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I took my 8 yr old to the dentist yesterday and she has three cavities :( She is normally a fairly anxious/ slightly sensory kid (out of exacerbation). It is very hard to get her to relax and cooperate for a tooth cleaning and xray. I cannot imagine how we are going to deal with the cavities. The doctor laid out some options for me. My main concern is not doing anything to cause a pandas flare up. We have never seen a flare up in either kid due to a cleaning.






valium + nitrous oxide


(doctor said sometimes with kids even using these two things do not work- hhmmm- should anticipate that will be us)


valium + nitrous oxide + blanket (this must be like a straight jacket. REALLY do not like this option on many levels. Worried that extreme stress if this technique is employed could cause pandas flare.)


general anasthesia in hospital



oy. Not many good choices here. Wondering what experience your kids have had with valium and/or nitrous. Did they react positively? Did it lessen anxiety? Did it cause a flare up?


Thanks for the input!



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This was a very tough issue for our family, too! We used Valium + Nitrous on several occasions. It was the ONLY way we were able to get through dental procedures; we know, because we walked out of the office after unsuccessful attempts with a sobbing boy several times over the years.


They ordered 2 doses of Valium; 1 half-dose for 30 minutes before appt. and we were to bring the 2nd half-dose with us, in case we needed it at the office. Worked like a charm, but did NOT put him out, just made him able to cope (took the "edge" off his anxiety.)


Since our dental issues were extractions for orthodontic issues (ie. potential for oral bacteria to enter blood stream with teeth are pulled), we also put him on a course of antibiotics (he was not on prophylaxis at the time) starting 2 days prior and continuing until the course was finished, just to make sure it wasn't followed by a flare-up of the immune system.


Best of luck.


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I don't know if you read the discussion here regarding nitrous oxide use? There is some concern regarding B12, folate and methionine synthesis. I'm leaving you one link, but you can read up doing a search of those key words if you think it might be a concern.


I'm hoping too, that your Dentist is not using amalgam (silver) fillings? I would remortgage my home before I would allow a silver filling. Short video link below for anyone who has not been around that block.






Video University of Calvary

dental amalgam fillings tubulin inhaled vapors



I wish I had some good advice. I know valium sure worked for me when I had impacted wisdom teeth taken out. It was wonderful. My oldest son didn't have any problem with Versed for teeth or GI scope, but I'll let other parents with more PANDAS specific kids comment.

Edited by kim
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Eileen, my dd just had a dental check last week and our dentist treated her with a new toothpaste available only to professional that reverses decay with daily use...even really bad decay. He said it was a great option for cavities rather than fillings. We asked where we could get some and he said not available publically yet. I just called my dentists office and explained your situation (another pandas child) and they would be happy to talk with you to tell you how to get this paste, how it works, etc. It is called M I S paste. Pm me and I'll give you the number if my dentist if you like.

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Eileen, I know these are not great options but I would steer clear of using nitrous oxide as it can be problemsome for children with underlying immune conditions.


"Nitrous oxide depletes the B12/folate system and deactivates methionine synthase, which is an enzyme that catalyzes the conversion of homocysteine and methyltetrahydrofolate to methionine and tetrahydrofolate. Such a deactivation in a patient with a defect in the MTHFR (methylenetetrahydrofolate reductase) gene, which is associated with diminished enzyme activity, could result in increased homocysteine levels, increased oxidative stress, and activated NMDA glutamate receptors. All of these could contribute to inflammation; additionally, nitrous oxide also may cause hematologic problems, neuropathy, and neurotoxic effects.". 




I wish I had some suggestions for you but I wanted to alert you to the potential problems of nitrous oxide. When my DD was scoped last we used propofol and she did well with that. I would hate to have to resort to general anesthesia for cavities, but you can't NOT do the procedure either. This summer my DD will have to have all 4 wisdom teeth out and I will insist on using propofol again.

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I was VERY scared about this, too...and again, we deal with the same thing....always slightly anxious and same throwing up fear...I don't have any real advice other than to let you know that my daughter had 2 filled this month and although nervous she did get past it a lot better than I thought she would....here is what we did..


1. did not mention when the apt. was until the day of it so she would not get more nervous (only on that day)

2. told her what to expect

3. had the ipad there for her to watch something else

4. they did not give her a shot...I think they used a laser or something....but, it was a lot less stressful

5. reward for afterwards


The biggest scare for her was if she was going to get a shot...and while getting them filled it looked like smoke coming from her mouth during it and I didn't think to warn her about that .....that is when she started throat clearing ticcing again (which she always does when nervous)..but, it was sad to see her doing that with her mouth wide open at the same time.


anyways, we didn't do much....and no extra drugs or meds...and got through it!!!!....but, I will say that it probably would not hurt to get the extra relaxing meds just to be safe!

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Thanks for all of the replies so far.


Coco- it really touched me that you would call your dentist for me :wub: I will pm you later (short on time now, as I really like that option).


Kim and Nancy- I was really concerned about the nitrous, as dd does have one MTHFR mutation, and I had seen some issue with that. I havent' done my research yet- as this forum is always the best starting and ending point for me.


My dd had propofol for her pex procedure, and that went really well. The dentist will do the procedure in the hospital, but is not sure what the anesthesiologist would use- so I would have to inquire further.


At this point I am thinking to try the valium route, and if that does not go well- consider the hospital. All this after checking out this new toothpaste.


Kim- NO silver fillings. I was not even aware they were used anymore. This dentist only uses white.


Thanks everyone! As usual!!!

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You know my husband has anxiety, panic attacks, and mild tics--although I couldn't say if it's the same beast as PANDAS--but he LOVED LOVED valium. It was prescribed for him to take prior to a procedure four years ago and he still says how awesome it made him feel (very relaxed and mellow)...LOL. He was taking zoloft at the time too.


I'm wondering if you could use valium and then just go to the numbing shots--skipping the nitrous oxide? Perhaps those medications don't mix?

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I tried to PM you about that toothpaste but got the message your box isn't accepting new msgs, maybe full?

anyway would LOVE to know the info on that toothpaste.


My DS had 8 cavities last checkup, because he has celiac which we didn't know for so long eroded the enamel on this teeth. So we've been using enamel support but would love to get my hands on that toothpaste.


can you post or PM me?


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Here's what I know: the product is called MI Paste and MI Paste Plus. It's available through your dentist with a prescription. It is a milk-based formula so don't use if dairy allergy. It is not gritty, more like a creme and available with or without flouride. Must not eat for 30 minutes after using and does reverse decay in children and adults. Check out their website by googling mi-paste.com. My DDS dentist is very conservative and understands pandas, and specializes is treating special needs children. I trust him. If you would like my dentists name, just pm me. I cleaned out my box.

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