Oral Sedation Dentistry

Are you someone who is anxious or fearful about dental treatment and even worries about it all the time? In Part One of this series, Comfortable Dentistry in the 21st Century “Overcoming Fear and Anxiety” we discussed how you can learn to overcome and cope with these negative emotions and become comfortable with modern dentistry so that you really do have the opportunity to have a “Lifetime of Dental Health.”

While it might take some faith in the beginning to realize that this is possible, Dear Doctor magazine describes exactly how to develop a relationship with the right dentist promoting:

  • Open discussion of your fears and experiences in a calm and safe environment;
  • The listening relationship that you need to feel safe and in which you have the time you need to go at your own pace;
  • Ultimately allowing you to develop the sense of control you need to reduce automatic anxiety responses.

Part Two bridges the gap to the next step in making your dental visits even more comfortable with the help of oral sedation or anti-anxiety medication. These oral sedatives or “anxiolytics” (dissolve anxiety) are administered by mouth (orally) to help transition you from anxiety to comfortable dental procedures.

Anxiety Just Melts Away

When you are afraid, your threshold for pain is much lower, you become hypersensitive to every sensation, prick, and noise. Fear and anxiety trigger the release of certain chemicals like adrenalin which put your “fight or flight” instincts on high alert. You anticipate that something is going to hurt and so you tense your muscles, even if it is subconsciously. In this heightened state of anxiety you experience more pain during and even after treatment. However this response can virtually be eliminated with oral sedation dentistry!

The whole purpose of oral sedation is to make you as comfortable and relaxed as possible. It allows you to let your guard down, relax both your mind and body, and focus on feeling peaceful rather than anxious. Your apprehension and hypersensitivity to pain melt away, yet you remain awake and in control.

Sometimes referred to as “comfortable” or “relaxation” dentistry, these terms are used to describe the feelings most people perceive during their dental visits, which are produced by oral sedation.

Safety and Effectiveness

Oral Sedation dentistry allows you the confidence and peace of mind to experience dental procedures in a whole new way. Hours seem to pass like mere minutes so that necessary dental treatment can be performed comfortably. When you are relaxed you allow your dentist to be able to work more efficiently by focusing on the work at hand, with the confidence that you are comfortable.

A variety of oral sedative and anxiolytic medications have been developed especially for these purposes. They have been subjected to rigorous research and testing and have a long safety record after decades of use. In addition several have “amnesic” properties, meaning that you remember little to nothing after treatment.

The safety of sedation medications is measured by pharmacists and health professionals on a scale called the “therapeutic index.” The larger the number is on the scale, the safer the drug. Oral sedatives and anxiolytics used in dentistry have the highest numbers possible on the therapeutic index, making them the least likely to cause an adverse reaction.

Age One Dental Visit

When parents or caregivers mistakenly say, “They are only baby teeth, they are going to fall out anyway” they have the wrong impression. The Age One Dental Visit sets the tone for lifelong dental health. The fact is, primary teeth serve as the guides for the permanent teeth and are critically important to the health and function of their adult successors. What’s more, primary teeth are the child’s teeth for most of childhood — children don’t usually begin losing them until about age six, and the last primary teeth aren’t lost until around age twelve. It’s just as important to care for them as for the permanent teeth that come later.

An Ounce of Prevention

What really is prevention anyway? Prevention in the truest sense of the word means stopping an anticipated problem before it even starts. The importance of primary teeth and preparing for a lifetime of good oral health are the main reasons why parents should bring their children to see a dentist or pediatric dentist (children’s specialist), preferably before their first birthday. It’s more than just a casual visit: even a one-year old needs a comprehensive examination and even some preventive applications. Parents will benefit from the guidance of “Family Oral Health Education” including: risk assessment for decay; training (hands on) in teeth cleaning; nutritional counseling and use of cups for drinking; fluoride recommendations based on individual needs and important follow-up appointments for monitoring based on the level of risk determined by your dentist.

The Age One Visit may also reveal underlying conditions that may indicate future problems, and determine how often follow-up visits might be needed. Children with low risk for oral or dental disease might only be seen annually or semi-annually until the primary (baby) teeth are all fully erupted in the mouth and in occlusion (biting function). Children assessed at high risk might be seen as often as every two to three months.

