What would you do (kid dental situation)

In My Humble Opinion
1

Partly inspired by this thread (how timely), and a consult with a sedation dentist…

Dweezil is my 14 year old son. He has mild autism. He tends to develop irrational fears of things (e.g. for a while it was boats - refused to go on “It’s A Small World” because that involved boats, even though I’m not sure you could drown in the 6 inches of water even if you broke in at 2 AM when nobody was around, got stone drunk, and deliberately wedged yourself head first between a boat and the wall).

Dweezil has had dental fillings a couple of times. Came through them with flying colors. He didn’t enjoy them, but then who does?

Fast forward to a couple months ago. Hygienist spotted a bit of decay during his cleaning, so we brought him in for a filling.

He wouldn’t even open his mouth to let the dentist look. No mirrors, nothing. I was prepared to force his mouth open (yeah I know, counterproductive, but I was mad at the sudden change in behavior) but the dentist insisted on backing off, and referring us to a sedation dentist. I asked if she couldn’t simply use Halcion (or whatever) plus nitrous as she does for me but she’s not comfortable doing this with a child.

That consult was today.

The process is: the kid gets doped up on a couple of meds beforehand (Halcion, Clonidine, and an antinausea/pain med) then gets IV sedation during. He could be in the chair for an hour and a half or more.

Estimated treatment cost? nearly three thousand dollars.

Of which perhaps a couple hundred would be covered by dental insurance. Our dental insurance SUCKS in general, and especially in regards to coverage for anesthesia other than novocaine. I have, in the past, basically been told that even if novocaine doesn’t work for me (and it doesn’t, at least not alone), too fucking bad.

So we’re looking at being out of pocket for most of 3 grand.

This is, not surprisingly, money we don’t have just lying around.

Anyway - if anyone has any experience dealing with a similar situation, I’d be grateful for any suggestions.

Has anyone ever succeeded in getting dental anesthesia covered by medical insurance?

The only thing I can think of right now is to sit Dweezil down, point out the costs involved (3 grand vs. maybe 400 if the regular dentist does it), and lay it out that if he cannot attempt to get through this using more reasonable techniques, the whole family will suffer. I don’t know if that will work for him though.

If it were just a few hundred dollars more, we could scrape that up without too much trouble - e.g. we could pay for the nitrous out of pocket.

And what’s with the price difference anyway - I had a tooth extracted a few years ago, and the IV sedation was only a couple hundred more (out of pocket of course, and willingly paid).

2

Forgot to mention in the OP: I’m not certain the regular dentist would even consent to see him again for the filling even if we were willing to give it a try.

3

I don’t have any experience with this kind of situation, but a couple of options come to mind. One would be to call Dweezil’s PCP and ask for some Ativan or a good dose of Valium he could take about an hour before the dental appt. This, combined with nitrous, may very well do the trick. Of course, this is assuming that Dweezil is full adult size (which most 14YO boys are) and the doc is comfortable with this.

The other is to find a dentist that will do the necessary work in the hospital in an OR. I think if a hospital anesthesiologist was doing the anesthesia, the insurance would be more willing to cover it.

Don’t know if either of those thoughts are helpful, but you might give it a shot.

4

Explain the difference in cost to him, and bribe him with $100.00 if he goes along with the plan. If he doesn’t, then you KNOW you’ve got a problem on your hands.

5

This is actually very similar to what I’m thinking right now. He told us the other day that the tooth in question was bugging him, and he was even willing to go back to Dr. V. to have it fixed. But he has a long history of being willing to do something unpleasant, then panicking and needing to be held down when push comes to shove (specific example a year ago, he needed to have blood drawn to retest for some food allergies; we had reason to hope it was now safe for him to eat some formerly-forbidden items, he really wanted to eat them, he knew the blood draw would help, he was eager for it… but when we got to the lab he panicked, and I literally had to pin him to get the blood drawn).

Anyway - we are thinking of putting things right in front of him: 400 bucks vs. 3,000 or whatever, this is how much a movie costs, this is how much we spend on eating out each month, and this is how long it’ll be before we can eat out or see movies again if we have to go this route. Plus the promise of a reward if the attempt is successful.

6

Is it possible just to put it off for a while? since his phobias tend to be sort of mobile, it may be in three months he’s no longer so anxious. And I’d also call around to other dentists that offer gas and see if you can try a combination of a valium and the gas. Certainly trying something else before throwing $3 grand to the wind is reasonable.

