Then it was our turn. They weighed ds2, so that they'd get the correct dosage. Then I was ushered into a private office with the anesthesiologist and a dental assistant. I sat on a comfy chair with ds2 on my lap and the doctor explained the whole procedure to me, how long it might take, and asked if I had any questions. I asked about the jab etc. He was very nice and patient, and kept telling me I asked very good Qs. Very reassuring person, although he must have been asked these same Qs 100x a day.
He would be giving ds2 a shot of ketamine first. Yes! My young son gets to take that drug at 3yo!! Ok just joking. Ketamine is actually good if you don't abuse it. It makes them drowsy but they are still able to breathe on their own. This is unlike General Anesthesia when patients would need a breathing tube, and so this method has less risks. Also, in kids, they don't cause hallucinations like how they do to adults. I also jokingly asked if he would get addicted to it. He won't, according to the Dr. It's too low a dosage?
So I hugged him, and the dental asst, held out a whole basket of toys and asked ds2 to pick what he wanted, so we talked about the planes, the cars and the skateboards. The Dr was holding the syringe and needle already. It wasn't till he jabbed it down into ds2's upper arm that ds2 knew what was happening, but I think it wasn't very painful, because he just cried a bit and was distracted back to the green plane that he chose and we (both I and the asst.) were talking very excitedly about it. I used my best animated high pitched voice.
Although the Dr had already told me how ds2 would react to the drug, it still was a little scary. Just after 1min, his hands went floppy and he dropped the plane onto the ground. I was still talking to him, but he seemed to be unable to hear me. I think if this happened at any other time, I would have called 911 and dash him to the hospital. His eyes were open wide and he stared at me, but more like, past me or through me. It was a vacant, spaced out look.
The dental asst left after picking the plane up for me to keep. The Dr had told me about the wiggling of the eyes too, but again, I was so surprised to see it in action. It was just so weird. Both eyeballs, or was it just the iris and pupil, moved rapidly from side to side. Ok, maybe just the iris and pupil. They jiggled from left to right quickly, like a little jerk, then stopped, then moved again. That kind of thing. The Dr said he could carry ds2 onto the dental chair already, so I passed him over. But I asked if I could take pics first.
I don't know if it was odd to him, but he said ok, without any reaction. So I followed him into the dental room at the far end, where the dentist was waiting. The dentist looks like Grisham in CSI (Dh said, not me). Anyway, he is also a very kind and confident person. Firm and warm handshake. But definitely camera shy. He was testing ds2's eye reflex when I took out the cam, and he darted to the side at once.
They wouldn't really mind if I stayed in the room, but there would be less hindrance if I went out to wait, and there is a long wait too. So I went back to the waiting area and told Dh and ds1 they could go out and get lunch if they wanted. I stayed and picked out a magazine to read. The office had many interesting periodicals actually. TIME, sports and race cars mags, and all the parenting and women's mags, then a range of kids' mags from Highlights to NickJr. But now it was my turn to be like the mom I saw earlier. Read a magazine listlessly. I prayed very hard too, of course.
They apparently did X-rays first, so they knew if there were any more hidden decays. Cos shortly after, the dental nurse or maybe a just a more knowledgeable dental person other than the dentist (don't know what term to use here) came out and showed me the X-rays on an illuminated fluorescent board. She explained the films to me and shockingly showed me an extra tooth that ds2 has, on the upper row of front teeth!
My first Q was anticipated by her. She said it was not the permanent teeth, and she showed me the whole row of permanent teeth, quite cool to see all of ds2's perm teeth waiting there in a row to emerge when he is 6yo and older. Ha. It truly was an extra tooth! And it was in the position just above the incisor, in between the current milk incisor and the permanent one. She said in future, when the permanent tooth is going to grow out, it would be impeded by this extra tooth, and it would cause pain and crooked teeth, and I would eventually still have to get it out. So would I want them to take it out now?
I thought about it and asked a few more Qs, then said yes. What they would do is, to cut the roof of the mouth just behind the incisor, and then take the tooth out. They called it odontoplasty - which is the remodelling of a tooth's enamel or the removal of it.
I read up a bit more about extra teeth (supernumerary teeth) at home after that, and other possible complications might arise if they are not removed, for example, fusion of the nearby permanent tooth with the supernumerary tooth.