Diagnosing and Treating Tooth Decay

One of the prime purposes for an Age One Visit is to examine the child for a number of forms of tooth decay that can affect babies and small children. For many years, health and childcare professionals have recognized a specific pattern of such decay, known as Baby Bottle Tooth Decay (BBTD). BBTD was believed to be primarily associated with the use of a sleep-time bottle that contains a liquid with natural or added sugars such as formula, juice or Kool-Aid. It generally occurs between the ages of twelve to eighteen months.

In recent years, similar cases of early and severe tooth decay have been found in children who do not fit the classic BBTD pattern of bottle use. The term Early Childhood Caries (ECC) is now being used to reflect a broader concept of the problem of tooth decay in infants and young children. ECC includes cavities associated with many causative factors, mostly sugars. These include continuous use of a “Sippy-cup,” at-will breast-feeding throughout the night, use of a sweetened pacifier or the regular use of sugar-based oral medicine to treat chronic illness.

ECC develops rapidly — the progression from the hard, outer enamel layer of the tooth into the softer, inner dentin can occur in six months or less. It first affects the upper front baby teeth, which usually erupt at around eight months of age, followed by the primary molars (back teeth), which begin to erupt at about twelve months of age. At its most severe stage, ECC may then affect the lower front teeth.

The extent and severity of ECC can vary depending on culture, the child’s genetic makeup and socio-economic factors. On the other hand, ECC is really much like any other type of tooth decay, dependent on the presence of three conditions: specific bacteria in dental plaque on the teeth, unprotected teeth and the right mix of carbohydrates from food and drinks, such as natural or refined sugars.

Porcelain Veneers Without the Drill

The notion of adding materials to teeth in order to change the way they look is nothing new to dentistry. Traditionally, teeth are prepared in some way or fashion in order to place and retain a restorative material — typically a filling, porcelain veneer or crown. Not only is tooth reduction generally necessary to restore lost or damaged natural enamel as a result of the ravages of tooth decay or trauma, but it is also necessary to create room to place an aesthetic and functional “restoration.”

The purpose of this article is to introduce and provide a clear understanding of an alternative cosmetic treatment option, the “no-prep” or “prepless veneer,” whereby no drilling is required to enhance a smile. It also endeavors to bring clarity and understanding to the numerous areas of confusion regarding this treatment modality. Most importantly, it examines the case selection process; when prepless dentistry will work and when it won’t. As with almost all dental and medical procedures, there are risks, benefits and alternatives. It is with the help of a dental professional experienced in these advanced techniques, together with your own goals and understanding, that you can make decisions that are right for you.

No-Drilling: Reality Or Ridiculous?

“Prepless veneers” is a concept that elicits various reactions and opinions among dentists, ranging from absolute disbelief that they can facilitate effective restorations, to appreciation for these conservative and advanced works of art! This range of opinion about a novel approach to cosmetic dentistry is vast and with good reason. The concept of “additive only” restorations intuitively causes the experienced clinician reason for concern as visions of bulky, over-contoured teeth quickly come to mind. Unfortunately, some prepless techniques and products circulated heavily in the media have shown thick, bulky looking restorations, causing skepticism among some dentists and consumers alike.

And yet, despite these concerns, an undeniable trend is emerging among many esteemed cosmetic dentists to incorporate not only minimal prep, but also “no-prep” restorations into their compendium of viable treatment options and alternatives.

In recent years, new developments in techniques and materials have resulted in a fresh look at the aesthetic possibilities for the no-prep veneer option. Cases done by talented dentists and lab technicians have produced results which would meet the highest standards in cosmetic dentistry [Figures 1 and 2]. Part of the advanced level of training for prepless veneers includes the important aspect of proper case selection. Not every situation lends itself to a no-prep approach, but when it does, the results can be not only beautiful, but also stable and reversible!

