Dental treatment for children

It is very helpful to start seeing children at an early age (as young as 2 or 3), to establish a comfortable rapport with them, and to help the children and parents develop the best strategies for healthy teeth. If your child has never been to a dentist before, then it is important that we all work together to make it a pleasant experience.

Most of what follows is to give you some thoughts to consider,

particularly for young children that are likely to be nervous.

1. The first visit

If possible, at the first appointment for a child, we like to keep everything short and easy. It can be a very strange experience for them, with new people and surroundings to absorb. We try to keep our appointments strictly on time, so that there is minimal waiting. To calm and distract all patients, in the reception area there is a table for Duplo, a Playstation, a wide variety of books and magazines, a TV, and a fish tank.

Ideally, the first visit should be used to meet your child, to give them a ride in the chair, and to make a simple examination. We may talk to them about brushing their teeth and the type of foods to eat.

Unless there is something urgent, the simplest procedure is introduced first e.g. polishing their teeth, taking X-rays, temporary fillings, and over subsequent appointments more difficult treatment can be attempted. So much depends on the age, maturity, and past experiences of the child. All children have different needs and capabilities that have to be recognised, so it is a matter of assessing them as we proceed, and we do not want your child to feel pressured. Whilst we need to know what your concerns are for your child, and what you would like to achieve for them, please understand that above all else this must be a positive experience for your child, and we may have to be flexible.

2. Your own past experiences

As a parent, you know just how easily children pick up on your reactions to everything. They start to form their perceptions of the world from their family, from friends, and from TV. They are very attentive to conversations and moods. Never underestimate the skills of a child to sense the subtleties of your verbal and body language.

If you or any member of your family have had poor experiences at the dentist, then it is extremely important that your child does not sense these inhibitions. Dentistry has made important advances over time, and there are many ways of treating patients with care and comfort. Please be very careful what your family and friends mention to your child about dentistry.

3. Suggestions for the first visit

In preparing your child for their first appointment, you may consider that they be given no prior notice of the visit. Perhaps only tell them on the actual day where they will be going. Otherwise, they may try to gather information about dentists from other sources (friends, siblings), which are more likely to be negative rather than positive. After all, we all easily remember the bad events in life and like to tell these experiences to others, rather than the good events.

Use positive or neutral statements.
"We're going to the dentist to see how your teeth are growing."
"Let's see what the dentist (or "tooth doctor") can suggest to help fix your sore tooth."

Avoid using the word "just" in a phrase. e.g. "He's just going to count your teeth."
This implies that there could be worse things available.
See what a difference that single word can make - try, "He's going to count your teeth."

No teasing, even if meant in fun. We see this mostly from older siblings.

Be careful of your tone and intonation. Compare the following to each other:
"We're going to the dentist." "We're going to the dentist." "We're going to the dentist."

No negative statements e.g. "He's not going to hurt you...". This implies the possibility of pain.

Have the least nervous parent accompany them.

NEVER use threatening language e.g. "If you don't behave, then I'll ...".
They are always to be praised for any positive attempts during treatment, no matter how minor.

Only the parent should come into the surgery with the child. All other children should stay in the reception area or perhaps be left at home. They are often a distraction or may even tease the patient.

Please don't offer possible treatments of your own making:
"He'll probably have to fill the tooth."
"Well, you might need a needle."
"He'll have to drill out the decay."

* After all, even you don't really know what will be suggested, so why not say:

"Well, I really don't know."
"He'll tell us when he's had a look."

Allow us to introduce your child to the experience slowly, at a speed which is comfortable for them. With the right approach, children can become excellent patients. We will make much better progress if they are not unnecessarily apprehensive.

Parents are generally very welcome in the surgery.
However, if you feel you are likely to impart fear, then consider waiting in the reception area.

Siblings OR parents who make unhelpful comments will be asked to wait outside.
Treatment will be suspended if the dentist considers the situation to be unmanageable.

4. Causes of damage

There are 2 main causes of tooth damage:

Bacterial decay - bacteria (plaque) are always present in a mouth. If they are given plenty of sugars, they will multiply rapidly, and dissolve the hard minerals in the teeth, leaving only a soft layer of decay. Gradually they work deeper into the teeth until the tooth collapses or pain is felt. These holes first appear where the bacteria can easily build up e.g. in the grooves of teeth, or between teeth.

