Jan 31

My Child Has a Toothache

Unfortunately, I hear this from parents of new patients several times a month.  This doctor does see pediatric patients for routine care and emergency care.

Preparation for the visit starts well before the appointment.  Kids are very perceptive of  parents and siblings feelings, attitudes, and projected fears.  Parents that are calm, reassuring and have made statements to the child such as “the tooth doctor will fix the tooth and make it feel better” is a good way to start.  Statements like “you have eaten too much candy and don’t brush your teeth and now doctor is going to pull your tooth” are not good ways to start.  Believe me, I really do have parents that say this to their child before a visit.  Also please keep the last meal before the visit light and skip it if possible.  I have had parents give a child a big meal and then state “I fed her a big lunch because I figured she would be numb after the visit and oh yeah by the way, she gags very easily”.  Now I know this sounds silly, but I have had parents do these things to me.  Please don’t bribe the child either.  They know the bribes come after something unpleasant or someone or something they don’t want to sit through.

This doctor treats children with something I call TELL, SHOW,DO.  After sitting in the chair, I demonstrate to them and allow them to touch, hold and work the various things surrounding them.  They are allowed to work the small suction device or aka, Mr. Thirsty.  They will empty a cup of water with it as well.   Then I will tell them I will use Mr. Thirsty in their mouth so the teeth are not under water.  At this time I will gently allow the child to have me place the suction device in their mouth.  All items we are going to use are demonstrated in this fashion.  This is inclusive of the high speed hand piece, aka, Mr. Windy.  The word drill is NEVER used.  After a tooth picture (x-ray) is taken, the culprit is usually a deciduous  tooth (baby tooth) with a large cavity in it.  Deciduous teeth, usually the first or second molar are retained to about 7 1/2 and 8 1/2 for first molars and 11 1/2 and 12 1/2 for second molars.

Depending on the age of the child and where the succedaneous  tooth (permanent replacement tooth) is underneath the problem tooth, will most times determine what needs to be done.  If the child is years away from sheding the baby tooth naturally, the baby tooth should try to be retained.

A procedure called a pulpotomy will be performed.  The inflamed crown portion of the pulp tissue is removed and a zinc oxide sedative filling is set in its place.  Usually then a small prefabricated crown is cemented onto the tooth.  This doctor uses nitrous oxide analgesia in order to get the novicane on board easily.

I do allow parents into the room and I can usually see the surprise on the parent’s face when I am giving the local.  The child most times isn’t reacting with any discomfort at all and parents will usually say “Boy, they are better than me”.

Children today usually have fewer cavities than we did back in the 60’s and 70’s.  However, the trend tends to be either no cavities or a lot of them.  Poor dietary habits with continuous snacking and a high intake of juices will usually cause a great deal of decay.    A graduation from a juice bottle to a juice box,and cafinated soft drinks is the trend.  Many times the entire family will have very destroyed dentitions all from the same intake of sugary beverages.   It is unfortunate to hear from a parent “I guess they have my lousy teeth.  Everybody in our family has lousy teeth”  when in reality no one thinks the two cases of Coke, Mountain Dew or Pepsi are the real culprit.

There is no reason a child should grow up in fear of the dentist.  Early exams in a non-threatening environment with magic tricks, take home prizes and fun should have your child looking forward to his next visit.  I will be glad to see children as young as 3 1/2 and believe me they will have fun and you will leave thrilled that the visit was so easy.