grandma Rosalie

Dr Steve
October 1st 03, 12:46 PM
Thalesemia ? ? ? ? (sp?)

--
~+--~+--~+--~+--~+--
Stephen Mancuso, D.D.S.
Troy, Michigan, USA
DrSteve Q Mancusodds.com
{change the center letter to "at" (and drop two spaces) for email}
.................................................. ...

This posting is intended for informational or conversational purposes only.
Always seek the opinion of a licensed dental professional before acting on
the advice or opinion expressed here. Only a dentist who has examined you
in person can diagnose your problems and make decisions which will affect
your health.
.......................
Please ignore j..d...
~~~~``````````#####----

"Rosalie B." > wrote in message
...
> Wendy > wrote:
> <snip>
> >. (I'm slightly anemic and so are both of my other children - we
> >just are low normal in our family.) I cannot believe that these people
> >want to do yet another stick on this child without a damn good reason!
> >
> I must stay that I was always borderline anemic too, and dd#1 was also
when
> she was a toddler. She had lots of needlesticks and didn't ever complain
> about it. I had lots and lots of needles as a child, because the
treatment
> for asthma then was shots 3x a week, which my dad gave me for years. I
> think it hurt him more than me. He really hated to do it.
>
> I hate that commercial about how heartwrenching it is for a 3 yo to cry
> about needlesticks. I just think that is so lame. If you have the choice
> of testing your blood or dying, you test the blood.
>
> I do agree that there's no real reason to check Wendy's child again for
> that. I am also of the opinion that doctors do not really know how to
> treat anemia - nothing they ever gave me helped - iron pills and even a
> complete hysterectomy did not do it. And I think dd got better on her own
> in spite of what they did rather than because of it.
>
> My ds's first child had leukemia and was in the hospital a lot before he
> died and they put a thing in his chest to deliver drugs and chemo. He
> never complained about that but he hated to have his temperature taken in
> his ear. We couldn't figure out why that was such a problem for him
> because it's really pretty non-invasive.
>
>
> grandma Rosalie

Joel M. Eichen D.D.S.
October 1st 03, 12:59 PM
On Wed, 01 Oct 2003 11:46:24 GMT, "Dr Steve" > wrote:

>Thalesemia ? ? ? ? (sp?)


Porphyria is another royal disease with historical implications. One
of the symptoms of this disease is bouts of madness and it is believed
that King George III of England suffered from this genetic disorder
which may have gone back to Mary, Queen of Scots.




--
Joel M. Eichen, .
Philadelphia PA

DISCLAIMER FOLLOWS:

*********

Dental health-related material
is provided for information purposes
only and does not necessarily
represent endorsement by or an official
position of the SciMedDentistry gang
or any other official agency either
actual or fictitious or Steve Mancuso.

Advice on the treatment or care
of an individual patient should
be obtained through consultation
with a dentist who has examined
that patient or is familiar with
that patient's dental history.

STANDARD DISCLAIMER

Scott Seidman
October 1st 03, 01:18 PM
Mxsmanic > wrote in
:

> The one thing I'm curious about here is: Don't most forms of GA involve
> an inhaled anesthetic agent? And if so, doesn't that interfere with the
> dental work? I mean, usually you intubate a patient for GA with
> inhalants, but I don't see how you can do that for dental work without
> crowding out the dentist. So how is it done?
>

Easy-- he probably doesn't use gas agents!

Scott

Mark & Steven Bornfeld DDS
October 1st 03, 02:31 PM
"Joel M. Eichen D.D.S." wrote:

> On Wed, 01 Oct 2003 11:46:24 GMT, "Dr Steve" > wrote:
>
> >Thalesemia ? ? ? ? (sp?)
>
> Porphyria is another royal disease with historical implications. One
> of the symptoms of this disease is bouts of madness and it is believed
> that King George III of England suffered from this genetic disorder
> which may have gone back to Mary, Queen of Scots.

IIRC, the porphyria is also associated with excessive facial hair and
it is speculated that someone with this condition inspired the legend of
the wolf man.

Steve

>
>
> --
> Joel M. Eichen, .
> Philadelphia PA
>
> DISCLAIMER FOLLOWS:
>
> *********
>
> Dental health-related material
> is provided for information purposes
> only and does not necessarily
> represent endorsement by or an official
> position of the SciMedDentistry gang
> or any other official agency either
> actual or fictitious or Steve Mancuso.
>
> Advice on the treatment or care
> of an individual patient should
> be obtained through consultation
> with a dentist who has examined
> that patient or is familiar with
> that patient's dental history.
>
> STANDARD DISCLAIMER

--
Mark & Steven Bornfeld DDS
Brooklyn, NY
718-258-5001
http://www.dentaltwins.com

madiba
October 1st 03, 06:15 PM
Wendy > wrote:

> In misc.kids madiba > wrote:
> >> I don't think giving him anti-anxiety meds before a procedure is such a
> >> bad idea.
>
> > After having heard the whole story, you're probably right. But there are
> > plenty of tranquillisers out there besides Valium.
>
> Valium is all I know and I haven't even been able to get that for
> him. The first dentist didn't work on kids who needed that much
> work. The second dentist wouldn't use valium because he used NO. The
> third dentist didn't use sedatives at all and didn't want to. We're
> headed for the fourth dentist and I tried to prescreen her on the phone to