Chemical erosion - the modern diet consists of many acidic drinks such as fruit juices, cordials, soft drinks, sports drinks. The acids eat away the teeth layer by layer. The usual signs are that the tips of teeth start to wear down quickly, and the teeth become increasingly sensitive to cold drinks and sweet foods. The front teeth may start to develop rough edges.

5. Prevention

Hygiene - Teeth must be brushed at least TWICE daily, preferably by an adult for children under 7 years old. The most important time is just before bed, when many children (and parents) are tired and more likely to miss this step. If you like, then let them try themselves for practice, but the parent goes over again. Use a gently-flavoured children's toothpaste and a small amount of paste.

Diet - Minimise sugary foods. The most common and damaging foods are soft drinks, juices (any type), cordials, and lollies. Minimise snacks or sweet drinks between meals. The more frequently children eat/drink, the more often the teeth are exposed to damage. The last drink of the night must be water (not even a bottle of milk).

Dentist - We are here to identify any developing damage, to suggest methods of prevention, and to initiate preventative techniques such as fissure sealants and fluoride treatments. We are here to help, not to criticise.

6. Treatment

Childrens’ teeth are very different to adults' teeth. They have a weaker structure, and a thinner protective enamel layer. They are therefore more likely to decay and harder to fix. By the time decay is detected, it may have damaged a very large portion of a baby tooth. This means that different materials, techniques and strategies may be used for children.

The baby teeth are important for guiding the next adult teeth into the correct positions, and for developing speech and chewing habits. The ultimate aim of children's dentistry is to maintain the necessary baby teeth only until they are due to be lost normally, and with least trauma as possible.

The 1st adult molars come through at the back at 6 years old. Many parents are shocked to find that the cavity they spotted at the back is actually in an adult tooth molar, not a baby molar. These 1st adult molars are the most important teeth we ever develop. It is not uncommon to see decay in these teeth and have to treat them with root canal therapy and a crown in some children, or to extract them.

Some of children's dental treatment can be performed without the need for local anaesthetic (injections). However, this depends upon many factors, and we must usually give local anaesthetic. Perhaps surprisingly, most children can tolerate it very well, and then we can all relax during the rest of the treatment.

For aesthetic reasons, white fillings will be used wherever possible, but they require a completely dry operating area in which to set. This can be a big challenge in a small mouth with a wriggly tongue, so sometimes silver amalgams are used. Appointments are usually kept quite short. There is only so much time that some children can stay comfortably still. They have generally short attention spans, and the muscles controlling their mouth become easily exhausted.

7. Nervous children

Where necessary, some children require additional help to control their nervousness or excitability. Available methods include:

Local anaesthesia (LA) or "needles"
LA is not always used solely to block potential pain. Sometimes we might use it to reduce the vibrations from the drill, or to make the child feel more relaxed that they truly won't feel pain. Often it may be given for a small cavity where pain is very unlikely, but this acts as an introduction and test for a more difficult procedure planned for another time.

Nitrous oxide
"Happy Gas" or “Laughing Gas”. This is a very effective treatment for some children, and is often given in addition to LA. It is extremely safe, and acts only to relax the child, not to sedate them. It reverses quickly at the end of the appointment, and the child can walk unassisted after a few minutes recovery. It will also make them think as if the appointment was quite short. However, in young children, the nosepiece may be a bit scary. It can also get in the dentist's way for some treatments.

Oral sedation
An appropriate dosage of midazolam ("Hypnovel") is given in orange juice about 30 minutes before treatment. This is a quick-acting benzodiazepine (like "Valium") which makes the child quite drowsy. It is very safe. They will need assistance to get home. It wears off over about 3 hours. Sometimes this is combined with the Happy Gas to great effect. Often the child will have absolutely no memory of the treatment.

Specialist referral
For some children we refer them to a specialist paediatric dentist. This may be where all other simpler forms of treatment have been unsuccessful, or if there is so much treatment needed, that it would be kinder to have it all simultaneously performed under a general anaesthetic in day surgery.

8. Fees

Dentistry is largely based on a fee structure for the time required. Other factors that apply are the degree of difficulty for certain procedures, the skills required, and the cost of materials.

In dealing with children, we treat them as well as we would handle adults. We believe that parents would like us to perform in this manner. Although children are usually much more difficult to treat than adults, we try to keep the fees similar to adults, and thus make it affordable for parents. Health funds do not differentiate between children's and adult's procedures.