On June 18, 2017 the death of a 3-year old child made national news, when little Daleyza went in for some extractions and crowns and 30 minutes later was dead. It is reported that a Dental Anesthesiologist was in the office providing general anesthesia while the dentist and assistant provided dental care. Many people are left in shock that such a thing could ever happen. As I’ve read articles and followed social media comments, certain questions resonate above all others. “Why would a 3-year old need dental surgery and why would they need to have general anesthesia?“
There are many reasons why children may need to be fully sedated during dental treatment. Although certain populations may be more predisposed to needing sedation than others (i.e. autistic children; children with severe dental emergencies; children with severe dental fear, extensive treatment, etc.) the underlying reason is a lack of cooperation by the patient during dental treatment.
I’ve never used general anesthesia in my office, nor do I feel that there is a need to change that aspect of my practice. In my experience, I’ve found that most patients do very well with nitrous oxide, oral sedatives or a mixture of both. My treatment goal is to help individuals overcome anxiety. So, even in cases where nitrous oxide sedation is used, patients eventually come off of it. In the rare cases where someone needed hospital dentistry or general anesthesia, they’ve been referred out. These cases have been few and far between. Those who need nitrous oxide tend to be children who may have a difficult time sitting still for 30 – 45 minutes, due to a lack of understanding or a generalized anxiety. This is also true for adults.
During my last blog, I touched on anxiety, in general. Today, I’d like to briefly touch on the importance of your child’s first visit and what we can do to help our children be prepared for it so that they are less likely to need sedation, of any kind.
In my practice, the most anxious patients are adult patients, followed by their children. Far too often, these same parents project their own personal fears on them. Too many times, I will witness parents telling their child (ages 2 – 11) to, “Watch out! You’re going to get a shot and it hurts!”; “Do you remember that I told you they were going to give you a shot and then take out the tooth?”; “I know it hurts, because it hurts me, too”. In all honesty, these are manifestations of the parent’s dental fear and not that of the child. These type of statements only aid to make the experience that much worse for the patient.
I have a letter that I’ve written for parents in order to prepare them for their child’s first visit. To read it, you can follow this link: http://www.reyesdental.com/first-visit-forms/your-child/ In it, I explain that I prefer to have a parent not be in the room with the child. I also ask parents to not explain anything to their children about the dental visit as, many times, parents will innocently say too much and cause unnecessary stress or anxiety. If we prepare our children properly for their first visit, this helps the doctor develop a better bond with the child so that the child can begin developing a good long-term relationship of trust and cooperation. Assuming no immediate emergencies, I like to begin most treatment visits with the mildest treatment, such as those that require no dental anesthesia. Then, subsequent visits may allow for the possibility of doing 1 or 2 fillings under local anesthetic. It may seem like an inconvenience to parents to come for so many dental appointments, but it is well worth the investment of time to allow your doctor and child to build a proper relationship.
For that reason, we encourage parents to bring their children in as soon as the first 2 teeth come in. This also allow us to educate the parent about their child’s dentition and it serves as an opportunity to get the child acclimated to this “new” place that they must learn to see as a safe place. Some parents don’t feel that this initial visit is important, but I can’t stress enough how important early dental care is. This same recommendation is not only supported by the American Dental Association, but by the American Medical Association and the American Association of Pediatrics.
There’s a statistic that went around some time ago, that is a good quick reminder of how rampant dental disease is. It was said that 40% of children will have 4 cavities by the time they are 4 years old!!! Shocking, isn’t it? But what can we expect when babies are being put to bed with milk in their bottles? When children are not brushed and flossed regularly by their parents though the age of 8? When children are instructed to brush alone but parents do not actively participate in their home care? When children do not receive regular dental cleanings? When we filter fluoride out of our city water through reverse osmosis systems and then fail to supplement this with fluoridated products? When we give our children gummy vitamins not realizing that they can cause cavities because of their sweetness and stickiness, no different than raisins can? When we allow them to drink unlimited amounts of sweetened juices and acidic sodas?
Some of you may read this and say, “I didn’t know!” Of course you didn’t. As a profession, we’ve failed to educate you. As a society, we’ve allowed insurance companies to dictate how often and what kind of treatment we should receive instead of abiding by our doctor’s recommendations. Medicine has kept dentistry out on the fringe, so physicians fail to educate the children and families they see more often than us on the importance of dental health. Every good dentist will advocate for prevention, before treatment. For this reason, we would rather be an active part of your child’s dental care earlier than later. We want to get to know you, your child and the struggles that you are encountering on a daily basis.
Believe me. We understand what you’re going though. As a business owner and working mother, I’ve experienced days when I simply forgot to brush my little girl’s teeth because I was too busy or tired. I’ve struggled teaching them how to brush and floss properly so that they can do it on their own. Thankfully and with much perseverance, my 3 girls know that I will send them back as many times as I have to, if they fail to brush adequately. Even so, flossing continues to be a struggle in my home, just like other struggles such as making a teenager wear deodorant, take showers, wash their faces, do their homework, etc. I, like you, fight these battles every day but they are battles worth fighting. As a parent and a dentist, I can assure you that your dentist welcomes questions about your child’s dental care. Please ask those questions and educate yourself about how to best care for your children. Blessings.