Personally, I wouldn’t go into the finances with him. I guess I don’t think it’s a kid’s business to know his parents’ finances. Not that I think that kids shouldn’t know the value of a dollar, but I just think that they shouldn’t have to think about whether their parents can afford a medical treatment.

StG

7

If you live in a large enough community you will find that there are dentists who specialize in treating kids on the spectrum,and that their approaches vary as much as any subset of dentists. Oral care turns out to be a common problem for kids on the spectrum, usually because of sensitivity around the face and mouth or because of issues with the lighting/sound.

Since it is not yet an emergency, I would start by contacting one of the advocacy or parenting groups focusing on childhood autism – best is a local chapter obviously. You may be able to find one who is willing to treat him appropriately, and without the need for full on anaesthesia.

8

I know the kid in question is autistic, but I don’t think that means he’s dumber than others and there have been many times that I’ve wished my parents had been more forthcoming about our financial status when I was that age.

Heck, we’re now between 40 and 31 and my mother still doesn’t want us to know her exact financial status (only, Lilbro does her taxes and I’m not shy about informing them when I give her money, so she’s SOL :p).

9

Nava - My mother doesn’t divulge her financial info to me, and I’m the executor of her estate and my name is on some of her bank accounts. It’s just none of my business, and I wouldn’t expect her to. I do know that she bought a car this week (used - my family doesn’t do new) and wrote a check for $14K for it. Maybe it’s an American thing - we tend to be more closed-mouth about finances than Europeas.

StG

10

This was my first thought. There are a handful here who specialize in it, also.

11

Don’t know about dentistry but if your kid refused to go on It’s a Small World, then he is wise beyond his years.

(did he refuse Pirates as well?!)

12

Mama Zappa-I’m all for setting out the ins and outs of the financial situation for him, as long as you are willing to accept his decision on what route to go down in the end. If Dweezil says it has to be sedation, I think you have to allow him to make that choice.

I’m speaking as a health professional who has a relatively high pain thresh-hold, no squeamishness whatsoever, lets other people practice blood-draws and cannula insertion on my veins…and who has a major dental phobia which gets worse the older I get.

For me it’s not about pain, or fear of the unknown- pain I can deal with, and as a doctor I’m pretty sure what is going on, it’s a fear of being in a chair with someone’s hands in my mouth. For me the fear is about the sense of personal space and boundaries being violated. Weird that I’m not scared of gynae exams, but there you go, it’s just dentists. For me, it’s got to the point where I need Valium and a day off work for a routine scale and polish, IV Midazolam for anything more than that.
Anyway, in my rambling way, I’m trying to say that this might not be a pain thing, or a fear of the unfamiliar thing, or something he’s going to grow out of. He might be able to rationalise why the cheap option is better, but he just might not be able to do this any other way.

The worst outcome would be for **Dweezil ** to try this the cheap way, get even more freaked out and have to get the full sedation package for even a visit to the hygienist in the future…

13

But then it will be $3000 every time he needs a filling! :eek: Yikes, this is a hard one.

14

I second finding a pediatric dentist. TheKid was terrified of dentists when she was young (had a bad experience, was wigged out by stories from her dad and aunt). The positive with most ped dentists is that when you have a dentist and hygenist that’s it - those are YOUR people for as long as they work there/child goes there. Most pediatric dentists see people until they’re 21.
She has no problem now going in.

15

Some status updates and thoughts:

I called the dental insurer. They don’t routinely pay for sedation or whatever - but the person I spoke with did some checking and found that, supposedly, if a medical professional documents the need for the anesthesia, from a physical or mental need, then they may cover it. Note the word “may”. Also there are the “usual and customary”, and “cover 65%”, and “2,000 dollar per year limit”… so we’re still talking about being out of pocket by quite a sum.

I guess we’re lucky in that, if we absolutely have to, we can come up with the money. We don’t have it in savings, but we can sell some stock, and cut down on what luxuries we do allow ourselves. We don’t live a lavish lifestyle, but could completely cut out things like theater movies. From a “show him the money” side of things, that’s how we’d approach it: here’s what we spend as a family on a movie, this amount of money would pay for 50 (or whatever) trips to the movie theater. I think he can wrap his mind around that. He doesn’t need to know about the rest of the family finances at this point.

Irishgirl, you make a good point in that we could risk tripping him over into the SEVERE phobia realm. I dislike dental cleanings myself, but can sit through them without needing meds. My own phobia isn’t “hand in my mouth” sensitivity, it’s a result of a genuine Very Bad Experience at a young age. Dweezil might be more like you.

