Managing dental treatment for children is very different from that of adult dentistry.
Children are not miniature adults. They differ physically, emotionally and physiologically. Their treatment needs to be tailored to cater for these differences. Current research shows that by reducing the patient’s anxiety their pain threshold is increased. Given this, dental care must be adapted for each individual child.
There are on average 12 factors that are taken into consideration when deciding on a treatment management option for your child. Some of these factors include:
Comprehensive treatment of multiple teeth may require 3-4 appointments or 1 appointment under general anaesthetic.
Treatment may be conducted with the following:
Local anaesthetic is used to block nerve conduction so painful stimuli are inhibited. Topical anaesthetic gel, which comes in a variety of flavours, is placed on the surface of the soft tissues so placement of the anaesthetic is more comfortable.
We currently do not use the traditional syringe which is extremely fear-provoking
for children and can be uncomfortable to place. Our technique involves using
“The Wand™”. This is a computerised local anaesthetic delivery system which delivers local anaesthetic at a fixed tissue: pressure ratio. This means that placing local anaesthetic is even more comfortable and the plastic hand piece looks like a “wand” which is visually more appealing.
The numb feeling from local anaesthetics generally last between 1-1½ hours so it is important that your child does not chew their lip or tongue during this time. The local anaesthetic we use is 2% Xylocaine with adrenaline 1:80,000.
We will describe giving the local anaesthetic to your child, please do not use words such as “injection”, “needle”, “hurt”, etc.
Current research shows that reducing a child’s or adult’s anxiety will increase their pain threshold. One of the most fear provoking aspects of dentistry is having local anaesthesia for the patient and stressful for the dentist. Since May 2004, we have been using a computer controlled local anaesthetic delivery system. This means giving injections is more comfortable and the plastic hand-piece is less threatening in appearance than the traditional syringe.
The Wand™ – is used to place local anaesthetic at a very slow flow rate. The computer controls this flow rate and the pressure of the fluid. Injecting local anaesthetic solution very slowly reduces tissue distension and leads to a more comfortable injection with less post operative pain. The hand-pieces are disposable, this also minimises the risk of needle stick injury to our staff when dissembling. Children who have had the traditional injection in the past and then the Wand, have all responded positively to the Wand and prefer this method.
Dr Vasan is involved in teaching and hands on Wand demonstrations to other dentists.
Nitrous oxide is a mixture of nitrogen and oxygen gases and is also known as "happy gas".
The gas is delivered from a mixer into a small mask (nose piece). The concentration of the gas can be adjusted by the dentist until the child is relaxed.
Nitrous oxide works best on anxious older children (7 years plus) who understand what is required and are cooperative enough to keep the nose piece on. Patients often feel relaxed, or have a floating sensation and tingliness around their hands and mouth.
Once treatment is near completion, the gas is switched to pure oxygen for 10 mins to ‘flush out’ any remnants of nitrous gas. The recovery is therefore very quick.
General anaesthesia is often a choice where complex paediatric dental care is required or a large amount of treatment is needed for a young or very anxious child. Children who require multiple appointments can sometimes “burn out” or become uncooperative with future care.
A general anaesthetic allows all treatment and xrays to be conducted under one appointment, where 4-5 appointments with local anaesthetic may be required in the dental surgery.
A general anaesthesia is performed by a trained specialist paediatric anaesthetist in a day surgical unit. The patient is intubated and 'asleep'.