Paradigms and Beliefs — A Shift

The promotion and endorsement of “prepless” veneers is predicated on the following paradigms and beliefs:

  • It is not necessary to prepare a tooth to create a border (known in dental terms as a “margin”). Highly skilled dental technicians can design a custom-fit veneer that feathers into the tooth just short of the gumline.
  • Aside from the other obvious benefits of prepless veneers, they are not placed under the gum tissue. This eliminates the risk of the restorations having a negative impact on the periodontal (gum tissue) health.
  • In many cases it is possible to use an additive-only approach to create aesthetically pleasing and natural-looking restorations without reducing the underlying tooth structure.
  • Consumers who are looking for a way to enhance their smiles are more likely to seek out and accept a no-prep approach with a highly-skilled dentist in situations in which they don’t need aggressive enamel removal.

Tooth Decay — How To Assess Your Risk

Tooth decay is one of the most pervasive diseases of our time but modern dentistry has made major strides in the battle against cavities. Based on years of scientific and clinical research, dentists are now moving towards an approach to dental caries (tooth decay) management that is tailored to your personal risk rather than a “one size fits all.”

The previous method of “drilling and filling” to treat decay does not actually change the conditions that lead to the disease and the risk for further infection still remains. By profiling the degree of risk and implementing individualized preventive strategies, today’s dental professionals are using a more proactive approach — that works.

Dental Decay — A Dynamic Infectious Disease Process

The mouth is an ecosystem — living organisms continually interact with every other element in their environment. The teeth are composed of an outer covering of enamel, a highly mineralized crystalline structure composed mainly of calcium and phosphate. They are also bathed in a remarkable fluid — saliva, which plays a crucial role in maintaining a neutral environment or balance between the acids and bases in your mouth.

Acidity is measured by the pH scale, which ranges from 1 – 14. A pH value of 1 is extremely acidic while a pH value of 14 is extremely basic. The pH of the mouth is generally 7 — neutral.

Specific acid producing (acidogenic) bacteria attach themselves to dental plaque, the whitish sticky biofilm that collects and forms on the teeth. When you eat sugars or carbohydrates, these particular bacteria break down the sugars and produce acid as a by-product, which also makes the mouth more acid. At about pH 5.5, the minerals just below the enamel surface of the teeth begin to dissolve or “de-mineralize.” During this process, more calcium and phosphate leave the surface of the teeth than enter it — the first step in the decay process. And because the layer beneath the enamel, and the roots of teeth are made of dentin, which is softer than enamel, it is more susceptible to decay. For example, the roots of an exposed tooth will de-mineralize quickly and easily with even weak acids at pH 6.2 – 6.8, which is closer to neutral saliva.

Why Me? Individualizing Risk Assessment

Given similar habits, you might wonder why some people get cavities and others don’t? Dr. John Featherstone, an imminent researcher, introduced the concept of the Caries Balance in 2002, in which he demonstrated that dental caries (tooth decay) and dental health are the result of a delicate balance between pathologic (disease causing) and protective (health promoting) factors. Each person has his/her own unique balance that is constantly changing. The challenge is to identify what is out of balance and how to tip it towards health and protection.

Caries risk assessment can be likened to that for cardiovascular (“cardio” – heart; “vascular” – blood vessel) disease wherein a physician reviews your health history, takes your blood pressure, monitors your heart, and provides an individualized treatment plan to reduce or manage risk. If your blood pressure is high, it doesn’t indicate that you have had a heart attack or stroke or that you definitely will one day. However, it does mean that you are at a higher risk and it would be wise to take preventive actions.

New Tools Of The Trade

This process is precisely what we are doing in dentistry today with the Caries Management by Risk Assessment (CAMBRA) approach. Modern dentistry can now evaluate risk factors for dental caries and use them to make preventive recommendations. Not everyone has the same risk level for developing dental caries, which is further complicated by the fact that risk is dynamic and changes daily, as well as over longer periods of time.

Prevention includes determining both pathogenic and protective factors — both sides of the balance, and the factors that tip the balance. Some of these include Disease Indicators and Risk Factors that lead to imbalance and Protective Factors that shift the balance toward health. These entities are measurable and quantifiable but more importantly, they can be modified leading to predictable disease prevention.

Accurate determination of risk is greatly aided when your dental professional uses a caries risk assessment form to ask you specific, scientifically validated questions to help pinpoint imbalances. Your dentist may use two types of forms, one for children between the ages of 0-5 and the other for everyone (including adults) over the age of 6.

