FAQS

General Anesthesia

What is general anesthesia?

General anesthesia is a controlled state of unconsciousness that eliminates awareness, movement and discomfort during dental treatment. A physician or dentist with specialized training can use various medications to provide general anesthesia for patients receiving dental care.

Is general anesthesia safe?

Although there is some risk associated with general anesthesia, it can be used safely and effectively when administered by an appropriately-equipped facility. Precautions are taken to protect your child during general anesthesia; personnel who are trained to manage complications will monitor your child closely. Your dentist will discuss the benefits and risks of general anesthesia and why it is recommended for your child.

What special considerations are associated with the general anesthesia appointment?

A physical evaluation is required prior to general anesthesia for dental care. This physical assessment provides information to ensure the safety of your child during the general anesthesia procedure. Your dentist or general anesthesia provider will advise you about evaluation appointments that are required.

Parents are instructed to report to the dentist any illness that occurs prior to the general anesthesia appointment. It may be necessary to reschedule the appointment. It is very important to follow instructions regarding fasting from fluids and foods prior to the appointment.

Your child will be discharged when stable, alert, and ready to depart. Patients often are tired following general anesthesia. You will be instructed to let the child rest at home with minimal activity until the next day. Post-operative dietary recommendations also will be given.

Who should receive general anesthesia for dental treatment?

General anesthesia may be indicated for children with extensive dental needs who are extremely uncooperative, fearful or anxious or for the very young who do not understand how to cope in a cooperative fashion. General anesthesia also can be helpful for children requiring significant surgical procedures or patients having special health care needs.

Links to the American Academy of Pediatric Dentistry about general anesthesia

http://www.aapd.org/media/Policies_Guidelines/G_AnesthesiaPersonnel.pdf

http://www.aapd.org/media/Policies_Guidelines/P_Sedation.pdf

My child won’t let me brush his teeth. What can I do?

Why are the primary teeth so important?

It is very important to maintain the health of the primary or baby teeth. Neglected cavities can and frequently do lead to problems which affect developing permanent teeth. Primary teeth, or baby teeth are important for (1) proper chewing and eating, (2) providing space for the permanent teeth and guiding them into the correct position, and (3) permitting normal development of the jaw bones and muscles. Healthy primary teeth are important to a child’s overall physical, mental , and social well being. While the front 4 teeth last until 6-7 years of age, the back teeth (cuspids and molars) aren’t replaced until age 10-13.

When should I expect my child’s teeth to erupt?

Children’s teeth begin forming before birth. As early as 4 months, the first primary (or baby) teeth to erupt through the gums are the lower two front teeth, followed closely by the upper ones. Although all 20 primary teeth usually appear by age 3, the pace and order of their eruption varies.

Permanent teeth begin appearing around age 6, starting with the first molars behind the last primary tooth and the lower central incisors.

What should I do in an emergency?

Toothache:
Clean the area of the affected tooth thoroughly. Rinse the mouth vigorously with warm water or use dental floss to dislodge impacted food or debris. If the pain still exists, contact your child’s dentist. DO NOT place aspirin on the gum or on the aching tooth. If the face is swollen apply cold compresses and contact your dentist immediately.

Cut or Bitten Tongue, Lip or Cheek:
Apply ice to bruised areas. If there is bleeding apply firm but gentle pressure with a gauze or cloth. If bleeding does not stop after 15 minutes or it cannot be controlled by simple pressure, take the child to hospital emergency room.

Knocked Out Permanent Tooth:
Find the tooth. Handle the tooth by the crown, not the root portion. You may rinse the tooth but DO NOT clean or handle the tooth unnecessarily. Inspect the tooth for fractures. If it is sound, try to reinsert it in the socket. Have the patient hold the tooth in place by biting on gauze. If you cannot reinsert the tooth, transport the tooth in a cup containing the patient’s saliva or milk. If the patient is old enough, the tooth may also be carried in the patient’s mouth. The patient must see a dentist IMMEDIATELY! Time is a critical factor in saving the tooth.

Knocked Out Primary Tooth:
If you can not find the tooth, then there is a possibility that the tooth may be lodged within the gum. Please take your child immediately to the dentist to verify the location of the baby tooth. At times, a chest x-ray is indicated to rule out any possible aspiration or ingestion of the missing tooth. Do not attempt to re-implant the baby tooth. Please take your child to the emergency room right away to clear him or her of any medical complications or head injuries that may have occurred from the fall. Once cleared by medical personnel, please contact Dr. Brown.

Are X-Rays safe?