While I was typing this, I got a call back from the dental office - and our practitioner won’t touch him even if we get him Valium (or whatever) elsewhere. She’ll let him come there for cleanings etc., but not for fillings. When he’s 18, she’ll be willing to do the oral sedation like they do with me (halcion / nitrous). So I guess the whole “no more movies” argument won’t do any good.

The person I just spoke with is going to ask around to find out if there are others in the area who are more comfortable with just oral sedation. She also suggested I ask the specialists if they ever work with just oral (which would be considerably cheaper and would still allow the higher level of monitoring.

I told the person on the phone that we couldn’t afford to blow 3K every time he needs a tooth filled. I said “then we should just have them knock him out once, and pull all the teeth, and give him dentures”. She laughed. I said “I’m not joking”. It would be more cost-effective.

16

Reviving my own zombie thread here (sorry!) with another status update.

I was telling our story of woe to the receptionist at Dweezil’s orthodontist. She gave me the names of several people near them - including one card that said “children, adolescents and the handicapped”. On the way out of that visit, I was chatting with Dweezil about the situation, including the total cost if we had to go for the people who do the full-blown sedation. His reaction, verbatim, was “holy BLEEP!”. (yes, he said “bleep”).

We discussed it some more and he said he was willing to cooperate.

Went to see the guy with the “handicapped” card. He was a bit startled that our regular dentist’s first line of referral was to go with full-blown sedation, and that she should have referred us to a pediatric dentist (someone like him, that is) as a first step. Dweezil cooperated with the consult - and the decision was made to give him one Valium (5 mg), and use nitrous, and go for it.

Dweezil cooperated beautifully. Only side effect was that he took a couple hour nap the afternoon after the work was done. Which was better, I think, than the drug cocktail the sedation people were planning on using!

Our total out of pocket for that will be about 250 dollars. One tenth of what we’d have to pay if we did sedation.

I had Moon Unit at our regular dentist a couple of days before the actual work and mentioned this other fellow (to see if she’d heard of him). She had, and said he was good. She just sort of shrugged at the way Dweezil had behaved for her; she said maybe he was just having a bad day. :rolleyes:

So we’ll stick with the pediatric specialist until Dweezil is older, at least.

So 4+ months of stress, over a dentist’s overreaction. Grrrr.

17

Well, I’m glad you came back with an update, and I’m glad that things worked out so well in the long run. I’m not that impressed with your dentist–I think the shrugging bugs me more than the original overreaction which caused so much stress.

And in retrospect, I’m kind of amused at how much focus this thread had on finances and how much to involve the kid, when it appears your immediate problem was solved by simply investigating another dentist, which would have been a reasonable suggestion no one made.

But, hindsight is 20/20, isn’t it?

18

Glad things worked out.

This goes to prove my theory that sedation dentistry is a big fraud. I had a pretty severe dental phobia and I let things go for a long time. I used to cry just walking in to a dentists office to make an appointment. One dentist offered me sedation dentistry for some root canals I needed, and it would have cost like a thousand dollars. When he saw I clearly couldn’t afford this and was still crying, he offered to give me some Xanax.

It cost me twenty bucks and worked like a charm. It even helped me get over my dentist fear and now I do fine without medication.

19

Yeah - I take Halcion + nitrous for anything major (root canal, the first few crowns) and have since then been able to have a crown done just with nitrous (and what’s with that for recreational use? It worked to relax me and possibly enhanced the novocaine, but I cannot IMAGINE using it because it felt good. Bleh). After a nightmarish root canal without Big Drugs, I won’t risk that again, but that handful of times with oral sedatives have done a LOT to relax me.

Sedation dentistry certainly does have its place - with an autistic kid, we know a lot of families whose kids couldn’t cooperate without true sedation. But it was big-time overkill for us, at least as a first resort.

Eureka, someone did suggest seeing a pediatric dentist, and ultimately that’s what we did. We just got in a mindset of being panicked, didn’t know where to look, even someone at the dentist’s office tried to find us someone who could work with just Valium (or whatever) + nitrous… I’m still pissed about that whole situation. I actually considered switching dentists over this… but then we’d have to find someone new (and our current person really is very good, as evidenced by the fact that I can now get work done without being nearly hysterical with fear).

20

Just reacting to this: Dad and aunt should be flogged for telling stories. :smack:

I’ve worked very hard to not spread my own terror of the dentist. I’ve never told them I’ve had painful experiences. I acknowledge that the novocaine pinches a bit when it goes in but then nothing hurts. And I acknowledge that it can get tiring to sit there with your mouth open so long. I’ve even made Typo Knig take the kids for fillings rather than doing it myself, out of worry that my own issues would show through.