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Medical Forum / General / Dentistry / October 2004Palate expander and nausea
[cross-posted to alt.braces] My 9YO daughter had a palate expander put in last Wednesday. She immediately felt nauseated. She vomited that evening and on each of the next two days. She hasn't vomited since Friday, but she wakes up nauseated or becomes nauseated within an hour or two after waking. She feels sick for a couple of hours and then feels okay. Sometimes later in the day, she'll feel nauseated again. Today she missed her fourth day of school. Her regular MD says she's not ill. He suggested that the palate expander may be irritating her vagus nerve, which has an effect on the nausea center in the brain. He gave her Phenergan. I gave her one before bed last night, and she slept fine but woke up pretty nauseated. I gave her half a pill this morning (a whole pill might have made her drowsy), but it didn't kick in until an hour after school would have started. The orthodontist is out of the country this week. We're about to take her to the orthodontist on call, and we expect that we'll ask him to remove the appliance, because she just can't miss any more school. I'm sure that it's not just a case of my daughter's being anxious about going to school, because she felt sick on the weekend. Also, she's felt sick in the afternoon as well as in the morning. Has anyone else had an experience like this? What were the solutions? If we have the appliance removed, are we still liable for the $3,000 cost of the treatment, or can we get some of the money back? Thanks for any help. Anne Sounds like you have projected fears of wearing an appliance in the mouth to your child. Seriously, and I do not intend to be disrespectful in this statement. Unless your child is a chronic mouth-breather, or the appliance was made entirely wrong (not very likely, as labs don't tend to mess up like that), then, the child has anxieties about the appliance. Instead, you should send her to school nauseated or not. Once around her classmates, I bet the reaction ends.  Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > [cross-posted to alt.braces] > [quoted text clipped - 30 lines] > > Anne > Sounds like you have projected fears of wearing an appliance in the mouth to > your child. Seriously, and I do not intend to be disrespectful in this [quoted text clipped - 3 lines] > should send her to school nauseated or not. Once around her classmates, I > bet the reaction ends. Thank you for your response. I don't take offense. Really. I don't think the appliance was made wrong. Also, I didn't have any fears about the appliance. I can't see sending a nauseated kid to school. (She was very nauseated, not just a little queasy.) I had the appliance taken out today. She still felt a little nauseated afterward. I don't think I would ascribe that to anxiety about the appliance. She didn't seem anxious otherwise. She's an articulate kid; I think she would have verbally expressed any anxiety about the palate expander. I'm just a parent, but from talking to her physician and to the on-call orthodontist, who took out the appliance, I wonder if some people may have a stronger connection between the palate and the brain's nausea center. Anne >> Sounds like you have projected fears of wearing an appliance in the mouth to >> your child. Seriously, and I do not intend to be disrespectful in this [quoted text clipped - 22 lines] > >Anne I did not examine your child, nor do I know you, but the description sounds more like a child trying to manipulate her world. She is not a mouth-breather right? If she lived for 3-4 days with it in place, she would have adapted once she realized there was no other choice. .. Stephen Mancuso, D.D.S. Troy, Michigan, USA Writing on a tablet PC,so forgive me if the PC misreads my poor handwriting. >If she lived for 3-4 days with it in place, >she would have adapted once she realized there was no other choice. >.. >Stephen Mancuso, D.D.S. Yep. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE Not meaning to protrude in this problem, it would seem that as the days go by, it would be indicative if the problem was the appliance or not. Does the child continue to be nauseated now that the appliance has been removed. Or has removing the appliance solved the problem. Can you please post the child's continuing condition, i.e.the child is well, the child is continuing to be nauseated, the orthodontist or the physician offered a plausible reason for the nausea if it is continuing. In other words, what is the present status. If not being too forward, (I am not a dentist) can you follow up with information. Has the appliance been put back? This is of interest since you ask if some people may have a stronger connection between the palate and the brain's nausea center. Apologies to all if I am out of line. Of course, as Dr. Steve has said, if the child is a chronic mouth breather or the appliance was made entirely wrong, that may be the problem. All thing considered, if the child was well before the appliance being worn, she should have the same condition without the appliance once again. Would appreciate a followup. Gail I agree. This is a psycological issue. sounds like the sleeping pills helped until they wore off. You might consider taking her to psyciatrist maybe some hypnotherapy. It maybe something in her past that is bringing on this nausia perhaps drowing incident etc... > Sounds like you have projected fears of wearing an appliance in the mouth to > your child. Seriously, and I do not intend to be disrespectful in this [quoted text clipped - 38 lines] > > > > Anne >[cross-posted to alt.braces] > [quoted text clipped - 30 lines] > >Anne this comes under the category of who knows. I've done thousands (?) of expanders over 24 years and never had this reaction. BUT the following thoughts go through my mind: 1. is she turning the screw and how much 2. is the appliance made of all metal or part metal and part plastic 3. if you are turning it and stop turning it does this improve the nausea 4. how has your daughter reacted to other medical/dental procedures. was she in favor of this or was she against it 5. what do you have to lose in taking it off? another lab bill from the orthodontist if you then decide to put it back. 6. if it were one of my daughters, I would remove it and she what happens. 7. the vagus nerve is an interesting comment and it has been some time for me since I considered the anatomy of the vagus nerve but it seems to me that the location of the nerve is quite far anatomically from the site of the expander Charlie Ruff, DMD Specialist in Orthodontics Diplomate American Board of Orthodontics > 7. the vagus nerve is an interesting comment and it has been some time for me > since I considered the anatomy of the vagus nerve but it seems to me that the > location of the nerve is quite far anatomically from the site of the expander It's been a while for me as well, but I think the gag reflex is mediated by the Vagus (CN X) via the pharyngeal branches. Maybe this expander is a tad too long in the back? Just an idea SP SignatureNot a real Addy, yet >> 7. the vagus nerve is an interesting comment and it has been some time >> for me [quoted text clipped - 8 lines] > Just an idea > SP My *guess* would be the same regarding extension (Vagus - ahh that's a stretch - but who knows), or perhaps the child was sick despite the MD's assessment, or just didn't like it and found parental confirmation by throwing up. I have seen all three. My money would be that she (? forgot if M or F) probably was having trouble tolerating it. How did she do with the impressions for the appliance - did she lose her last meal then? Some just have an extremely hard time with their gag reflex - IME if the appliance is left in for 3-4 days toleration increased. If it were my patient and I was convinced that maxillary expansion was a must for successful TX, I would be trying a modified appliance, and pretty quickly too. I've found that backing off can sometimes reinforce poor patient behavior, and other times you probably ought to just back off - a bunch. JMHO. OTOH, I have one patient on recall, about ready (dentally) to start comprehensive ortho, that gags when I tip the chair back, and/or when my mirror gets within six inches of his mouth. No, I'm not exaggerating. carabelli Hey Charlie - GO SOX! > OTOH, I have one patient on recall, about ready (dentally) to start > comprehensive ortho, that gags when I tip the chair back, and/or when my > mirror gets within six inches of his mouth. No, I'm not exaggerating. > > carabelli Scopolamine (motion sickness) patches? Make a big deal about it... saying that it WILL work... Have them put it on one hour b/4 the appointment, behind the ear. I have patients who gag as I come at them with the film for simple BiteWings... this is even b/4 the film is in the mouth. Another thing I've tried is anesthetic spray all over the palate, or have them *paint* thier own palates with EMLA. Warn them that it tastes really bad, though. I've also heard that there are acupuncture/acupressure points that can help with this, but I don't know any acupuncturists. The last thing that I know: have them in as late in the day as possible... often I find it's a lot worse in the morning. If you can get them after lunch, and hand them a tooth brush, and