Tooth decay risk assessment evaluation form.
Risk assessment forms allow dentists a simple way to determine your potential for future tooth decay. Evaluating disease indicators of past behavior is often the most accurate and best indicator of future disease.

Disease Indicators

Disease Indicators work by showing you what could happen based on what has happened. Identifying them includes the use of modern dentistry’s most sophisticated tools for early diagnosis of decay. They include:

  • Visible cavities (decay) that is visible in teeth ranging from very early (microscopic) detection using, for example, laser technology, to cavities that are visible to the naked eye.
  • X-ray pictures show early decay that is visible by using today’s highly sensitive yet low dosage x-rays.
  • White spot lesions are the first sign of decay in the contacting areas of adjacent teeth that are often reversible with fluorides.
  • Cavities within the last 3 years — any previous cavities add to your risk.

Decay Prevention For Children

A child’s oral health must be protected from birth through adolescence and into adulthood. Unfortunately, many children develop tooth decay early in life – a condition that can progress into serious oral health problems. Keeping a child’s teeth strong and healthy requires preventative measures. At our pediatric dental practice, prevention is the foundation of all we do. After all, it is far easier and more affordable to avoid oral disease than it is to treat it.

DID YOU KNOW…

that most children do not get the preventive dental care that is recommended for them? According to the Department of Health and Human Services, only half of U.S. children visit a dentist for preventive purposes each year. Of those who do, children under age 5 are least likely to see a dentist compared to older children over age 6. But early childhood prevention is important for establishing a healthy mouth that lasts a lifetime.

Frequently Asked Questions

WHEN SHOULD PREVENTATIVE DENTISTRY START FOR MY CHILD?

Prevention begins early. A mother’s diet while pregnant will contribute to a child’s developing primary teeth in the womb. After birth, parents should cleanse a baby’s gums and begin brushing the teeth gently as they emerge. Infants should visit a pediatric dentist for a preventive care exam no later than age one.

BESIDES BRUSHING, WHAT ELSE CAN BE DONE TO PREVENT EARLY CHILDHOOD CARIES?

Diet plays an important role in a child’s dental health. Sugar feeds the bacteria responsible for tooth decay and gum disease. Limiting foods and beverages containing sugar deters cavities and helps protect the enamel. Avoid giving your child sugary juices, candies and sodas, and never let your child go to bed with a bottle.

WHAT CAN MY CHILD’S PEDIATRIC DENTIST DO TO PREVENT DECAY?

Depending on your child’s age, oral health and risk factors, a pediatric dentist may recommend in-office preventive treatments to help stave off tooth decay. For example, fluoride treatments may help strengthen the teeth – especially in children with low exposure to fluoride in local water sources. Another option is dental sealants, which are placed on newly erupted permanent molars to fill in pits and crevices that are susceptible to decay. As your child grows and becomes more active, his or her dentist may recommend the use of a sports mouth guard when participating in contact sports like soccer or gymnastics.

Pediatric Dentistry

Pediatric dentistry is a dental specialty focused on the prevention, diagnosis, and treatment of oral health problems in children. Pediatric dentists have specific training that qualifies them to provide care for children’s teeth and gums as they change throughout childhood. Pediatric dentists provide comprehensive care, from preventative treatment like cleanings and sealants to treatment for oral disease and injuries. A pediatric dentist will also counsel parents about a child’s nutritional and hygienic habits.

DID YOU KNOW…

that early childhood caries is the most common chronic disease in American children? It is far more prevalent than other common childhood illnesses, such as asthma. Furthermore, tooth decay and gum disease that begins early in life are likely to progress over time, potentially leading to a lifetime of oral complications.

Frequently Asked Questions

WHAT AGES OF CHILDREN DO PEDIATRIC DENTISTS TREAT?

A pediatric dentist will treat patients from birth through adolescence. The American Academy of Pediatric Dentistry recommends that young patients begin visiting a pediatric dentist no later than the first birthday when most children already have a first tooth. Children will continue to visit the dentist periodically throughout childhood to prevent tooth decay and gum disease.

