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My Child Needs Dental Treatment - What Should He/She Expect?

April 6, 2023

One thing I like to tell parents is to not over-prep your child. If we make too big a deal of things, we put the dental visit up on some pedestal where it's this big important event and the pressure is on, basically telling kids they should be thinking about it and worrying about it all up until the appointment. We want things to be relaxed and easy. I like to tell kids at their cleaning visit, if we've determined they need to come back for something, that what we'll be doing at next visit is, for example, cleaning the tooth similar to today! Today we cleaned sugar bugs off the outside of the tooth, and next time, there's 2 teeth with some sugar bugs on the inside that we have to clean. Same thing as today, but it's an extra special cleaning for just 2 of your teeth instead of all of them. When it comes to introducing materials, rules of engagement, expectations for the day, those are things we like to go over with kids on the day of. That way, it's not too far in advance and I have all the things in front of me to conveniently show your child. Every day, I explain in kid-friendly terms these dental procedures in ways that convey age-appropriate understanding without under-representing (lying) or over-complicating things.

There are many difficult things about having dental treatment done! It feels funny, it takes a long time, your child has to breathe through their nose, they have to hold still, etc. Not all procedures are the same in these regards either, but I'll try to lay out the basics.

With regards to things feeling funny, it depends, of course, on what we're doing, whether it's a cleaning or an extraction or anything in between. Generally speaking, though, your child will feel everything I'm doing! I never want kids to feel pain, so while your child won't get numb for a cleaning, they will get numb for an extraction, of course. So, no pain. But still - they'll feel and know what I'm doing. For cleanings, this usually just means the gums maybe feel a little tickly. When we clean out a cavity in advance of a restoration of some sort, the tooth will feel the water spray and shower of the Solea laser we use, which enables us to fix cavities without kids needing anesthetic - no shots! Kids, during a filling or crown, will feel various pushing sensations as the filling or crown is placed. This becomes most intense if we're doing an extraction. Your child will feel what I'm doing, but it won't hurt. The analogy I like to use is that it's like mom getting an epidural. The area is numb and frozen - no pain / pinchy / owie sensation, technically - but that doesn't mean she doesn't feel all the pressure, that she doesn’t feel what's happening. So, we make sure to talk to kids about what they're going to feel so they can hopefully have some realistic expectations. When it's for an extraction, some kids understand my explanation (verbal & physical demonstration), and are totally fine with the pressure. Especially younger kids, however, can struggle to comprehend, and they find it too strong and intense. Fortunately, most baby teeth are quick to extract, when it's needed, and - because they are numb – your child gets over being upset about the too intense feeling within a minute because it's all over now and it does not, in fact, hurt!

All this to say that our goal is always to do as little treatment as is necessary. Some kids with wiggly baby teeth LOVE to wiggle them and get that tooth fairy money ASAP. Other kids are the "don't touch it don't touch it don't touch it" kind of kiddos, and from those we often get requests from parents to help extract the tooth. There are certainly circumstances where I will, but most often it's a tooth that will fall out naturally and everything is going well and it's good for kids to learn to figure it out. There's 20 of them, anyways, and your child definitely doesn't want to have to get shots to get numb for each and every one of the 20 baby they have in the course of 6-7 years.

For tooth restorations, again, we use the Solea laser to enable shot-free dentistry - so no tooth pain - but kids will still feel what's going on, and will still have a handpiece, a mirror, a suction, a tooth pillow, etc. all in their mouth. While not needing shots is AWESOME, just like everything else, it's still a lot of things going on to tolerate. Some kids handle this really well, and others struggle to allow me to look, or for the mirror to be by their teeth because it's grazing the tongue, or going back to needing to get numb, some kids will tolerate the "shot" without a problem, didn't even know it was done! But then 5 minutes later as it's feeling numb, they cry because the feeling of being numb is too disturbing and they can't understand why it feels SO different and they go into shut-down mode. I always say that if a child will talk to me, we can get through ANYTHING together. If a child is shut down and no longer listening or engaging, we're stuck.

With regards to time, part of being a pediatric dentist is reading the kids and knowing when I have 5 minutes of cooperation left before kids are going to go from having a good day to having a bad day, and changing the goals of the day as needed to leave while it's still a good day. Sometimes this means treatment gets split up into multiple appointments. We always like to do as much as we can with each visit, but also not to attempt so much that the dental experience loses its relaxed and fun nature; however much that means we can do is dependent on the individual. It's always a balance between going fast enough to not excessively wane a child's tolerance, but as slow as is needed to make everything comfortable physically and psychologically. The latter often causes the former where kids get pushy with their tongues, lose tolerance in having instruments in their mouth, lower their gag reflex over the course of the appointment. Also, while a calm child will experience a 1 out of 10 pain scale as a 0, a scared child will startle and their fear response will calculate in their head to create a response as if a 10 out of 10.

Holding still is hard for everyone if asked to hold still for longer than you'd like to. Every child has a timer. Nitrous Oxide and TV help to buy us time, but every kid will still eventually run out of the patience and tolerance necessary to hold still. Even when feet move you would be surprised with how much this makes the head move! I think everyone can agree you'd prefer the dentist not to be struggling with a moving target - we don't want to leave with any surprise tongue piercings. When we start to see signs that the timer for a given child is running out, we need to figure out how to finish and adjust the day's treatment goals so we can all experience a successful day where the kids want to come back again next time.

Breathing through their nose despite their mouth being open is also confusing! We often send the nitrous oxide nose home with kids when we know their next visit will be for restorative dental treatment so they can practice lying back with mouth open but still breathing through their nose - it can be confusing for some kids! Even if it's not, some kids come in with asthma, allergies, big adenoids, anomalous sinus anatomy, cold/flu illness, etc. which also make it difficult.

Dentistry is hard! It's the science of millimeters, and it is the only profession where we do these micro-surgeries on awake kids! ENT takes kids to the hospital to have general anesthesia and be put to sleep so they can do two ear tubes, which takes them about 5 minutes to do. And that's perfectly appropriate in terms of safety - you don't want your child to move when the ENT doctor is RIGHT THERE on the ear drum. But for teeth, we work on kids who don't fully understand what's going on, who want to be good helpers, but for whom it's still a lot going on and everything feels funny, and there's water spray, and pushy feelings, etc. Our job is to work kids through all the strange feelings of the dentist and make kids leave happy to come back again next time!

A kid playing with his toys

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