Dental treatment options for young children

The past few years have seen profound tooth damage in increasingly younger children. If dental repair is difficult or impossible for any reason, treatments such as sedation using nitric oxide (laughter gas) or general anaesthesia are used in dentistry.

Caries is a major oral health problem affecting 60-90% of school-aged children. The incidence of early-age caries has risen sharply in the children’s ward of the RSU Institute of Stomatology. in 2018, 1,356 children were treated for general anaesthesia in the unit, 926 in 2010 and only 85 in 2001. Patients had an average age of 5 years. Often parents with two-year-olds, three-year-olds, only turn after helping with a children dentist when the condition in the oral cavity is already critical. Guidelines of the Latvian dental Association stipulate that the first visit of a child to a dentist should be planned at the age of 1 in order to assess the risk of caries of a child and to take measures that will protect against further deterioration of teeth. Unfortunately, there are a fraction of parents who do not follow these recommendations or are not aware of them, and only turn to a dentist when the baby has already developed pain, inflammation. Caries have a negative impact on the child’s health, quality of life, reduce the child’s ability to take a full diet. A full diet plays a key role in developing and maintaining healthy teeth, but healthy teeth are important to be able to take a healthy diet throughout your life.

At least 1 or more visits by a child’s dental hygienist are recommended before treating a child’s teeth to reduce the risk of dentist fear and encourage further child co-operation. In children under 3 years of age, different behavioural management methods may be used to treat teeth if they fail and the child requires extensive and invasive (local anaesthesia, pulp treatment, extraction) dental/oral care, then treatment is recommended for general narcosis.

Indications for general narcosis:

1. patients with severe early childhood carriages (≥ 3 cardiac teeth at age 3)
2. patients unable to cooperate due to a lack of psychological or emotional maturity or mental, physical or medical disability (disability);
3. patients whose local anaesthesia is not effective due to acute infection, anatomical variation or allergy;
4. fearful, anxious and uncommunicable children and adolescents who do not cooperate;
5. patients requiring significant surgical (dental) treatment;
6. patients whose use of general narcosis may prevent psychotrauma and/or reduce medical risk;
7. patients requiring urgent, extensive dental/oral treatment (care).

Contraindications for general narcosis:

1. healthy patients with minimal dental indications who cooperate well;
2. very small patients with minimal dental indications that may be resolved by minimally invasive intervention (e.g. atraatraatic restoration, fluoride varnish) and/or postponement of treatment;
3. convenience of patient/dentist;
4. patients with medical and physical conditions that make general anaesthesia unpredictable (AAPD Guideline on Behaviour Guidance for the Pediatric dental patient, 2016).

When a child is 5-6 years old, sedation with nitric oxide (laughing gas), which has been in use for more than 150 years, can be used to reduce fear in dental treatment. This method reduces fear and anxiety, and makes dental treatment much more enjoyable and simple. It is a safe procedure used in paediatric dentistry around the world. If the method is used appropriately by specially trained dentists with certified equipment and suitably trained assistants, it has a very high rate of success. Nitrogen gas exposure is temporary, so after treatment, the patient can go home straight away.

How does it work?

• During sedation, the child breathes a mixture of nitric oxide and oxalic gases by means of a special mask while also undergoing dental repair.
• During sedation, the child does not fall asleep and is conscious, but feels much more relaxed and calm
• A child can speak and explain their feelings during a procedure
• Most children experience pleasant warmth, relaxation, sleepiness, gentle tingling of their hands and legs during sedation. Once sedation is interrupted, these sensations disappear completely within 5-10 minutes.

Contraindications:

• Inability to communicate;
• Inability to breathe through the nose
• Serious psychiatric or behavioural/personality disorders;
• B12 or B9 deficiency/impairment;
• Chronic obstructive pulmonary disease
• Neuromuscular disorders such as multiple sclerosis
• Cancer treated with chemotherapy with Bleomycindrugs
• Patients in the first trimester of pregnancy.

Prior to the visit, only a mild meal at the latest 2-4 h prior to the procedure is recommended for the child. Drinking water up to 2 hours before the procedure is allowed. After the visit: Although nitrogen oxide is no longer present in the body 30 minutes after the end of the procedure, parents should look after the child about 2 hours after the visit.

Poor oral hygiene, incorrect and occasional brushing of teeth, as well as frequent consumption of sugary products are major risk factors for caries. It is therefore important that parents take an active part in educating, motivating and other oral health-promoting measures for their child. The Working Group of the Latvian dental Association has developed recommendations for improving oral hygiene for children of different ages, in which it is recommended to use fluoride-containing toothpaste and dental floss in order to ensure mechanical removal of tooth plaster and local fluoride effect on dental surfaces. Children are recommended to use fluoride-containing toothpaste with a curfluoride content of at least 1000 ppm immediately after hatching of the first tooth.

Good oral hygiene habits, instilled early in childhood, also provide a low incidence of caries as a teenager. Education, motivation and accountability of patients/parents for their/their children’s teeth play an important role in preventing caries. Family is one of the most important social supports in educating a child. In early childhood, parents and other family members alike are exemplary in following a healthy lifestyle. Later, as teenagers, they should become a support group at moments when a child lacks strength and motivation, such as maintaining good oral hygiene. Furthermore, it should be noted that the child is dependent on the wishes and financial capacity of the parents (e.g. to purchase toothpaste and toothbrush).

Today, the core objectives of caries treatment include early diagnosis of potential caries risk factors, the earliest possible detection of new cardiac lesions and halting their development, and the implementation of measures to accelerate the process of tooth remineralisation by various means. It is important to protect teeth from carousel formation in a timely manner to reduce the number of children in need of dental repair. Parents and dentists, dental hygienists, as well as other medical professionals, especially general practitioners, pediatricians, gynecologists, should take responsibility here. Because disease prevention has always been seen as the most effective tool in any healthcare system.