Pediatric Dental Cleanings, Fillings and Sedation. What I wish I knew!

Recently I took the children to their six month dentist check up/cleaning. It was the first full cleaning for L, who is not quite 3.5 years. And seems old hat for E, who is almost 6.5.
L did well and charmed his way through the process. Chatting it up and cheesing for the camera. He recieved a good report. No cavities!




Sister, true to form was polite, but not all that thrilled with people poking and prodding her. I wasn't surprised when the hygienist mentioned Es sensitive teeth and her reluctance at the process. I purposely stood just outside of her exam room (but within sight and watching) hoping my absence would make it easier for her to comply without asking to be recused.



She was not interested in cheesing for the camera.

Sadly she has three cavities that need to be filled. One is in a front top tooth.  We've been watching it for six months, thinking she might lose the tooth soon. But it is now an issue and can't wait. The other two are between two bottom teeth. The hygenist, dentist and myself discussed with her the importance of brushing and flossing etc etc etc! But they also reminded me some children have weaker enamel and there is only so much prevention we can do. We discussed the plan, got the estimated costs printed out and made an appointment to return in two weeks for the fillings. It felt good to be in a place I trusted and to have a plan. And it reminded me of a dentist appointment last fall that didn't go the same way.

Last fall we visited another dentist in our area. A pediatric dentist, in network for our insurance and someone we had seen previously for multiple check up/cleanings. During our check up last fall, we learned E had cavities, but I was less than thrilled with the way the staff communicated the information, and their ability to answer my questions/concerns about the fillings procedure.  After having almost a year to digest the experience and having recounted it to several friends I feel like there are some valuable take aways. Things I wished I had known before being in the immediate situation.

Pediatric fillings: Red flags. 

1) Discussing costs before discussing the patient. 
During her cleaning the hygienist mentioned she saw a soft spot. And indicated it was probably a cavity. Before the dentist even came to check on my daughter, or discuss it with me, the hygienist was asking me to sign waivers on the filling procedures and financial commitment paperwork.

2) "Upgrading" the filling. 
From across the room the hygienist asked me "Do you want a white or silver filling?" In that moment I was genuinely confused. "Are we doing this today?" I asked. Mind you I still hadn't talked with the dentist. She answered to the effect of "No, but I'm working up the cost estimate".  Side note: I have since learned from another dentist, that white fillings take more time and patience to place and set and are thus not recommended for children unless it is a front facing tooth.

3) Sedation not covered by insurance. 
After I got over my shock (over the process, not the cavities, they are a part of life), talked to the dentist and received her assessment of the cavities, I received a treatment plan/cost estimate. I was still on autopilot. I mean I had two kids at the dentist at 4 p.m. after school trying to keep them from melting down while trying to have a conversation with the staff. Thankfully the $400 cost estimate woke me up. It was my second shock.  "Why is sedation not covered by our insurance?"  I asked. The sedation was 50% of the estimate. "Shouldn't they cover Nitrous Oxide (laughing gas), or a portion of it? Isn't that standard for children?" Me, still assuming we are all on the same page.  Office manager "We don't use laughing gas." Me: 😳

4) Sedation of any kind for children. 
At this point I shook off the autopilot. We were standing in the entry way/counter were they wanted me to sign paperwork and schedule the appointment to have the fillings done. "May I speak to the dentist again...." the play by play gets a bit shaky here,  because a little voice was screaming in my head....  Basic run down, after I played 20 questions with the dentist standing in the foyer of the business.

• They use a liquid cocktail for sedation, based on the child's weight. 
• No they do not have an anesthesiologist on staff. 
• No they don't know what role it could play that my child has an adverse reaction to Benadryl (which she does). 
• No they don't have a back up plan if she won't swallow the meds (and y'all the child HATES liquid meds!). 
• And BTW, we use Fentanyl in our sedation cocktail... um, what? 
• Full stop. FULL STOP YOU GUYS.

I tried to hold myself together long enough to get everyone in the car and drive home. We left, with a polite, "we'll call later to schedule". We did not return to that dentist. So many red flags. I am sure they are fully licensed and reputable. However, for me, Fentanyl was a deal breaker. Not to mention the other items listed above. At the very least I walked away and gave myself time to sleep on it. And thankfully I reminded myself it's ok to turn off autopilot and ask questions (And really that was a red flag too. Why did I have to play 20 questions to get all the pertinent information?). We have since found a dentist we love, in network for our insurance and E had the original fillings completed last fall. Call it Mama sense, or an inner voice, or divine intervention, I'm just happy to call it a closed chapter. This week's dental visit was a much smoother, calm experience for everyone.