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Wednesday, February 15, 2012

Murder House

Murder House (MUH-dah House)
The deed is done

            “I don’t wanna go to the dentist. It’s gonna hurt,” says Fiona. I can hardly deny my eight-year-old the truth, but I can tiptoe around it.
            “They’re going to rub medicine on your gums to numb them,” I tell her. “And they can put your tooth to sleep with a needle.”
            Fiona gasps, “I don’t want a needle! No!”

Oops. I shouldn’t have used the “n” word. Fiona starts her high-pitched screeching if she thinks a needle exists in the next room. When I got the kids immunized in preparation for dragging them round-the-world, Fiona cried as the nurse swabbed her upper arm with iodine. You would’ve thought someone was whacking off her limb with a rusty saw, yet the needle lay feet from Fiona’s body.

New Zealand is not the place for dental work for a squeamish, sobbing little girl. I learned after bringing Fiona to a dental clinic during the Christmas school vacation (otherwise known as summer holidays) that school dental clinics do NOT use conscious sedation such as nitrous oxide (or "laughing gas"). Children with lots of cavities, abcesses or an overabundance of anxiety are sent to hospital and given general anesthetic.

Poor Fi, who has a large cavity on a baby tooth (likely a result of too many lollies and not enough fluoride) is made to sit still while the blonde-haired, gap-toothed dentist in her 50's rubs Lidocaine (a topical anesthetic) on her gums. 
            "I'm going to put a temporary filling on this tooth that should hold until her adult tooth comes in," says Dr. D.
During this time, Finley clips together large Lego-like pieces from his spot beside me on the floor. Click – click – click…
           "What about numbing that area with Novocaine [local anesthetic]? I ask.
            Dr. D replies, "We'd have to inject it through her gums, and I don't know if she'd tolerate that."
            All 45-pounds (about 20 kilograms) of Fiona are quivering on the blue plastic dentist's chair. Fi's wearing pink sunglasses the dentist gave her to shield her eyes.

             "We need to make your tooth better," says Dr. D. "I'm just going to clean it out and put in something like toothpaste."
             "Uh-uh-uh," moans Fiona, still quivering as the dentist's gloved hand approaches my girl's mouth with a drill.
Fiona's fillings

From my perch on a rolling corner stool in the school dental clinic, I scan the room: A large toothy replica sits on the windowsill; posters about the importance of proper brushing and flossing line the walls. The space is white, clean and bright, with the same equipment I'm used to seeing in the States.

The big difference though is, parents in New Zealand don't have to pay for their kids' teeth exams, cleanings or fillings: Free basic dental care is available for all New Zealand children and teenagers up to 18 years of age.



Free dental care is provided to all children- from birth to Year 8 schooling- at the school or community dental clinics.  Dental therapists provide dental examinations, fillings, extraction of primary teeth, applications of fluorides, placement of fissure sealants and, oral health education and promotion.

http://www.healthysmiles.org.nz/default,128,dentistry-in-new-zealand.sm
Kiwi kids' dental care is free of cost but not free of pain.
Most Kiwis can recount dental horror stories from their grade-school days. Pete, the Partner, says they used to call the school dental building (back in the 70’s when nearly every NZ school had its own clinic) the “Murder House” (which, in Kiwi, sounds like “MUH-dah House”). Pete says he received no numbing agent back then – everything was done with the attitude the kids had to open wide and suck it up. 

I've poked around online to learn whether it's illegal for dentists in NZ to administer nitrous oxide in their clinics. The NZ dental council website says:


The dentist may provide both the sedation and the dental treatment only if an appropriately trained assistant is present throughout the procedure to assist in monitoring the level of consciousness and cardiorespiratory function of the patient…The procedure must be performed in a location which is adequate in size and staffed and equipped to deal with a cardiopulmonary emergency.

 http://www.dentalcouncil.org.nz/Documents/Codes/COP_Sedation.pdf



So maybe New Zealand dental clinics are not equipped for a heart-lung emergency? It seems overkill to send a kid to the hospital and knock them out to fix a few cavities, yet it's cruel to work on kids' teeth without even administering a local anesthetic. Pete says his 9-year-old niece went to the hospital and had general anesthesia to have cavities filled.

Dentists in the US can, and often do, administer conscious sedation like nitrous oxide in their offices. Nitrous is mixed with oxygen and delivered through a small mask over the nose. The Colgate website states: 
It is safe and quickly eliminated from the body. Your child remains awake and can continue to interact with the dentist. When the gas is turned off, the effects of sedation wear off very quickly. 


The American Academy of Pediatric Dentistry website explains why a dentist would sedate a young patient:


Sedation is used for a child’s safety and comfort during dental procedures. It allows the child to cope better with dental treatment and helps prevent injury to the child from uncontrolled or undesirable movements. Sedation promotes a better environment for providing dental care.


Any anesthetic carries risks. Children have died from allergies to local anesthetic and complications from general anesthetic and even nitrous oxide. Deaths are rare and often linked to an underlying health issue.  It makes you pause, but doesn’t stop the pain.

