How to Accomplish Dental Treatment on a Young Child

Pediatric dentistry is a delicate service. One bad experience can cause a child to fear the dentist forever. When your child enjoys a great experience each time they go to the dentist, they develop trust which sets them up for a lifetime of good dental oral health. The less scared one is of the dentist, the more likely they are to maintain dental visits, helping with prevention and early detection. Our goal is to ensure that each encounter with every child is the best possible. 

Appointments for cleaning at the pediatric dentist can be challenging in the beginning, especially for little ones. With patience and good experiences, dental visits can become relaxing, educational, and even fun. 

When a child is diagnosed with decay or cavities, navigating a restorative appointment presents another level of intervention. Each child is unique so we assess every child differently based on how they manage the dental process. To accomplish treatment, we look at many elements from medical history, age, weight, behavior, amount of treatment needed, difficulty of treatment, previous experience, and attitude towards the pediatric dentist and dental office. In this blog let’s explore various behavior options to accomplish dental treatment with children, including tell-show-do, nitrous oxide, oral conscious sedation, IV sedation, and general anesthesia. 

Behavior Management 

The first approach to behavior management that we consider and discuss is non-invasive techniques. This involves patiently guiding the child through a dental visit with demonstration and verbiage to help the child understand the things we do. We often use a technique called tell-show-do where we do exactly that. We tell the child what we are going to do, we show them, and then we do it. In my experience, most kids can tolerate a lot of treatment when we provide care with lots of patience. As a mom, I get it. If you want me to attempt treatment without any advanced management, I am happy to do so. We take things step-by-step. We always start with easier treatment to gauge and assess how a child is going to do. If they are unable to tolerate treatment in a less invasive manner, we then discuss other options. 

Nitrous Oxide

For some children, dentistry is intimidating because the unknown can be scary. Nitrous oxide is one of the safest and most effective modalities of advanced behavior management that pediatric dentistry offers. Nitrous oxide can relieve anxiety and discomfort for a child during a dental visit. A safe colorless gas, nitrous oxide, is called “laughing gas.” In our office, we call it “ice cream air”. Using nitrous oxide in pediatric dentistry offers many benefits to our children. Nitrous allows them to relax quickly in five minutes or less. Nitrous wears off rapidly and completely with no lingering side effects. Look for more detailed information in a future blog. 

Oral Conscious Sedation

Sometimes behavior management and nitrous oxide are not enough to help a child through an appointment.  For example a child may need one extraction and is not old enough to understand the discomfort (pressure) that they feel while the tooth is being removed. Oral conscious sedation is a modality that helps children relax more than nitrous without putting them into a sleeping state. Oral conscious sedation uses medication to decrease the anxiety of a child, comfort and calm them.  With oral conscious sedation, your child may become drowsy and fall asleep. They will not be unconscious and are able to respond to commands, cooperate, and participate with the dental professional. If oral conscious sedation is recommended for your child, we discuss the details of risks, benefits, and the procedure day. The treatment works for most, but not all, children. If the medication does not work for your child, we will discuss other options. One of the most important parts of a successful sedation is to be sure that your child does not eat or drink anything after midnight the night before the procedure. A few children become nauseous during the procedure. When a child has had food or drinks after midnight, the child can vomit during the procedure. Vomiting can cause a child to aspirate and experience problems with breathing. This danger can be avoided by following the rule of “nothing to eat or drink after midnight” for all forms of sedation. With oral conscious sedation, we also use local anesthetic. After the procedure, you need to keep an eye on your child so that they do not accidentally chew or bite their tongue, cheeks or lips. More information to come in a future blog. 

Intravenous (IV) Sedation or General Anesthesia

If we determine that your child requires a deeper sedation to complete treatment, IV or general anesthesia may be recommended. This type of sedation is recommended for young children with multiple areas of decay, children with a history of dental trauma or bad experiences, children with fear and anxiety, and children who need extensive work or extractions. This sedation may be chosen if the parents know that their child will not sit to tolerate treatment, if oral sedation has failed before, or if parents want to protect their child from potential dental trauma. 

IV sedation is done in our office.  A pediatric anesthesiologist medical doctor and their nurse administer and monitor the IV sedation. We use Pediatric Dental Anesthesia Associates (PDAA). See their website for more information. Initially, nitrous oxide is used so that your child falls asleep while watching a movie, playing a game, or picking out toys. After your child is asleep, the doctor starts an IV to keep the child safely asleep throughout the procedure. This sedation is sometimes referred to as “twilight” sedation. This sedation is the same one used for wisdom teeth removal or a colonoscopy, for example. Your child is still breathing on their own and is comfortable, but unaware of the dental work. This allows us to complete all dental work in one visit. Little or no local anesthetic is needed which helps to prevent post-op biting of lips, tongue, or cheek. Most of the time, children easily wake up and have a sleepy day. Sometimes, they wake up a little grumpy but quickly recover. IV sedation is typically not covered by insurance. PDAA will work with you and your insurance company for possible reimbursement. 

If a deeper sedation is needed and/or insurance coverage, we recommend general anesthesia. General anesthesia is performed at an outpatient surgery center.  A pediatric anesthesiologist medical doctor and their certified registered nurse anesthetist (CRNA) administer the sedation. Your child is completely asleep during the procedure. This sedation allows us to complete all dental work in one visit. This type of sedation is often covered by insurance. Warning: children typically do not wake up happy from general anesthesia. They are usually confused, and they calm down before being dismissed from our office. Often children have a hard day after general anesthesia or will sleep it off. 

If your child has significant medical history or is medically compromised, we may recommend that you seek treatment at a children’s hospital and will guide you in that direction. 

Modern pediatric dentistry offers a range of options to ensure that your child receives the best care possible based on their unique needs.  We offer a variety of modalities. Being a mom myself, having patience, and looking for the best options for your child, help us get your child’s dental work done. For more questions and details please call our office. We are happy to answer all your questions. 

Remember to brush your teeth TWICE a day and see the dentist TWICE a year! 

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