have them brush their teeth in your office, there is often better compliance. Just some ideas, or some BS, take your pick. SP SignatureNot a real Addy, yet One of the best tricks for controlling gagging is very salty hot water gargle. Water hot as is practical without burning and saturate with table salt. 6 oz cup is usually sufficient. Gargle with all liquid in 2-3 'rounds'. Don't know why it works but it does. Chloraseptic spray can be useful. >> OTOH, I have one patient on recall, about ready (dentally) to start >> comprehensive ortho, that gags when I tip the chair back, and/or when my [quoted text clipped - 22 lines] >Just some ideas, or some BS, take your pick. >SP -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com "Don't know why it works but it does" No scientific evidence? It needs a study to verify. In the meantime, my theory falls into this class. Don't know why it works this way, but it does." As sure as the sun comes up in the morning. And a valium would solve the gagging problem, most likely, if the FDA gets with it. Gail Gail >"Don't know why it works but it does" > >No scientific evidence? It needs a study to verify. Emperical evidence. The salt dries the mucous membranes and removes the thick mucous from the membranes. It also dulls the sensations of the throat. Have you never gargled with salt-water for a sore throat ? >In the meantime, my theory falls into this class. Not even close on a good day. Joe Bob in Muskogee is taking an anti-depressant, and causing Crohns problems in someone else, somewhere else ? Homeopathy theory is better than that. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com W-B "Not even close on a good day" I sincerely wish you were right. People are living miserable lives. Examples are rampant but mostly unrecognized and attributed to other causes, including amalgams. Do you believe aside of organic illnesses which have good research and betterment of health, the overall health of US, Canada, UK is better now with all the ailments of depression, unresolved misery, surgery (keeping the surgeons and researchers busy on nonsense that might be avoided) half the population needing anti-depressants, etc. Years ago, growing up I never knew anyone on an anti-depresssant, today I barely know anyone NOT on an anti-depressant. Does that say anything, or just better to ignore it until no one is safe from an undisclosed illness. Gail > Not even close on a good day. > [quoted text clipped - 5 lines] > > W_B Okie from Miscokie? .... SP SignatureNot a real Addy, yet "Joe Bob in Muskogee is taking anti-depressant. and causing problems in someone else, somewhere else? Damned right. Same with Okie from Miscokie to __________in Oshkosh, Wis. Gail >"Joe Bob in Muskogee is taking anti-depressant. and causing problems in someone >else, somewhere else? [quoted text clipped - 5 lines] > >Gail Absolute rubbish. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com "Absolute Rubbish'' I hope you never experience the absolute rubbish this syndrome causes. Mayor of Boston, if he were more open could tell what it feels like. So can almost anyone on the Alt support.crohns-colitis newsgroup. Of course they don't think Joe Bob in Muskogee can be responsible.and yet no better cause has been given that is consistent for all. It's really quite simple in spite of all the doubts. There must be an answer as to why this cause is seemingly so illogical and yet so true as anyone pursuing it can establish. Many things are not known why or how, but are. Gail . > It's really quite simple in spite of all the doubts. There must be an answer > as to why this cause is seemingly so illogical and yet so true as anyone > pursuing it can establish. Many things are not known why or how, but are. > > Gail > . Y' know... it sounds like there is a psychological comopnent to this disease. Keep talking about it like this and you'll influence all those highly suggestible subjects to develop the disease. It's getting repetitive, Gail... It's getting repetitive, Gail... It's getting repetitive, Gail... It's getting repetitive, Gail... Like I said b/4: Go and find some grad students in Psych to test your hypothesis. We have an a.shole on the airwaves here in the mornings, and I listen to him after I drop the kids off to school. I do this just so I can yell back at him and call him an AH.... it wakes me up, and puts me in a W_B kind of mood. This morning, he said (on air) that he could drive safely anyday with 0.18 of alcohol in the blood (the limit here is 0.08...) Him and his cronies spent 10 minutes on that theme. Now, you just watch the rise in the number of accidents with autos here, between now and Xmas, just because this a.shole said it on the air waves. Gail, the only person you are helping is YOURSELF, and, at least IMHO, you are potentially hurting others that are in a fragile state of psyche. Get off the obsession or do something constructive with it. <whew...