Anytime anyone needs anesthesia, it is a big deal. This is especially true for parents of children having anesthesia for dental procedures. We recognize this process can be stressful for those who do not do it often, like us, and we will try to inform you of what to expect and answer any questions you may have before, during and after the procedure.
What to expect for the appointment:
The night before the appointment, the anestheiologist will telephone you to review relevant medical history and discuss a plan to initiate anesthesia to the child.
At the time of appointment, the child will sit in parents lap in the waiting room and the anestheiologist will administer a quick acting sedation medication as a shot. Usually, this injection is placed in the arm or leg and takes 10 minutes to take effect. The child soon becomes relaxed, sedated and more agreeable to the initiation of anesthesia. The parent then bring child into the treatment room. When the child reaches the correct amount of relaxation, the parents will return to the waiting room and the anesthesiologist will painlessly attach child to monitoring equipment and deepen the child's sedation with the gas. Once at the correct sedation level, the anesthesiologist will insert a breathing tube to ensure respiration and prevent any materials in the throat and mouth from entering the asleep child's lungs.
After the anesthetic is underway, Dr. Ly will begin to work on your child. Any area that could be uncomfortable afterwards is usually made numb by the placement of local anesthesia. As the child is asleep, they will not feel the shot go into the mouth, but they will enjoy the benefit of the numbness after they wake up from anesthesia
At the end of the procedure, Dr. Ly will meet with the parents in the waiting area to discuss what was done and if there are any questions or concerns. During that time, the anestheiologist will continue to monitor the child, and will reunite everyone as soon as he or she begins to wake up. Although the child may be grumpy for a little while after coming out of anesthesia, there are no long term side effects.
Children often cry when waking up from anesthesia. The reason for this is usually they are disoriented emerging from anesthesia and they were very anxious entering anesthesia. Part of anesthesia helps with the suppression of inhibitions which partially explains the increase in emotions we see as children "wake up". This will resolve when they are reassured by their parents. Children usually go home and nap for a few hours. Parents need to keep an eye on them for a while once they get home.
Although IV sedation or general anesethsia can be scary, it can help with a child's anxiety, making his or her appointment more comfortable and safe.
Q: What is Nitrous Oxide? Nitrous oxide/oxygen (N2O-O2) is a blend of two gases -- oxygen and nitrous oxide. A fitted mask is placed over the nose and the patient continues to breathe normally. At the end of treatment, it is eliminated after a short period of breathing oxygen and has no lingering effects.
Q: How will my child feel when breathing nitrous oxide/oxygen? Your child will smell a faint, sweet aroma and experience a sense of well-being and relaxation. Since it may produce a feeling of giddiness, it is often called “laughing gas.” Children sometimes report their arms and legs feel “tingly.” It raises the pain threshold and may even make the time appear to pass quickly. If your child is worried by the sights, sounds or sensations of dental treatment, he or she may respond more positively with the use of nitrous oxide/oxygen.
Q: How safe is nitrous oxide/oxygen? Very safe. Nitrous oxide/oxygen is perhaps the safest sedative in dentistry.
It is well tolerated. It has a rapid onset, is reversible, can be adjusted in various concentrations and is non-allergenic. Your child remains fully conscious — keeps all natural reflexes — when breathing nitrous oxide/oxygen. He/she will be capable of responding to a question or request.
Q: Will nitrous oxide/oxygen work for all children? Dr Ly and his staff all know and understand that all children are not alike, so every service is tailored to your child as an individual. Nitrous oxide/oxygen may not be effective for some children, especially those who have severe anxiety, nasal congestion, or discomfort wearing a nasal mask. Dr. Ly will review your child’s medical history, level of anxiety, and dental treatment needs and inform you if nitrous oxide/oxygen is recommended for your child.
Premature loss of your child\s baby tooth.
The Solution: Space maintainer -- a combination of bands and wires designed to hold the remaining teeth in a position that will allow the future permanent tooth to erupt in the proper location.
Advantages: Prompt placement of a space maintainer will give the permanent tooth the best chance of erupting in the mouth in the correct location. This will minimize orthodontic problems caused by premature loss of a baby tooth.
