While pediatric dentistry has made great strides in making young patients’ dental visit experiences more relaxing, some children and teenagers still have difficulty with anxiety. Their anxiety in turn can make necessary care much harder to provide.
For difficult cases, many dental providers for children now incorporate a technique known as conscious sedation to help ease anxiety. With this technique, they’re able to perform procedures like cavity-filling or tooth-extraction that are more difficult with an anxiety-prone patient.
While general anesthesia creates a total loss of consciousness, conscious sedation uses precise medications to suppress consciousness at different levels ranging from light to deep suppression, and create a relaxed state for the patient. A child under sedation can still breathe normally and respond to certain stimuli, including touch and verbal commands. For only a light or minimal effect, a dentist normally administers the sedation drug as a pill the child takes orally. For deeper sedation, the medication is most likely delivered through a vein (intravenously).
Sedation reduces fear and anxiety but not necessarily pain, so it’s often accompanied by some type of anesthesia, either a local anesthetic delivered by injection to the procedure site or with a nitrous oxide/oxygen gas combination that’s inhaled through a mask worn by the patient.
Even though the child isn’t completely unconscious, one of the dentist’s staff will monitor vital signs (heart and respiration rates, blood pressure and blood oxygen level) throughout the procedure. This continues even after the treatment is over until the child’s vital signs return to pre-sedation levels. Once released, they will need a ride home and should rest for the remainder of the day. They can then return to school and resume other normal activities the next day.
With the advent of newer and safer drugs, conscious sedation is becoming a more widespread technique in both medicine and dentistry. Using it to ease a child’s anxiety increases the chances they’ll receive all the dental care they need without unpleasant memories of their visit that could follow them into later life.
If you would like more information on the role of conscious sedation for children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Sedation Dentistry for Kids.”
Many otherwise attractive smiles have one noticeable blemish — a large gap between the two upper front teeth. If you have such a gap, there’s a solution that could transform your smile.
The most likely reason for the gap is an issue with a bit of muscle tissue between the gums and upper lip known as the frenum, part of the face’s muscular system. The frenum, though, can overdevelop and grow between the two front teeth into the front part of the palate (roof of the mouth). This can keep or push the teeth apart to form a gap.
To correct the issue, it’s first necessary to consult with an orthodontist, a specialist in bites and tooth alignment. It’s possible for there to be other factors contributing to the spacing including tongue thrusting or finger sucking habits, or missing or misaligned teeth. If the examination reveals an overly large frenum, then the treatment usually commences in two stages.
First, we would need to close the gap by the moving the teeth toward each other with some form of orthodontic appliance like braces or clear aligners. Once closed, the next stage would be to surgically remove the excess frenum tissue and cosmetically alter the gums if necessary.
The order of treatment is important — if you remove the frenum tissue first, any resulting scar tissue could prevent closing the gap with orthodontics. Further, cosmetic surgery on the gums beforehand could result in the loss of the papillae, the small triangular gum tissue between teeth, which results in an unattractive “black” hole.
A frenectomy, the procedure to remove the excess frenum, is a relatively minor procedure that can be performed by a periodontist (gum specialist), oral surgeon, or a general dentist with surgical training. The area is numbed with a local anesthetic, the tissue dissected with a small scalpel, and the resulting small wound closed with a few stitches (another option is to use a surgical laser to remove the frenum). Healing should be complete in about a week with only minor discomfort.
Depending on your individual circumstance, full treatment can take time. But in the end these otherwise routine dental procedures can have a huge impact — a more attractive smile without the noticeable gap.
If you would like more information on treating abnormal teeth spacing, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Space between Front Teeth.”
You can find some version of the ever popular kids’ meal at most major fast-food restaurants. It’s a neat little package: child’s size portions of burgers, chicken nuggets or sides—and often a small toy or treat to boot—all tucked into its own colorful cardboard container.
The drive-thru menu board at your favorite fast-food joint gives you plenty of choices to fill out your child’s meal. But you may notice something missing on many major chains’ kids’ menus—the mention of soft drinks as a beverage choice. You can still get one for your child’s meal, but the visual cue is no more on the menu board.
None of the “Big Three”—Burger King, McDonald’s or Wendy’s—post soft drinks as a menu item for their kid’s meals. It’s the result of an effort by health advocates promoting less soda consumption by children, the leading source of calories in the average child’s diet. With its high sugar content, it’s believed to be a major factor in the steep rise in child obesity over the last few years.
