Pediatric Dentistry Treatment Options

Treatment of uncooperative/pre-cooperative children, with uncontrollable body movements, can be unsafe in a dental treatment room.  There are several options available to help manage your child during dental treatment.  Each option has risks and benefits.  The information below will help you understand the advantages/disadvantages and the limitations to the various treatment options we offer.  Our doctors and staff will discuss all treatment options with you and make recommendations as to what is the best modality to treat your child while keeping them safe and comfortable.

No Treatment

No treatment can be a reasonable alternative; however, oral infections or disease can lead to hospitalization and can be life threatening.

Local Anesthesia (Sleepy Juice) Only

Local anesthesia is often required to restore (place a filling) or extract (remove /wiggle) a tooth.  This technique involves injecting a numbing anesthetic (lidocaine) via a small needle into the gum tissue near the tooth that needs to be fixed.  This treatment option works well for the very cooperative child that doesn’t mind getting an injection.  For younger children who are afraid of needles, this option should be used in conjunction with nitrous oxide and/or oral conscious sedation.  Young children are often unpredictable and can become restless and fearful without warning.  For a variety of reasons, some children may become frightened (ie. noise from the dental drill (tooth whistle) or from the strange sensation of their numb tooth, teeth or tongue).  For this reason, we recommend at least nitrous oxide’ and in some instances conscious oral sedation, for children under 5 who require local anesthesia to fix their teeth.

Nitrous Oxide Sedation (Laughing Gas) and Local Anesthesia (Sleepy Juice)

This type of sedation is effective with children who may have slight anxiety but are willing to have the treatment performed.  It is effective for children who have limited work that needs to be done.  Children with more extensive treatment needs will require multiple visits or oral sedation.  Nitrous oxide is used on most often on children who have good behavior, and have treatment that can be done in a half hour or less. This gas is most helpful with minor fillings and surgeries for slightly anxious children age 4 and older.  Children who are uncooperative/pre-cooperative or who are unwilling to follow instructions (eg. breath through your nose) etc. this technique will not be successful.

Nitrous Oxide is a very safe sedative gas inhaled by your child while wearing a mask on their nose (like a clown nose). The maximum relaxing effect is reached by breathing the sweet smelling air through their nose.  It is important that your child understands that throughout the procedure, they will need to breath through their nose and avoid mouth breathing.  After breathing the gas, your child typically feels relaxed and less anxious. Nitrous oxide DOES NOT put your child to sleep.  At the end of the procedure, we will turn off the nitrous oxide and place our child on oxygen only.  Once your child is on 100% oxygen, they will have no residual effects from the nitrous oxide gas.  Nitrous oxide is one of the safest drugs that we have in anesthesia and dentistry. Note: Most insurance companies DO NOT cover nitrous oxide.

Conscious Oral Sedation (with Nitrous Oxide and Local Anesthesia)`

This is not “sleep dentistry”.  We do not believe in this technique or in using “deep sedation” with children.  We use oral conscious sedation to help facilitate your child’s treatment and your child will be awake.  Oral sedation is commonly used with children over 3 years of age who require the use of local anesthesia and whose treatment requires greater than 30 minutes of treatment time.  Sedation patients may require two visits to complete their dental treatment.  Our goal is to help your child relax and to ‘take the edge off’ so they don’t mind being in the dental treatment room.  Children with severe asthma are not candidates for conscious oral sedation.

Your child is not to eat or drink anything after midnight the night before their appointment.  If your child is sick, or sounds congested, we may reschedule their sedation; your child’s safety is our greatest concern.

This sedative requires that your child sip the fruit-flavored medicine from a cup.  We flavor the medication to improve the taste.  After drinking the medication, you will wait with your child in our sedation waiting area, where you may read to your child or watch a movie with them. Once sedated, we will treat your child with great care and respect.  Some children may fall asleep during the dental treatment; however, the majority will be awake or partially awake.  Occasionally, a child may cry or resist treatment during the procedure.  Sometimes the sedative will not be effective and we may recommend that your child be treated with general anesthesia.

After the sedation, your child is not to go back to school; rather, they should remain home for the remainder of the day.  They will need to have an adult with them to monitor them with appropriate supervision. Because our sedation is very mild, it may seem that your child is not sedated anymore. However, we recommend that your child engage in quiet, indoor play at home, and that they have limited physical activity.

General Anesthesia
All of your child’s dental treatment can be completed in one visit under general anesthesia in an operating room at a hospital.  Your child is completely asleep and unaware of any treatment being performed.  This is the same technique used to remove a child’s tonsils.
General Anesthesia is sometimes necessary for children that are unable, by either age or maturity level, to cooperate during dental treatment.  This is a wonderful option for an infant, a very anxious child, children who require major dental treatment, children with strong gag reflexes, children who have had negative dental experiences, children who have sound or smell aversions and children who are medically compromised or have special needs.  These operating room cases are performed on an outpatient basis at our affiliates at Central Carolina and Highsmith-Rainey Hospitals.  Children treated with general anesthesia must have a recent physical examination by a pediatrician and meet with the anesthesiologist prior to their treatment at the hospital.  Most medical and dental insurances cover a portion of these fees, however, pre-authorization is often required.

Second Opinion
We encourage you to seek a second opinion if you are uncomfortable with our treatment recommendations for your child.

If you have any questions, please feel free to call our office at 919.499.9950.