                “That really hurt!” says Fiona after the dentist installs a temporary filling. And Fiona’s not done with dental work: she must return for two more fillings after school resumes. How will she handle the drill again without anesthetic, or react to a needle stuck in her gums to numb the tooth? Finley, too, requires work: he’d broken half a baby molar (we’re not sure how and when that happened) and a small cavity needs filled.
Unable to believe I can’t get something besides a long needle full of Novocaine for my kids’ dental procedures, I call the clinic the week before the kids are due for their appointments.

            “Do you ever use nitrous oxide?” I asked whoever answers the phone.
            The person responds as if I’d asked whether to shoot up my children with heroin:

“OH NO!” She said. “We can’t do that. We only do anesthesia in the hospital for children under six.”

I would resort to my own shlocky methods. The morning of the dental visit, I buy cough syrup with Pholcodine (the box says it has a “mild sedative effect”) that could be administered to kids as young as six.  That, along with the NZ equivalent of children’s Tylenol, might help dull the pain. I collect Fiona and Finley from school at lunch time and drive them to McDonald’s for a pre-Murder-House-Happy-Meal. I give them each a half-teaspoon of cough meds and a tablespoon of liquid Tylenol, which I mix into their black current juice. How sneaky and strange to drug my children at Mickey D’s!

My attempt at amateur pharmacy makes no difference whatever. The kids race around like puppies as we walk from the minivan to the clinic.

            Minutes later, Fiona's shaking while lying in the dentist's chair. Dr. D. decides against using Novocaine.

            “I don’t think she’d react well to the needle,” she says. “We’re just going to rub a little lotion on your gums, sweetie,” Dr. D explains to Fiona.

“Uh-uh-uh,” moans Fiona. Here we go again. The dentist shows Fiona the pink filling material she’ll pack into her back baby molars, plus the water drill she’ll use to “clean away the yucky stuff.” Everyone’s calm until Dr. D starts drilling. I’m standing at Fiona’s side, holding her small hand when Fi holds up her other hand in the “Stop!” motion while boosting the volume of her moan. This is where Dr. D turns-Mr.-Hyde:
            “You just STOP!” instructs the dentist sternly in a Kiwi accent. “I am NOT hurting you. You stop this nonsense right now!”

What do I do? Smack the dentist? Yank the drill from her grasp? No, instead I squeeze Fiona’s hand tighter and tell her it’ll be over soon. I am complicit in this procedure. A contributor to my child’s pain. In minutes, the deed is done. Fiona sports a patch of orange overlaying two back baby molars. She whimpers as she swings her twiggy legs from the dentist chair.

Dr. D initially told me she’d have to extract Finley’s half-broken molar. Now, maybe following Fiona’s distress, she’s rethought her plan. “I don’t want to put his tooth to sleep,” she says.

            I am NOT allowing anyone to yank out my child’s tooth without pain medicine (besides the aforementioned cough syrup which still has had NO effect whatever).

            “You’re NOT pulling out that tooth without numbing it first,” I insist.
Dr. D peers at me over half-spectacles and says, “No, I think we can leave it as-is.”

            I ask, “Can you just paint a sealant over the tooth to prevent the whole thing from decaying?”
Dr. D and her assistant look at each other as if they hadn’t considered the option.
Finley's half-tooth seal

            “Yes,” says the dentist. “We’ll do that.”
Finley endures the cleaning and sealing without moaning, or even whining afterwards. He needs one more small cavity filled before we’ve completed (for now) our Kiwi pediatric dental experience. Meantime, I’m faithfully administering fluoride each day while continuing to help Fiona and Finley brush and floss their teeth. The [kid] lollies are all but banished from the house. I still have the cough syrup, though. Next time, I’ll be the one swigging from the bottle before we enter the Murder House. At least I didn’t get a bill.

6 comments:

  1. I have a wonderful dentist in Spokane. I believe in drugs. She gives me nitrous, hot hand wax treatment, vibrating chair, earphones, and I beg to have a root canal...No child should suffer so....

    ReplyDelete
  2. I am beside myself as you tell this horrible story. Your daughter and any other child and adult deserves better treatment and a lot more civility than what Dr. D did to you and your daughter. I know because I'm a dentist in USA. I use a pre numbing agent prior to the novocaine (I let it soak in for 5-8 min). I also offer nitrous oxide to all my patients, especially children as they respond to it very well.

    I only wish you were closer to me so I could take care of your daughter.

    Matt

    ReplyDelete
  3. As a pediatric dentist, I made every one of my staff read your story so that they can see why we take the extra effort with our patients to make sure they are comfortable, pain free and love going to the dentist. I also want to show my paying patients what free dentistry looks and sounds like so they can appreciate the fact that you get what you pay for. Unfortunately for Fi, the broken, unrepaired molar will cause severe space loss and possibly an abscess in the future. I wonder if you so called "murder dentist" had the intelligence to give you that information?

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  4. Are you sure that was a dentist?
    New Zealand and Australia have a fair number of "dental therapists" which are being pushed by a number of our politicians in America.

    I'm a dentist in California.
    Even with my "free dentistry," I try to do everything that I can to avoid discomfort (not to mention pain).

    Seriously, if you come over (after I've established my clinic in a couple years), I'd be happy to take a look at your kids teeth.

    ReplyDelete
  5. This is very insightful, I really like this blog.Thank you for sharing!

    ReplyDelete
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