Sodas and similar beverages are also prime suspects in the prevalence of tooth decay among children. Besides sugar, these beverages are also high in acid, which can erode tooth enamel. These two ingredients combined in soda can drastically increase your child’s risk of tooth decay if they have a regular soda habit.
You can minimize this threat to their dental health by reducing their soda consumption. It’s important not to create a habit of automatically including sodas with every meal, especially when dining out. Instead, choose other beverages: Water by far is the best choice, followed by regular milk. Chocolate milk and juice are high in sugar, but they’re still a healthier choice than sodas due to their nutrient content.
Keeping sodas to a minimum could help benefit your child later in life by reducing their risk for heart disease, diabetes and other major health problems. It will also help them avoid tooth decay and the problems that that could cause for their current and future dental health.
When die-hard music fans hear that their favorite performer is canceling a gig, it’s a big disappointment—especially if the excuse seems less than earth-shaking. Recently, British pop sensation Dua Lipa needed to drop two dates from her world tour with Bruno Mars. However, she had a very good reason.
“I’ve been performing with an awful pain due to my wisdom teeth,” the singer tweeted, “and as advised by my dentist and oral surgeon I have had to have them imminently removed.”
The dental problem Lipa had to deal with, impacted wisdom teeth, is not uncommon in young adults. Also called third molars, wisdom teeth are the last teeth to erupt (emerge from beneath the gums), generally making their appearance between the ages of 18-24. But their debut can cause trouble: Many times, these teeth develop in a way that makes it impossible for them to erupt without negatively affecting the healthy teeth nearby. In this situation, the teeth are called “impacted.”
A number of issues can cause impacted wisdom teeth, including a tooth in an abnormal position, a lack of sufficient space in the jaw, or an obstruction that prevents proper emergence. The most common treatment for impaction is to extract (remove) one or more of the wisdom teeth. This is a routine in-office procedure that may be performed by general dentists or dental specialists.
It’s thought that perhaps 7 out of 10 people ages 20-30 have at least one impacted wisdom tooth. Some cause pain and need to be removed right away; however, this is not always the case. If a wisdom tooth is found to be impacted and is likely to result in future problems, it may be best to have it extracted before symptoms appear. Unfortunately, even with x-rays and other diagnostic tests, it isn’t always possible to predict exactly when—or if—the tooth will actually begin causing trouble. In some situations, the best option may be to carefully monitor the tooth at regular intervals and wait for a clearer sign of whether extraction is necessary.
So if you’re around the age when wisdom teeth are beginning to appear, make sure not to skip your routine dental appointments. That way, you might avoid emergency surgery when you’ve got other plans—like maybe your own world tour!
If you would like more information about wisdom tooth extraction, please call our office to arrange a consultation. You can learn more in the Dear Doctor magazine articles “Wisdom Teeth” and “Removing Wisdom Teeth.”
Keeping your child’s teeth and gums healthy may sometimes seem like “one step forward, two steps back.” You do all the right things like daily brushing and flossing, and keeping sugar consumption to a minimum. But they’re still getting too many cavities.
We can add something else to what you’re already doing to decrease their cavity rate: apply a concentrated fluoride mixture (stronger than what’s found in toothpaste or drinking water) directly to their teeth. Studies have shown that topical fluoride is effective at reducing the risk of new cavities in children at high risk for decay, and may even reverse early decay.
Topical fluoride can be applied as a gel, foam or varnish. The particular method used depends on factors like the child’s age or the preference of the dentist. But any of the three methods can deliver a short-term, high dose of fluoride to the teeth.
As a result, the burst of fluoride strengthens tooth enamel against decay, with plenty of evidence of its effectiveness. As such, the American Dental Association recommends periodic topical fluoride applications for children older than 6, and especially those that appear to be at higher risk for decay.
You might, however, be concerned about the long-term health effects of these stronger concentrations of fluoride. Again, research indicates that the only long-term hazard associated with too much fluoride is a condition called fluorosis, which produces heavy tooth staining. Fluorosis, though, is more of an appearance issue and doesn’t harm the tooth itself. And it can be avoided in the case of topical fluoride by performing the procedure correctly and conservatively.
There’s also a short-term risk of a reaction to the fluoride mixture if the child swallows too much during the procedure, which could cause stomach upset and pain, vomiting or headaches. We can avoid this by using precautions like dental dams and other isolation methods to prevent the child from ingesting it.
Using proper precautions and procedures, topical fluoride is a safe and effective way to give your child added protection against decay. Avoiding this destructive disease can help ensure they’ll enjoy good dental health for the rest of their lives.
If you would like more information on keeping your child’s teeth and gums healthy, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Fluoride Gels Reduce Decay.”
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