The most common type of supernumerary teeth would be the mesiodens, which is what ds2 had, right in the middle, above the incisors. see this dentist's blog. His blog has been very useful and contained a lot of info that I had already read up on before the visit. He also explained sedation in some other posts. http://cyberdentist.blogspot.com/2007/01/mesiodens-or-extra-tooth.html
He did say in his post that he would wait till the extra tooth emerged before pulling it out. However, in the 48 comments that ensued after his post, I read in many cases that the teeth that grew out later are misaligned or that the permanent teeth or the extra tooth did not grow out and still had to be removed. So I guess since ds2 was already sedated, it made sense to just remove it now.
I was also surprised to see so many blogs, so many cases of supernumerary teeth online. I didn't know it was that common because I had never heard about it before, from my family members or friends. However, one online article did say it can be hereditary. All the articles did say that it has to be removed because it is not normal.
Ok, after that, I went back to waiting in the reception, and that Dh and ds1 came back with my lunch so I went outside to have the taco.
Then we all went back in and Dh and ds1 settled down to play Super Munchkin Card game (which Eric and Elaine, the newest engaged couple in church gave us). I still didn't feel like doing anything that required concentration. So I held on to the same magazine and flipped the pages, looking at pictures of beautiful cakes and how to make them. I checked the time constantly, and the minutes ticked by slowly. When one hour reached, I began to be a bit fidgety.
Finally, the dentist and anesthesiologist came out at 3.30pm (2hrs after ds2 went in) and brought us to the recovery room. Ds2 laid on a huge bean bag, with his finger attached to a heart rate monitor. They told us he may take anytime from few minutes to 45min to wake up.
There was a TV and DVD player there, and the dental nurse asked ds1 which DVD he would like to watch. He picked a dinosaur one, and then she gave him a popsicle to eat. Nice touch, to occupy the elder sibling.
Ds2 looked really poor thing. He lay there motionless, with his mouth still wide open. He felt a little warm, but it wasn't a fever. This is the pic. Notice they placed a lined bin for vomit too (top right hand corner)?
Both dh and I looked into his mouth. We saw the stitches, and there was still a little blood coming out of the incision. We saw the 2 stainless steel crowns for the premolars at the back also. He could've had the pretty cosmetic white porcelain crown, but I thought it didn't matter, since it was for milk teeth. Dh said when the teeth fall out, we can keep them as souvenirs.
His lips were very dry (ketamine slows saliva production) and cracked. And the sides of the mouth where the lips meet are also kind of red and sore. The nurse explained that his mouth is very small, and they had to keep it open with this device during the treatment, and his lips kept rubbing against it, causing friction sores. So poor thing.
As the dental nurse checked his teeth, he stirred and woke up! That was quick. He looked around then cried. The anesthesiologist was already working on the next kid already, but the room was just next to ours, doors opened, so he came in and said his head may still be floppy, so we shouldn't let him walk around by himself. He may be nauseous, disoriented and dizzy too. He said, his mouth would feel very dry, but it was still numb, so after 3-5minutes, when they were sure his mouth had regained some feeling, they would give him a popsicle to rehydrate his mouth.
I and Dh took turns to carry him. He wanted to be carried all the time, and he was heavy! So I was very glad that Dh took leave that day. The other reason was ds1. When he saw the dental nurse prodding in ds2's mouth, he got overcome with anger and cried and said that nurse was hurting his brother. He got a but emotional after that, until we distracted him with the dinosaur. So it was good both Dh and I were there, so we could pay full attention to each son at all times. I know ds1 was probably scared that his brother looked like that too, initially, motionless and then later on when he awoke, he was so miserable. So I did explain everything to him.
He does tend to get very protective over ds2 sometimes. Even with other younger kids too. In church, he got very angry with others who, in his opinion, mistreated Zoe, a toddler in church that he likes a lot. Eg, the Elder Brian was playing with Zoe one evening, when ds1 kept shouting at Brian. I asked ds1 why he was shouting away so angrily, he said Brian was bullying Zoe! So possessive.
Below is a pic of the still dazed ds2. Still in the recovery room. They needed to observe ds2 until he can keep his head up by himself.
In the meantime, I settled $350 of the bill. The rest would be covered by this charity group discount that I applied for. The total bill came up to almost US$1800. I have the itemised bill, and it doesn't look unreasonable actually. I am not too shocked at this. My dad had crowns on his teeth too, and his cost S$7000 last time. He had several crowns I recall.
