Expert: Dr. Randolph Myerson - 10/7/2008

Question
Hello,

My son is high-functioning Autistic and has ADHD and is almost 8 years old.  His mouth is very crowded.  In May our pediatric dentist advised that we take out 4 of my sons baby teeth - the ones next to each of the 4 front teeth (canines) to ensure his permanent teeth have space to grow in correctly.  They wanted to use sweet air and do it in their office.  I decided to get a second opinion by my dentist, who was not sure what should be done after meeting with him and viewing his x-rays.  She sent us to an Orthodontist for an opinion.  She had however noticed an ectopic erruption on the X-rays which the pediatric dentists had not mentioned, so now the possible count was up to 5 teeth.  Anyway, the Orthodontist was not completely sure either and said that she would discuss it further with my dentist and get back to me.  They got back to me saying that taking the teeth out now may be the least invasive way to go, being that we want to prevent as much orthodontic treatment as possible at a later stage, as my son won't tolerate this very well.  They wanted an Oral Surgeon to do the work.  I spoke to the Oral Surgeon on the phone about my son's condition and the work that needed to be done and he said General Anesthesia would not be necessary and that he would do it in his office.  We turned up that day, and after looking at the X-rays he said he was not sure that this work should be done, and after looking at my son he said if he does it he will only do it under General Anesthesia.  At this point I was very confused.  

My son had another problem in his mouth (just a sore) for which we went to our original Pediatric office and met with a different doctor there who we had never seen before.  I spoke to her about the issue and she said that she suggests we do it in their office with an Anesthesiologist who would use IV sedation.  I spoke to the Anesthesiologist who explained it is a light general, and my son would get a shot in his arm and then most of the medicines would be administered by IV, but my son would be sleeping and not sedated.  

I am so unsure what to do.  It sounds like I should definitely go through with the procedure, but two pediatric dentists in the same practice suggested such different methods; sweet air vs IV sedation; and my dentist and the orthodontist thought I should use the Oral Surgeon who wants to do a General Anesthetic.

Any light you can shed on this for me would be very greatly appreciated.

Regards,
Beverley

Answer
Of course, I cannot make any recommendations since I've not examined your child or the x-rays for that matter.  You have several different approaches recommended and all are valid means of achieving a successful result.  The question remains as to which approach is best.  The "sweet air" approach offers the least medication risk and the greatest possibility that your child will not be sufficiently cooperative to complete the treatment.  It may work out just fine.  Maybe not.  At the other extreme is the general anesthetic which offers the best chance of successful treatment and the greatest risk of medication complications.  The sedation approach is a good compromise that stands between the other two options.  Here's the hard part...the choice and the decision is yours to make.  Discuss the risks of each approach thoroughly with the professionals with whom you've met.