Is there any way to make going to the dentist less anxiety-producing for my child?
Most children can be supported by their parent successfully during a regular dental visit. However, when the visit includes a long or painful procedure, your dentist may recommend sedation.
A recent survey of U.S. dentists showed an increase in the use of sedation in all patients. Three-to five-year-olds are sedated most often during dental procedures. Older children are now being sedated to avoid the use of a physical restraint or holding them still. Parents have become strong advocates of this new approach.
Goals of sedation include keeping the child safe, minimizing pain, controlling anxiety, decreasing movement and modifying behavior. The dentist should collect a complete health history including allergies and any medical conditions that may affect sedation. The person prescribing and administering the sedation should be experienced in pediatric dosing of sedating medications. Ask how your dental office is prepared for an emergency. In this unlikely event, the office should have a protocol outlining what to do and how to access advanced life support. It is important to have appropriately sized equipment, oxygen, monitoring devices and a well-trained staff who can respond and perform CPR.
There are several levels of sedation depending on the type of procedure.
1. Minimal sedation. Medication is given to decrease anxiety. Kids are able to respond to verbal commands, but may have impaired thinking and coordination. They should continue to breathe without assistance throughout the procedure. Most of the time kids are able to go home without monitoring after the procedure.
2. Moderate sedation. Medication is given to depress consciousness. Kids can still respond to verbal commands or light touch and breathe on their own. The medicines used for moderate sedation have the ability to cause deep sedation depending on the dose and the patient. Deep sleep may result in a drop in oxygen. Someone other than the dentist should monitor children carefully during the procedure. The dentist and staff need to be prepared for any change in condition and respond appropriately.
3. Deep sedation. Medication is given to suppress consciousness so that the patient will only respond to repeated verbal commands or pain. At this level kids may breathe so shallowly that they may need help with keeping the airway open and breathing.
4. General anesthesia. This is a medicine-induced loss of consciousness. This type of sedation is not appropriate in the dental office. Advanced life support equipment should be in the same room.
Parents must plan ahead for dental procedures requiring sedation. The dentist should provide clear instructions for care before and after the procedure. Children may not be able to eat or drink before the procedure or may need careful observation at home afterward.
Can teeth whiteners be used on kids safely?
Teeth whitening is accomplished by the use of over-the-counter products of hydrogen peroxide or sodium perborate or products used by the dentist. Although there have been few studies on using teeth whiteners in children, experts know that the whitening products can cause tooth sensitivity, irritation to the gums, and destroy permanent teeth that have not yet erupted.
The American Academy of Pediatric Dentistry recommends that teeth-whitening products not be used on children who still have primary (baby) teeth. It is recommended that parents and adolescents discuss the best method of teeth whitening prior to using any products.
What are the risks of oral piercing and tongue splitting?
Oral piercing and tongue splitting can have many risks. The tongue is a sensory organ full of nerve fibers, so pain definitely can happen when you pierce or cut it.
The body’s response to injury is to send serum full of healing cells to the site of injury, and this causes swelling. If the tongue swells too much, it can affect the ability to breathe.
Infection is another problem. There have been cases of tetanus and hepatitis caused by body piercings. The mouth is full of bacteria that can cause open wounds to become infected. Tongue splitting may allow bacteria in the bloodstream that can ultimately cause an infection in the heart.
Jewelry used in oral piercings can crack or chip teeth or dental work. When the gums come in contact with jewelry they become swollen and irritated and pull away from the teeth. When this happens, the roots of the teeth are exposed, which can lead to decay and other damage. Once the irritation and inflammation are resolved, the gum tissue may get thicker and grow over the jewelry. The metal in the jewelry can cause an allergic sensitivity. Finally, objects in the mouth can cause increased drooling and pose a choking hazard.
Piercings and tongue splitting can affect the ability to speak clearly or can even cause a speech impediment. These practices remain unregulated, and sometimes kids will resort to doing their own piercings. Given the infection concerns, threats to major organs and the damage to teeth and gums, the American Dental Association and the American Pediatric Dental Association strongly discourage oral piercing and tongue splitting.
How does HPV affect oral health?
Many oral and throat cancers, including tonsil cancer, are caused by HPV. Around 9,000 cases of HPV-related head and neck cancers occur each year. These cancers are more common in men than in women. Symptoms of HPV-related head and neck cancers include soreness or irritation that does not go away, red or white patches, tenderness or numbness in the mouth or lips. There may be lumps or thickening in affected tissues or rough spots that are crusty or eroded. Eventually, there is difficulty chewing, swallowing, speaking or moving the jawbone. There may be hoarseness, a change in the voice, earaches and even weight loss in advanced disease.
Recurrent respiratory papillomatosis (RRP) is another disease caused by HPV. In this condition, noncancerous tumors grow in the air passages of infants, children and adults. RRP symptoms tend to be more severe in children than adults. Juvenile-onset RRP is usually caused by HPV contracted during pregnancy, childbirth and breastfeeding. Hoarseness, the most common RRP symptom, is caused when RRP papilloma interfere with the normal vibrations of the vocal folds. The tumors grow quickly and young children with the disease may find it difficult to breathe when sleeping or may have trouble swallowing. Given the chronic breathing problems, RRP is sometimes misdiagnosed as asthma or chronic bronchitis.
There are various treatment options for the warts and tumors caused by HPV. None of them provides a cure. Most just decrease symptoms temporarily. Sometimes the disease limits itself. Unfortunately, once you have HPV in your system you can give it to other people. To date, early vaccination is the best chance to curb the incidence of this disease.
Ann Petersen-Smith, PhD, APRN, CPNP-PC, CPNP-AC, is working in the Pediatric Call Center at the Children’s Hospital Colorado. She has had the honor of teaching and mentoring many PNP students during the last quarter century. She also does consultant work that includes writing, editing, teaching online programs, and committee work for the Society of Pediatric Nurses and the Colorado State Board of Psychologist Examiners.