> discover if she'd prescribe a sedative before I make the 1/2 day journey
> to her office for his 11th visit to the dentist in 4 months, but her
> assistant just said she has in the past. I'm taking that as a hopeful
> sign.
>
> Is there any other sedative I should discuss with her?
Klonopin (clonazepam) is very safe, the tranquillising effect is not as
strong. Its mainly for kids that have seizures, but it also helps
against pain.
If he really is a bundle of nerves Versed Syrup (midazolam) will do the
trick. But this is a strong tranquilliser so you need to have a dentist
with monitoring equipment, as you should with Valium too. I found it to
be excellent for people getting bone marrow core biopsies (in adults).
> By the way, I had a long talk with his pediatrician's nurse today, who
> recommended yet a 5th dentist, but no solution to the anxiety. In fact,
> he's slightly anemic and they want to draw more blood in a retest. I said
> the hell with that, let's just assume he IS anemic and not bother testing
> him again. (I'm slightly anemic and so are both of my other children - we
> just are low normal in our family.) I cannot believe that these people
> want to do yet another stick on this child without a damn good reason!
>
> > I get the feeling the morphine trips in hospital sensitised him. Careful
> > when he reaches his teens..
>
> Sigh. Okay, what's THIS new danger?
I meant he's experienced the blissful painless state that morphine puts
you in and is reluctant to settle for anything less now.
Teens? - the drugs thing.
> Wendy, who needs a new hobby


--
madiba

Wendy
October 1st 03, 07:28 PM
In misc.kids madiba > wrote:
>> > I get the feeling the morphine trips in hospital sensitised him. Careful
>> > when he reaches his teens..
>>
>> Sigh. Okay, what's THIS new danger?

> I meant he's experienced the blissful painless state that morphine puts
> you in and is reluctant to settle for anything less now.

Ah, that makes sense. Well, he was not quite 3 when he was on his (all
too infrequent) morphine trips, and I think there's a good chance he
doesn't even know that the blissful state was caused by something named
morphine. He certainly hasn't shown signs of becoming a daycare
drug-addict at the moment (sometimes he gets up in the night but I don't
think it's to knock over any drug stores.) :-)

> Teens? - the drugs thing.

All joking aside, that's a good point. I'll keep my eyes open.

Wendy

V35B
October 1st 03, 09:47 PM
MAdiba,

Wrong again, Klnopin is a benzodiazepine just as Valium. Both have
antiseizure effects. In fact Valium is the drug of choice for status
epilepticus. NEITHER will relieve pain. Neither have any analgesic
property....



Better get that book....



madiba wrote:

> Wendy > wrote:
>
>
>>In misc.kids madiba > wrote:
>>
>>>>I don't think giving him anti-anxiety meds before a procedure is such a
>>>>bad idea.
>>
>>>After having heard the whole story, you're probably right. But there are
>>>plenty of tranquillisers out there besides Valium.
>>
>>Valium is all I know and I haven't even been able to get that for
>>him. The first dentist didn't work on kids who needed that much
>>work. The second dentist wouldn't use valium because he used NO. The
>>third dentist didn't use sedatives at all and didn't want to. We're
>>headed for the fourth dentist and I tried to prescreen her on the phone to
>>discover if she'd prescribe a sedative before I make the 1/2 day journey
>>to her office for his 11th visit to the dentist in 4 months, but her
>>assistant just said she has in the past. I'm taking that as a hopeful
>>sign.
>>
>>Is there any other sedative I should discuss with her?
>
> Klonopin (clonazepam) is very safe, the tranquillising effect is not as
> strong. Its mainly for kids that have seizures, but it also helps
> against pain.
> If he really is a bundle of nerves Versed Syrup (midazolam) will do the
> trick. But this is a strong tranquilliser so you need to have a dentist
> with monitoring equipment, as you should with Valium too. I found it to
> be excellent for people getting bone marrow core biopsies (in adults).
>
>>By the way, I had a long talk with his pediatrician's nurse today, who
>>recommended yet a 5th dentist, but no solution to the anxiety. In fact,
>>he's slightly anemic and they want to draw more blood in a retest. I said
>>the hell with that, let's just assume he IS anemic and not bother testing
>>him again. (I'm slightly anemic and so are both of my other children - we
>>just are low normal in our family.) I cannot believe that these people
>>want to do yet another stick on this child without a damn good reason!
>>
>>
>>>I get the feeling the morphine trips in hospital sensitised him. Careful
>>>when he reaches his teens..
>>
>>Sigh. Okay, what's THIS new danger?
>
> I meant he's experienced the blissful painless state that morphine puts
> you in and is reluctant to settle for anything less now.
> Teens? - the drugs thing.
>
>>Wendy, who needs a new hobby
>
>
>

madiba
October 2nd 03, 12:07 AM
V35B > wrote:

> MAdiba,
>
> Wrong again, Klnopin is a benzodiazepine just as Valium. Both have
> antiseizure effects. In fact Valium is the drug of choice for status
> epilepticus. NEITHER will relieve pain. Neither have any analgesic
> property....
>
Look genius, we were discussing tranquillizers. Benzods are the best
tranquillizers. Klonopin is safer because there is less resp. depr. than
in valium. It IS included in pain management schedules, look it up.
>
> Better get that book....
Go back to school.
>

--
madiba