> Bon Soir SP SignatureNot a real Addy, yet Well, maybe it's more complicated than simple. It is repetitive, because it needs to be absorbed, not ignored so that it continues without ANY understanding of the subject. It DOES affect persons and ignoring it does not make it better. Being extremely busy helps. Diverting attention from the person on the anti-depressant or stimulant helps, but not altogether. Suggestion as you imply can be a factor in things happening provoking accidents and such as the radio announcer you speak of, but not with crohns. No stimulant, no crohns. However, once crohns is there, I believe I become a stress factor for harping on it. But I am not the cause, I take no anti-depressants or stimulants. But it does scare some people to hear of it. I only say it once, if they can believe it and make it work, they have an advantage. Crohns and all related symptoms is in a class by itself. No amount of suggestion can bring it on. Maybe though, they become more aware of it for better or worse. Can't say. Too complicated to relate all here, but ignorance in this illness is not better. I am not helping myself, I can shut up if the persons dear to me had immunity. If they are in a fragile state of psyche, well, that's all debatable. It is best to drop the subject. My friend, was found unconscious by her son with a pulse of 10 beats per minute. Took her to the hospital in intensive care for a few days. Thank G-d she is allright now. No cause has been found by her physician of many years. She always said she understaood what I was saying, but that is questionable. When her son called me, he said he was taking Xanax, I told him to stop immediately, and he hung up on me. Easy to say, get some grad students in Psych to test your hypothesis. I do not have that resource, and just getting anyone to make sense of the theory is the main obstacle. There is no comparison to the announcer on the radio. While he may influence drivers, his is pure suggestion. Crohns is not pure suggestion. And I would appreciate any constructive suggestions that would WORK. I am not looking for problems, but I recognize them when they appear, maybe not immediately, but later. Well, this has accomplished nothing, I am sure, but what was Dr. Burrill Crohn all about, he devoted his life to finding the cause, he and other collegues (sp) never gave up. Unfortunately the answer never appeared to him. His paper on the subject can be had from the library. A subject for millions of dollars of research now being spent here, in Canada, UK, Europe, and I should shut up? Well, maybe. Gail > His paper on the subject can be had from the library. > A subject for millions of dollars of research now being spent here, in Canada, > UK, Europe, and I should shut up? > Well, maybe. > > Gail My point remains: what you post re: Crohn's is not helping anyone. JMO SP SignatureNot a real Addy, yet SP. How can you be certain my posts have not helped anyone. I differ with you on that point. If you have a better way to spread the word, please tell me. Dr. Crohns and associates belabored the Illness coming from nowhere for many years. Never found the answer. Not to be arrogant, I DO have the answer. And many people (in the thousands can be spared) How to go about it. People are reluctant to say such a stupid cause has helped them and worse yet, most will not give up the offending medication so this faces more obstacles than one can relate. Plus it will take away a very profitable medication for the pharmaceutical cos. and no physician or surgeon can benefit from the lessening of illness, especially such a good one that no one can question. Besides how can a Pediatrician whose patient is a child brought to him by the mother ask the mother "Is she on a anti-depressant or stimulant" Not very professional, is it. What would it do to his reputation. Can he risk that. If you have any constructive answers, please share them. The Pediatric Inflammatory Bowel disease Center at Cedars-Sinai at Los Angeles treats pediatric children for this illness. Can you reach these children. The big problem is getting feedback from anyone that is well, They are no longer interested in the problem. If you can get around that, you are a genius. I have thought of retired physicians, who have nothing to lose with the crazy tactics, but even they are not interested. Do you have an answer. Gail One thing is certain, the CAUSE. I do not mean to involve