Thursday, September 22, 2011

Dental Details

Peeper had her semi-annual dental cleaning today, and she did great, as usual.

Her teeth, not so much, though. They found three issues with them - two of which we knew about, and one surprise.

First, of course, was that same damn filling that we can't seem to keep in that front tooth. Remember when we took her in a few weeks ago, to have it repaired because it was chipping off for the second time?

(After rescheduling the appointment that we missed because of traffic, when she was crying "Deeeennnntiiiist!" from the backseat because she couldn't go that day.)

Well, that was on a Tuesday, and on Friday I noticed that the whole filling was gone.

At that appointment, we'd discussed it with Dr. C and were in agreement that if it didn't hold that time, the best thing would be to just cap it, so that we're not replacing / repairing the filling every couple of months for the next three years. We also were in agreement that we should do that under general anesthesia, so as to not jeopardize the wonderful relationship that she currently has with her dentist and dentistry in general.

I didn't want to wait until a month for the cleaning appointment and then another few weeks to actually get in to the OR, so I called the next week to try to schedule it, and after the insurance person talked with the dentist, they told me that they were afraid that our insurance wouldn't cover the ansethesia and OR, because it wasn't really medically necessary, since there was no actual decay going on. (Just a big whole right in the front of her mouth, where the cavity had been drilled out. Which food gets caught in, and now it's a brown spot, so maybe there is new decay happening because it's been exposed for a month.)

Since I had to sort of threaten the insurance company to get the OR paid for last time ("So what you're saying is that because the employer is in multiple states, you don't have to follow the state law that says that any policy served in this state must cover general anesthesia for dental work on a child under seven? I just want to make sure I have all my facts straight when I discuss it with my attorney." They called back fifteen minutes later to say that it would be covered.) I was pretty sure they were right about that, so we decided to just wait and discuss it with Dr. C. today.

Oh wait, but it wasn't Dr. C. I didn't even think to check on that when I called them at 8 am Monday (after very little sleep) to reschedule. Turns out Dr C was in the OR today.

I was a little annoyed with the hygenist for not giving us a heads-up about that. I can't imagine that she hadn't heard me tell Peeper - like twenty times - that "Dr. C will be here in a few minutes" and "In just a minute Dr. C will come look at your teeth," and I told her how Peeper adores Dr. C and pretends to be her when she dresses up as a doctor.

It wasn't until some very-not-Dr-C-guy was sitting down in the chair and saying hello that she told us that Dr. C wasn't there. Thanks for that.

Otherwise, she was great with Peeper, though - showing her all the instruments before she got them anywhere near her mouth, "tickling" her hand first with the "tickly toothbrush," even squirting water into her own hand and sucking it up with "Mr. Thirsty," so I can't be too annoyed, but seriously? Did you not think we might ought to warn the kid that her dental hero wasn't going to be there?

Anyway, then I was a little annoyed that the dentist who did see her didn't introduce himself, he just plopped down and started talking. We were in major damage control mode at that point, hoping to stave off a freak out about the missing Dr. C (she was fine) and trying to make him look like the coolest thing since sliced bread - "Look! This is Dr. C's friend. He's going to look at your teeth today! He has whiskers! What do you think his name is? Do you want to ask him his name?" - because, really, Dentist Dude, are you going to at least tell us your name?

At that point, she was asking to nurse, and I was trying to put her off because they'd said nothing to eat or drink for thirty minutes after applying the flouride, but I knew it wasn't going to go well if I didn't let her. So, I asked how badly that would mess up the flouride (she was happy to just reapply it) and could we please take a quick break before the actual exam.

He said that was no problem, and scurried off.

As I was giving Peeper her "goody to ten" (which took all of about thirty seconds) I told Shrike, "You know, Dr. C doesn't run away!"

Anyhoo - Dr. R confirmed that the filling was gone, and looked at the other tooth that I've been suspicious about for a few days (one of her first molars, with a little brown spot on it) and said that it's actually a chip, that may or may not have started with a cavity, but there doesn't seem to be a hole that goes any deeper, because it wasn't "sticky" meaning that his metal hook thingy didn't get stuck in it.

There's also a tooth in the very back that has cavities on two surfaces, or one cavity that spans two different surfaces or something like that. He "showed" it to us, but since I wasn't wearing my reading glasses, all I could make out was what he was doing with the hook thingy.

So, none of that is great, but the up-side is that the cavity/ies in the back buy us a ticket to the OR, where we'll also be able to fix up that front tooth - permanently, I hope.

Currently, the treatment plan calls for filling the back tooth, filling (again) the front tooth and assessing the chipped one to see if it needs a filling, as well as x-rays to make sure there's nothing else going on in there that needs to be dealt with.

I want to talk to Dr. C before then, though, and request that - if it's all the same to the insurance company - we just go ahead and cap that front tooth. Its three neighbors are capped already, and we're never going to be able to keep a filling in that tiny hole on that flat surface.

We're scheduled to do all that on October 12, at around noon.

The scheduler lady was concerned about it being that late in the day, "since she can't eat after midnight," but actually she can nurse until 4 hours before the procedure, and when you add up our ninety minute drive and the arrive-two-hours early thing, that just about fills up that time, and we'll probably be waking her before she wants to, in which case, she's not likely to want to eat anything solid for breakfast anyway.

As we were discussing this at noonish today, I realized that she'd not had anything but breastmilk this morning and was fine. Of course, she was nursing quite enthusiastically at the time, so she probably was hungry by then. But on procedure day, she'll be nice and stoned on Versed by that point anyway.

As to the clear liquids portion of the program, it's likely (oh, I hope) that she'll be asleep by midnight anyway, but I am going to argue with everyone I can about the midnight thing, until I get a different answer.

Here's my theory: If she were having this done at seven in the morning, she would be allowed to eat until midnight. (I asked both the dentist's scheduler and the woman who called me later from the hospital to adjust the appointment time, and they confirmed that.)

So, if seven hours of clear liquids is enough for the first patient of the day, why would the fourth or fifth patient have to go twelve hours?

Scheduler lady did tell me that for procedures scheduled after 3:30 pm they allow the patient to eat that morning, but it makes no sense to me at all that everyone until then gets the same cut-off time.

Why don't they just say they have to be on clear liquids for a certain number of hours before?

The "midnight" thing is arbitrary and stupid. And universal. WTF?

So, when I talk to Dr. C about the filling vs capping thing, I will ask her. And when a nurse calls me to confirm everything a few days before the procedure, I will ask her, and when she tells me midnight, I will tell her that I want to talk to the anesthesiologist.

If I were trying to convince them to let her eat until four hours before, or nurse right up until time, or something like that, I would worry that I was risking her safety during the anesthesia for the sake of her comfort that morning but, again, if the kid getting his teeth fixed at seven o'clock gets to eat seven hours before he gets knocked out, why can't she?

But enough about that.

When the filling first fell out, I started preparing Peeper to "go to the hospital to get your tooth fixed up" (and then I had to unprepare her) so it was fairly easy to jump back into it.

I've explained it all to her a few times already, and shown her the photos of herself all dressed up in her "doctor clothes" (hospital gown / scrubs - close enough) from last time, and we'll go over it many more times in the next couple of weeks, and I think she'll do okay.

I'm not thrilled that she needs more work, but I am glad that at least we'll get to fix up this front tooth. But is it wrong of me to be sort of looking forward to seeing what she has to say on the Versed, now that she's verbal?


  1. No wronger that me thinking, "Oooo, they need to video her on the Verded. ;)


  2. Versed. Yeah, when I notice a typo, just as I hit post, that's when it posts on the first try. :/



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