Radiographs (X-Rays) are a vital and necessary part of your child’s dental diagnostic process. Without them, certain dental conditions can and will be missed.

Radiographs detect much more than cavities. For example, radiographs may be needed to survey erupting teeth, diagnose bone diseases, evaluate the results of an injury, or plan orthodontic treatment.

Radiographs allow dentists to diagnose and treat health conditions that cannot be detected during a clinical examination. If dental problems are found and treated early, dental care is more comfortable for your child and more affordable for you.

The American Academy of Pediatric Dentistry recommends radiographs and examinations every six months for children with a high risk of tooth decay. On average, most pediatric dentists request radiographs approximately once a year. Approximately every 3 years it is a good idea to obtain a complete set of radiographs, either a panoramic and bitewings or periapicals and bitewings.

Pediatric dentists are particularly careful to minimize the exposure of their patients to radiation. With contemporary safeguards, the amount of radiation received in a dental X-ray examination is extremely small. The risk is negligible. In fact, the dental radiographs represent a far smaller risk than an undetected and untreated dental problem. Lead body aprons and shields will protect your child.

We carry the newest digital radiographic technology at Children’s Dentistry. Radiation is reduced by nearly 80% when compared to that of traditional film-based dental radiography.

What is the best toothpaste?

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Tooth brushing is one of the most important tasks for good oral health. When looking for a toothpaste for your child make sure to pick one that is recommended by the American Dental Association. These toothpastes have undergone testing to insure they are safe to use. If your child dislikes the taste of toothpaste, then simply using water will suffice for brushing until your child reaches age 3, after which time a fluoridated toothpaste is recommended.

Help! My child grinds his/her teeth!

Parents are often concerned about the nocturnal grinding of teeth (bruxism). Often, the first indication is the noise created by the child grinding on their teeth during sleep. Or, the parent may notice wear (teeth getting shorter). One theory as to the cause involves a psychological component. Stress due to a new environment, divorce, changes at school; etc. can influence a child to grind their teeth. Another theory relates to pressure in the inner ear at night. Other theories include a normal nocturnal behavioral pattern of children during the growth and development of their teeth and jaws.

The majority of cases of pediatric bruxism do not require any treatment. If excessive wear of the teeth is present, then a mouth guard (night guard) may be indicated. Please ask Dr. Brown whether a custom nightguard is right for your child.

The good news is most children outgrow bruxism. The grinding gets less between the ages 6-9 and children tend to stop grinding between ages 9-12.

What can I do about thumb sucking?

Sucking is a natural reflex and infants and young children may use thumbs, fingers, pacifiers and other objects on which to suck. It may make them feel secure and happy or provide a sense of security at difficult periods. Since thumb sucking is relaxing, it may induce sleep. Thumb sucking that persists beyond the eruption of the permanent teeth can cause problems with the proper growth of the mouth and tooth alignment. How intensely a child sucks on fingers or thumbs will determine whether or not dental problems may result.

Children who rest their thumbs passively in their mouths are less likely to have difficulty than those who vigorously suck their thumbs. Children should cease thumb sucking by the time their permanent front teeth are ready to erupt. Usually, children stop between the ages of two and four. Peer pressure causes many school-aged children to stop. Pacifiers are no substitute for thumb sucking. They can affect the teeth essentially the same way as sucking fingers and thumbs. However, use of the pacifier can be controlled and modified more easily than the thumb or finger habit. If you have concerns about thumb sucking or use of a pacifier, consult your pediatric dentist.

A few suggestions to help your child get through thumb sucking:
• Instead of scolding children for thumb sucking, praise them when they are not. Focusing on positive reinforcement rather than negative reinforcement is essential to stoping this habit
• Children often suck their thumbs when feeling insecure. Focus on correcting the cause of anxiety, instead of the thumb sucking.
• Children who are sucking for comfort will feel less of a need when their parents provide comfort.
• Reward children when they refrain from sucking during difficult periods, such as when being separated from their parents.
• If these approaches don’t work, remind the children of their habit by bandaging the thumb or putting a sock on the hand at night. Dr. Brown may recommend the use of a mouth appliance.

What is pulp therapy?

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The pulp of a tooth is the inner central core of the tooth. The pulp contains nerves, blood vessels, connective tissue and reparative cells. The purpose of pulp therapy in Pediatric Dentistry is to maintain the vitality, or livelihood, of the affected tooth (so the tooth is not lost).

A pulpotomy removes the diseased pulp tissue within the crown portion of the tooth. Next, an agent is placed to prevent bacterial growth and to calm the remaining nerve tissue. This is followed by a final restoration (usually a stainless steel crown).