Disadvantages: Your child will need to wear the appliance until the permanent tooth erupts. If not kept clean decay can occur under the bands.
Alternatives: If a space maintainer is not placed, the teeth will shift into the open area, making it difficult or in some cases impossible for the permanent tooth to erupt. This requires orthodontics to remedy.
Decay that has reached the nerve/pulp of the baby tooth.
Like adult root canals, the dentist will access the nerve chamber of the tooth, and remove some of the nerve/pulp of the tooth. Unlike adult root canals, this is a very short procedure, as only part of the pulp needs to be removed, and does not require the time consuming filing of adult root canals.
Advantages: If the tooth has been symptomatic this procedure will likely alleviate the pain. This allows for the tooth to be preserved until it is ready to fall out naturally. Disadvantages: Pulpotomies have a 90% success rate. Occasionally, the nerve of the tooth is so badly damaged that it does not respond to pulp therapy, resulting in the need for extraction of the offending tooth. Certain circumstances increase the likelihood of failure with pulpotomies. Dr. Ly will discuss your child's situation with you during diagnosis.
Alternatives: The only alternative to a pulpotomy is extraction, and placement of a space
maintainer. However, if it is possible to save the baby tooth, this is the best
alternative because it preserves the appropriate spacing for the adult dentition.
Protect and help keep badly decayed or fractured teeth
Badly decayed teeth
Need to protect and strengthen teeth
Tooth has had a baby root canal "pulpotomy"
A crown (often called a cap) covers the tooth and restores it to its original shape and size. Decay is removed and cleaned from the tooth and a preformed crown is placed over the tooth. Unlike adult crowns, in which the crown is made to fit the tooth and requires 2 appointments, baby crowns are placed in one visit die to the tooth being prepared to fit the preformed crown.
Crowns are incredibly strong due to the fact that they cover the entire tooth. This protects and strengthens the remaining tooth structure. They are the best chance for survival of a tooth that has had a baby root canal.
Crowns are an excellent restoration and have few disadvantages, however, most children's crowns are silver in color.
Typically there are no good alternatives to crowns. If the tooth has sustained enough damage to require a crwon, then the best prognosis for the tooth is to receive the crown. Placeing a filling on a tooth that should have a crown will likely result in the tooth fracturing, recurrent decay on that tooth and/or the loss of that tooth.
An inexpensive way to restore a small amount of tooth decay.
Decay on a small portion of any tooth.
A composite filling is a tooth colored quartz-like material. After tooth decay is removed and cleaned, this tooth colored material is layered into the tooth. Each layer is hardened or cured with a highly intense visible light, and the final surface is shaped and polished to match the tooth. The final restoration is virtually invisible.
Composite fillings are more than just attractive. They require minimal tooth preparation. In other words, less healthy tooth structure is removed to restore the tooth. Also, a sealant can be placed over the remaining exposed groves of the tooth to minimize the risk of decay on another area of the tooth.
Composite fillings can be subject to wear and tear from tooth grinding and from biting into or chewing on hard objects, etc.
In cases of extensive decay or if the baby tooth required a pulpotomy, a crown is the best option. If the decay is not treated, it will most likely increase in size and become a larger problem.
Normal pits and grooves on the chewing surfaces of back teeth can trap food that can't be removed by brushing or washed out by water or saliva. A sealant is a tough, plastic material designed to bond (stick) to tooth enamel.
How to protect normal pits and grooves on the chewing surface.
How to stop small amounts of decay from growing larger.
A clear or tooth colored sealant is painted onto the surface to "seal" the pits and grooves and protect against decay. They are generally applied to children's first permanent back teeth. They also can be useful for adults in certain situations.
Sealants are an excellent way to protect chewing surfaces of teeth from decay. they are a much better financial investment than treating decay after it has started.
Sealants are not permanent. They generally last about 5 years with normal wear, but can wear off or chip off earlier in certain instances. Also, sealants, do not prevent decay between teeth or the onset of gum disease, so regular home care and dental visits are important.
There are no appropriate alternatives to sealants. If a tooth has decay, it will need a filling or other restoration.