Kids: To Sedate or Not to Sedate? Part 3

In the last two articles we touched on the difficulties of treating an uncooperative child and what we can do to help make your child’s experience more pleasurable and enjoyable. Today we’ll continue the topic and talk about the different numbing techniques available.
First off I should mention that if we are able to diagnose and treat the cavity early enough, numbing may not be required. What I have found is that when the cavity is less than 2mm deep whether in and adult or child, we can often treat the cavity without numbing in about 90% of the time. Some people have extremely sensitivity teeth and in those situations we always have to numb, but it is important to note, early detection means smaller fillings and less likely that we have to numb. This is also why we recommend your child come in for their first visit when their first teeth come in, so we can review techniques to prevent cavities, and allow us to catch the cavities early on so they don’t get too big. As a rule of thumb, if the parent can see the cavity, it’s probably too big to do without numbing, and there is a possibility in may not be fixable at all, depending on the size of the cavity. When the cavity appears to be 2mm or more, we are leaning towards numbing the tooth or putting the tooth to sleep.
Traditionally this is done with a needle. In my experience the needle does not actually hurt that much if you use the right anesthetic and technique. There are also neat devices such as the WAND, which is a computer controlled anesthetic device which we have in the office as well. This device allows us to inject the medicine often painlessly. Again with the right anesthetic and right technique this device is not always needed, but it is nice to have when you need it. What I do find is, it is not the actual needle that bothers the patient as much as the numbing effect on your cheek, lips and tongue. Although most kids do not mind the numbing feeling and some think its pretty funny, some really are bothered by it, despite being foretold what to expect. With numbing you often feel a prickly, pins and needles type feeling at first and then everything feels really big and fat. It is an odd sensation, which some kids really have a problem with. The trick is warning them before hand and make it fun for them as it is a really funny feeling.
We do have a new injection technique at the office which is a needleless technique. There is no needles. The medicine is delivered by pressure. It is virtually painless (I’ve tried it on myself) and works very quickly. It can only be used in certain circumstances. It does not work well in adult molars or areas where there are thick bone. But for most kids, since the bone is very soft, this technique works really well. Not only is there no needle, but you don’t get the fat lip, cheeks and tongue associate with normal numbing.” The only thing that is numb is the gum and the tooth.”I have used this technique on a number of patients who I know would not do well with traditional numbing, and they did fantastic. It is a great alternative to the truly needle phobic patient.
Next month we’ll review the different sedation techniques for the truly phobic children!