you, but anyone, anywhere with an workable opinion is always welcome. Consider yourself lucky I do not write endlessly on this subject. > SP. > > How can you be certain my posts have not helped anyone. I differ with you on Big G, gotta go to Toronto. No time. Will answer later, that's a promise. SP SignatureNot a real Addy, yet Your post helpe me. I was dxd w/ Crohn's 3oyrs.ago,My daughter has it and one of my son's kids has it. Thanks for loving and defending your daughter... > If you can get around that, you are a genius. > I have thought of retired physicians, who have nothing to lose with the crazy > tactics, but even they are not interested. > Do you have an answer. > > Gail I still say the same: prove your theory. Stop talking about it as if it was proven fact. Go find some grad students in Psych and set up an epidemiological study and PROVE it. JMO SP SignatureNot a real Addy, yet "stop talking about it as if it was proven fact" It is "proven to me" and that is good enough for me for now. Has to be. Gail >"stop talking about it as if it was proven fact" It is "proven to me" and >that is good enough for me for now. Has to be. > >Gail That's not good enough for science. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE "That's not good enough for science" "Pity the one that is waiting for science. This is a risk free solution. Nothing lost in advancing it for oneself in addition to all the great treatments the physician can bestow. Gail >> If you can get around that, you are a genius. >> I have thought of retired physicians, who have nothing to lose with the crazy [quoted text clipped - 8 lines] >JMO >SP Yep. Good advice. Methinks the only proven fact is that Gail is "off her rocker". -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE "Go find some grad students in psych and set up an epidemiological study and PROVE it." Mentioned to someone and asking, doesn't the John Stroger hospital's policy of removing newborns from mothers on drugs and having a surrogate caretaker for them to stop their adverse reactions and Health Canada writing that mothers who give birth and were on anti-depressants in the last months and babies were born with respitory and seizure problems mean anything." Answer, two incidences or studies do not mean anything. Then what would a study I could undertake do when I cannot even compete with John Stroger Hospital and Health Canada. Where would a comprehensive study come from? For those with crohns, it can be like being struck by lightning. (Maybe a little exaggeration, but not much.) Gail Stovepipe.. are you a Dentist???? If so do you practise in NY? > Stovepipe.. are you a Dentist???? > If so do you practise in NY? Yes, and no: I practice in Quebec City in Canada. If you need a dentist in NYC, I can't think of a better person to go to than Steven Bornfeld. I've never met him, but he is a regular here and has a very good head for dentistry, IMO. If he is too far (Brooklyn) then he can refer you to someone who suits your personality. Thanks and HTH SP SignatureNot a real Addy, yet >One of the best tricks for controlling gagging is >very salty hot water gargle. [quoted text clipped - 4 lines] > >Chloraseptic spray can be useful. This sounds rather placeboish, not to imply that the placebo effect isn't a valid way to solve this problem. Nausea for me has always responded quite well with mental means; I wonder how well other means of suggestion would work to control this. Adenosine >>One of the best tricks for controlling gagging is >>very salty hot water gargle. [quoted text clipped - 12 lines] > >Adenosine Was talking about reducing the gag reflex. Works well for a sore throat too ! -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >One of the best tricks for controlling gagging is >very salty hot water gargle. I never heard that. THANKS. Is it for the patient or for the dentist? Joel >Water hot as is practical without burning and saturate with table salt. >6 oz cup is usually sufficient. Gargle with all liquid in 2-3 'rounds'. [quoted text clipped - 29 lines] >>Just some ideas, or some BS, take your pick. >>SP > this comes under the category of who knows. I've done thousands (?) of > expanders over 24 years and never had this reaction. BUT the following > thoughts go through my mind: > 1. is she turning the screw and how much One turn, twice a day. > 2. is the appliance made of all metal or part metal and part plastic Metal and plastic > 3. if you are turning it and stop turning it does this improve the nausea I didn't stop turning it. The timing of the nausea and the key turning seemed unrelated. > 4. how has your daughter reacted to other medical/dental procedures. was she > in favor of