Besides the 2 crowns, and the odontoplasty, there was the anesthesia cost ($450 for 2 hours), resins for the surfaces of 6 teeth, amalgams for several teeth, 3 pulpotomies, prophylaxis and intraoral periapical X-rays. The resins are the white colored ones, and they are more expensive than the amalgam fillings which are silver in color. Well, if my students or my kids were to ask me for advice on the specialty to take when they study medicine, I would suggest anesthesiology. On my bill, it says, the first 30min of sedation cost $150, and thereafter, each additional 15min cost $50. He started in the morning at 6am, and he was still working on other kids after ds2. Can you just make a guess how much he earns in a day?
The dental nurse asked me to settle the $350 which they said would be paid to the anesthesiologist, so I know he takes all of it. :-)
Dh said it's a really stressful job though. And this Dr is really nice. He gave us his cell phone number and said to call him if we have any further questions or concerns. Dh said, basically, he is on call 24/7.
Overall, we are very happy with this clinic, their service, the dentist and the treatment. They are really patient too. Not just with my Qs. While I was waiting for ds2, the next boy came in with his parents and a younger baby sister. I know he had fasted too, for 6 hrs, because he kept wailing to his dad that he was very hungry. He's about 6 yrs old, since he was taller and bigger than ds1. He cried and shouted a lot, then he was distracted in the playroom, which is good, but then he kept crashing all the toys in the playroom and throwing things and jumping on them. His parents kept calling his name and telling him to behave, but it was difficult. A cranky and hungry boy knows no limits. He brought some trucks out of the playroom and began zooming them all over the waiting room too. The nurses and assistants did not get angry or impatient with him. One of them did come out and talk to him and joked and so on.
His dad told him he can have all the popsicles he wanted, after the treatment.
When we were in the recovery room, I saw him being carried in, already sedated, by the anesthesiologist. When I went out into the waiting room, I saw both his parents, and his baby sister asleep on the couch! Oh my, the poor parents must have been tired out the whole day by him!
Both the dentist and anesthesiologist gave us the all clear later on, and ds2 refused the popsicle they gave to him! Ds1 happily took his, and licked on his 2nd! So we went home. At home, ds2 tried to walk on his own, but he had jelly legs! I was relieved that everything went well, so was lightening up already. Seeing him walk like that, we all had a good laugh. His whole body was quite wobbly. So we sat him down on the sofa and let him watch Blues Clues.
He was supposed to only drink water and clear juice, and if he could keep that down, then progress to other liquids, and soft solids. But he kept asking me for lots of food. It was so difficult to explain to him. I gave him water, then apple juice. He was really thirsty.
Then he asked for rice. I thought rice might be a little hard, so I gave him mashed up potatoes that I boiled in the chicken soup on Wed. He ate one bowl of it and wanted more! The ravenous boy! I distracted him for another 20min just to see how he'd take to the potatoes.
He reminded me of my C sections. Both times, right after they wheeled me back to the room, I felt so thirsty and hungry. But the nurses said I was to have no solids yet. I had water, and Milo, but still craved more food. I got Dh to open the packet of crackers we packed in the hospital bag and had them too. I didn't feel any nausea, just felt very hungry. The moment the nurses brought me my first bowl of pork porridge, I gobbled it all up. That was the best bowl of porridge I ever had! After that, I always ordered the Western meals on the menu. They had Muslim, Vegetarian, Normal Chinese, and Chinese confinement meals to choose from, besides Western, but the Western ones had more courses (eg dessert, soup, bread, besides the entree) so I felt that was the most filling. I still remember the best meal was the lamb chops, and Dh liked it so much, he ordered it too! Haha. He paid $7 for the meal, and said it was very worth it. They were so nice to bring in extra ones for him thereafter.
ds2 seemed to be just like me. So i did give him his bowl of rice, with chicken soup, and carrots. He downed the whole bowl. He also began singing along to the songs with Steve and Blues Clues (yes we still let him watch the old Steve). And then he stood up to dance too.
When ds1 irritated him, and he shouted "no! stop! no!", we knew he was back to normal.
We prayed together, a big thank you to God, for blessing and guiding us through this tense milestone in our parenthood journey.
{add on: this morning the dental assistant called to check on ds2 too.}