WHAT TYPE OF TRAINING DOES A PEDIATRIC DENTIST HAVE?

A pediatric dentist has the same credentials as a family dentist, only with two additional years of training specifically in the oral treatment of babies, children, teens, and kids with special needs. They are trained to understand not only the dental needs of a child but also the psychological and emotional needs as well.

HOW CAN I MAKE A PEDIATRIC DENTAL APPOINTMENT?

Our staff is happy to assist you through the process of making the first appointment for your child. Simply call our office to speak with one of our helpful staff members and schedule your child’s visit. We aim to make your child’s experience as comfortable as possible.

My Child’s First Dental Visit

Children should have a dental care home – preferably with a pediatric dentist who specializes in the oral health of children and adolescents. Early childhood dental visits help a child acclimate to the dental environment and become comfortable with his or her oral care provider. By attending appointments on a regular basis, children learn to put a value on oral care and establish healthy habits that can last a lifetime. The first dental visit is different for each child depending on the age and overall oral health of the patient.

DID YOU KNOW…

that despite recommendations by the American Academy of Pediatric Dentistry to see a dentist for the first time by age one, the majority of children in the U.S. do not have a first dental appointment until long after age two? Unfortunately, waiting has its consequences. As children get older, their risk of tooth decay increases – something that is easily prevented with early oral care.

Frequently Asked Questions

WHAT WILL HAPPEN DURING MY CHILD’S FIRST DENTAL APPOINTMENT?

The first dental appointment begins with questions about your child’s medical and oral health history. You will also be given an opportunity to discuss any questions you have as a parent or any symptoms your child may have been experiencing. Depending on your child’s age, the dentist may visually examine the teeth and/or gums for signs of decay or other complications. Older kids may have their teeth cleaned and x-rayed for closer examination.

Dentists often use the first dental appointment as an opportunity to speak with parents about the brushing, flossing and the importance of fluoride. It is also the time when pediatric dentists speak with parents about teething, preventing accidents, and the importance of limiting foods and beverages that contain sugar.

HOW DO I CHOOSE A DENTIST FOR MY CHILD?

Parents must be selective in choosing a dentist for their children. Though any dentist is capable of caring for your child’s teeth, a pediatric dentist specializes only in the treatment of children and adolescents. Pediatric dentists know how to relate to children and how to make them feel comfortable in the dental chair. For more information about pediatric dentistry, contact our office.

HOW OFTEN SHOULD MY CHILD VISIT THE DENTIST?

Children with healthy mouths and teeth typically need to visit the dentist every six months for routine check-ups and preventative care, such as cleanings and fluoride treatments. However, your child’s dentist may recommend an alternate schedule that better accommodates your child’s needs.

Importance Of Dental X-Rays

DID YOU KNOW…

that x-rays are considered safe and only emit minimal amounts of radiation? In fact, advancements in modern dentistry have made it possible to reduce the amount of radiation children are exposed to while getting dental x-rays. Pediatric dentists take further precautions by protecting the body with a lead apron while obtaining x-rays from young patients.

Frequently Asked Questions

DOES MY CHILD NEED A DENTAL X-RAY?

Your child may need oral x-rays for preventative purposes. Pediatric dentists often use x-rays to gauge the development of the permanent teeth and their placement. Sometimes x-rays reveal missing or extra teeth or other underlying problems not detectable with a visual exam. Your child’s dentist may also order x-rays to:

  • Monitor healing and recovery following a mouth injury
  • Identify an infection
  • Determine whether a child will need orthodontic treatment

WHEN SHOULD MY CHILD BEGIN GETTING DENTAL X-RAYS, AND HOW OFTEN WILL HE OR SHE NEED THEM?

Though there are no specific guidelines for getting the first x-ray, most children have had their first dental x-rays by age 5 or 6, when the permanent teeth begin to erupt. However, a dentist may request earlier x-rays if a child is at high risk of tooth decay or shows signs of other potential complications. Dental x-rays may be ordered as frequently as twice per year or as little as once every few years.

WHAT WILL MY CHILD EXPERIENCE WHILE HAVING HIS OR HER MOUTH X-RAYED?