this or was she against it She's been fine---no unusual fears. She's had cavities filled without novocaine. Thanks for your response. Anne > 5. what do you have to lose in taking it off? another lab bill from the > orthodontist if you then decide to put it back. > 6. if it were one of my daughters, I would remove it and she what happens. > 7. the vagus nerve is an interesting comment and it has been some time for me > since I considered the anatomy of the vagus nerve but it seems to me that the > location of the nerve is quite far anatomically from the site of the expander >She's been fine---no unusual fears. She's had cavities filled without >novocaine. That's pretty common since we don't use it anymore; Novocaine®, that is... -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >> this comes under the category of who knows. I've done thousands (?) of >> expanders over 24 years and never had this reaction. BUT the following [quoted text clipped - 32 lines] >> location of the nerve is quite far anatomically from the site of the >expander my final thoughts: 1. if it is made of plastic it is possible that some of the monomer (the liquid part of the plastic) could be leaching out and causing nausea. Just a guess. Don't bank on it. 2. if you remove it and replace it, use an all metal appliance and see if it makes a difference 3. you can also do oen turn/day with equal effect as two turns per day. probably won't make any difference. just looking for possibilities 4. one of the principles of child rearing that worked especially well for my wife and I was: Treat children like adults (notice I said tx not expect them to act) unless proven otherwise. that means to me, that I would probably take the appliance off if your daughter wanted to do it. let her make the decision. the issue of control can be very worthwhile in a case like this charlie ruff Charlie Ruff, DMD Specialist in Orthodontics Diplomate American Board of Orthodontics Follow-up: After my daughter missed four days of school because of vomiting and nausea, we had the appliance taken out, though the molar rings are still in. (An aside: Unbeknownst to us, the orthodontist was out of the country. We had to go to the on-call orthodontist to have it taken out.) She was nauseated the afternoon it was taken out (Tues.) and then again Wednesday morning. (The nurse called from school. I reminded my daughter that she'd felt better the previous day by 11, and she agreed to stick it out in school until that time. She made it through the rest of the day.) That was the last time she felt sick. I don't know what to make of everything. My daughter is not manipulative. She's not anxious about school, and she seemed to be adjusting well otherwise to the palate expander (that is, learning how to eat well and speak well with it and how to use the Water Pik to clean food out of it). We may try to have it put in again as a test, but now there's an association between the expander and nausea, so I'm worried that in a retry, that association might be enough to *cause* nausea. So we would never know the true connection between the expander and the nausea. I just wonder: She said the palate expander never was painful. In her case, is it possible that whatever nerves are stimulated in the case of palate expansion gave my daughter the sensation of nausea, instead of pain or stretching? Anne > I just wonder: She said the palate expander never was painful. In her > case, is it possible that whatever nerves are stimulated in the case > of palate expansion gave my daughter the sensation of nausea, instead > of pain or stretching? > > Anne Anne, I don't want to be a pill, but the experts on this NG have told you what they think. The major thing is that the more you let your child dictate the treatment she will accept (consciously or unconsciously), the worse the results will be. I would go so far as to coordinate anti-nausea medication prescribed by her doctor with a repeat of the treatment until such time as her nervous system (conscious or unconscious) learns to accept it. My opinion is also that by now, she feels your uncertainty. What would you do if you had bought a season of riding lessons for her and she got thrown the first day? Would you wring your hands and show lack of resolve or would you yell: 'so what? get back up there and in a while you'll be proud of yourself!' Perhaps re-making the expander in all metal and a bit shorter in the back may help. However, I for one, think it would be a mistake to give up and let this child's subconscious win this battle. Harsh? Yes. But that's what I honestly think. SP SignatureNot a real Addy, yet |
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