The x-ray process is completely painless for children. They will be seated for the duration of the imaging process and will not experience discomfort. The length of time required will depend on the type of x-rays taken. For more information about pediatric dental x-rays at our office, contact us to speak with a helpful staff member.

Care Of My Child’s Teeth

Your child’s mouth, jaw, and teeth are ever growing and changing. In fact, a child’s dental needs are often far greater than an adult’s due to the rapid changes that occur between birth and adolescence. Rather than trust just anyone with your child’s dental care, look to a pediatric dentist who understands the unique oral health needs of children and can provide the most specialized care possible.

DID YOU KNOW…

that pediatric dental care is about more than exams and professional cleanings? In fact, a pediatric dentist is a parent’s greatest partner in protecting a child’s oral health. Dentists can detect developmental problems, make recommendations for orthodontic treatment and even provide custom mouth guards to protect the teeth and jaw from contact sports in childhood and adolescence.

Frequently Asked Questions

WHY SHOULD I BRING MY CHILD TO A DENTIST WHO SPECIALIZES IN PEDIATRICS?

Pediatric dentists have specialized training working with children for approximately 2 to 3 years following dental school? This additional training time provides important skills in child growth and development, as well as child psychology. A pediatric dentist understands how to relate to children and works to provide an atmosphere that is welcoming and less intimidating to young patients.

WHAT WILL MY CHILD’S DENTAL EXPERIENCE BE LIKE?

Your child’s pediatric dentist will monitor your child’s oral health with two or more visits per year. During those appointments, the plaque is removed from the teeth and the mouth is examined for signs of decay and gum disease. Emphasis is placed on prevention both at home and in the office. Depending on your child’s risk factors and the results of his or her exam, the dentist may recommend specific treatments, such as fluoride treatments or sealants.

HOW SOON SHOULD I BRING MY CHILD TO A PEDIATRIC DENTIST?

The American Academy of Pediatric Dentistry recommends a first dental visit no later than age one. These early visits are mostly educational, but can set the foundation for a lifetime of healthy oral habits. However, it is never too late to visit the dentist for the first time. Whether your child is a few months old or a few years old, there is no better time than now to start thinking about his or her oral health. Call our office today to schedule your child’s appointment.

Composite Fillings (Tooth-Colored Fillings) For Children

More than half of children over age six have some degree of tooth decay. When cavities are left untreated, they can lead to pain, infection and even tooth loss. Fortunately, pediatric dentists can fill cavities to prevent them from worsening or causing complications. Modern dentistry has made it possible to fill cavities discreetly using tooth-colored fillings, also known as composites. Children with tooth-colored fillings can retain decayed teeth in a way that is both functionally effective and visually appealing.

DID YOU KNOW…

that tooth decay is the most common chronic disease affecting children in the U.S.? According to the American Academy of Pediatric Dentistry, children as young as 6 months old can experience tooth decay. Tooth-colored fillings can repair damaged teeth, but the most effective form of treatment is prevention. Parents can help their children prevent cavities by limiting exposure to sugary foods and beverages.

Frequently Asked Questions

WHAT WILL MY CHILD EXPERIENCE WHEN GETTING A TOOTH-COLORED FILLING?

Your child’s teeth and gums will be numbed using a local anesthetic. The dentist will then remove decay from the teeth and clean the treatment site. A composite material will be bonded to the tooth surface and cured. Finally, the filling will be adjusted for comfort. Though most children experience little or no discomfort during this process, it is normal to feel some pressure. If your child has dental anxiety or concerns about the treatment process, speak with your child’s dentist about sedation options.

DOES MY CHILD NEED A FILLING?

Your child may need a dental filling if he or she has cavities. Though some cavities are obvious and cause pain, many are less easily seen and asymptomatic. That is why all children should visit a pediatric dentist twice yearly for a professional dental exam. Regular exams can identify tooth decay in earliest phases when it is most easily treated.

HOW LONG WILL A COMPOSITE RESIN FILLING LAST IN A CHILD?

Composite fillings are very strong and capable of withstanding normal wear and tear in children. Most tooth-colored fillings will last many years so long as children brush twice daily, floss once per day, adopt healthy dietary habits and visit a pediatric dentist regularly for exams.