Pediatric Dental Health

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Can Von Willebrand Disease Complicate Dental Treatment?
Von Willebrand (vW) disease may pose bleeding problems for children (and adults) who need dental treatment.
Proper precautions must be taken before, during, and after dental treatment.

Von Willebrand disease is an inborn disease of a blood plasma protein (vW Factor), which is required for proper adhesion of platelets to blood vessels.
Without platelet adhesion, bleeding time is prolonged.
Prolonged bleeding can occur during or after dental treatment in patients who have vW disease.

Patient with vW disease should avoid taking aspirin, NSAID medications, and antihistamines.

There are three forms of vW disease. Type I vW disease is the most common, affecting 80% of patients. It is caused by a decrease in the amount of vW Factor (vWF).
In type II vW disease, only small, ineffective versions of vWF abound.
Type III vW disease is the most severe form, but it is also rare.

Before a dental procedure, type I patients may need to take Stimate (DDAVP) in a nasal spray.
Stimate releases vWF from the lining of blood vessels.
Stimate may, however, cause problems for type IIb patients.
Stimate is ineffective in type III vW patients.

During a dental procedure , vW patients may need to receive an I.V. administration of Humate P, a purified product, which contains vW proteins and Factor VIII.

After a dental procedure, vW patients may need to take Amicar (EACA) every 4-6 hours for 5 days.
Amicar prevents the premature breakdown of blood clots, and is an anti-fibrinolytic.

For more information about
vW disease, look at RNWeb.

"Why Doesn't My Baby Have Any Teeth Yet?"
Parents are often concerned when their baby's first teeth haven't erupted (come into the mouth) on time.
A baby's first teeth, the lower central incisors (lower front teeth), normally erupt between five and seven months of age.
Delayed eruption can be associated with prenatal, natal, or postnatal factors.

Prenatal environmental factors may affect development and eruption of teeth.
Maternal illness during pregnancy can also affect a baby's dental development.

The complications of premature birth are correlated with delayed dental eruption in infants.
The complications include: a long period of orotracheal intubation (use of a breathing tube in the hospital), neonatal (pre-term birth) infections, and delayed initiation of full oral feedings.

Postnatal (after birth) factors are also correlated with delayed eruption in infants.
These factors include: low birth weight, nutritional deficiencies, hypothyroidism, and hypopituitarism.

Infants with syndromes or birth defects may experience delayed eruption of primary and/or permanent teeth.

Parents who are concerned about the delayed eruption of their baby's teeth should consult a pediatric dentist.
Remember that a child's first dental visit should take place around the age of one!
The pediatric dentist will attempt to diagnose the problem and determine its etiology (cause).
He/she will determine if anything can be done to promote eruption of the teeth.
A referral to a pediatrician may also be required.

A good article on the subject of delayed eruption of primary teeth is:
Viscardi RM, Romberg E, Abrams R:
Delayed primary tooth eruption in premature infants: relationship to neonatal factors.
Pediatric Dentistry 16(1):23-28,1994.

Can Diabetes Affect Dental Health?
Children's diabetes can increase the risk of oral and dental infections. The cells which fight infections are weakened by insufficient suagar utilization, due to the lack of insulin.

Most children with diabetes have Type I DM (diabetes mellitus). Type I DM is the second most common chronic childhood disease. In this type of diabetes, the beta cells of the pancreas fail to produce enough insulin to meet the body's needs. Cells cannot take up sugar unless insulin is there to make it happen.

In untreated Type I DM, there is too much sugar (glucose) circulating in the blood, and not enough of it going into the body's cells. Thus, the body's cells don't have enough energy to function well.

The cells responsible for fighting infections need glucose too. The infection-fighting neutrophils (and other cells) can't take up and use glucose, because there isn't enough insulin available. Due to the lack of insulin, infections of all kinds are common in diabetic children, and this includes dental infections.

A recent journal article stresses the important link between diabetes and dental infections:
Shahgoli S, Shapiro R, Best JA:
A dentoalveolar abscess in a pediatric patient with ketoacidosis caused by occult diabetes. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 88:164-66,1999

The signs and symptoms of Type I DM can appear abruptly,even though the disease itself may have progressed silently up to that point. In a period of days or weeks, a child can develop: excessive thirst (polydipsia), excessive urination (polyuria), weight loss (despite hunger), and lethargy (malaise). These are all of the hallmarks of Type I diabetes.

In type I DM, the inside of the mouth (mucous membranes) can appear dry. Additionally, breathing can be very rapid (KussmaulKien respiration), and the diabetic child may have a fever.

Untreated Type I DM can progress to diabetic ketoacidosis, which is life-threatening. If you suspect that your child has diabetes, please see a pediatrician immediately.

For more information, please look at
Children With Diabetes.

What Is Electronic Dental Anesthesia?
Electronic Dental Anesthesia (EDA) can be used to control moderate discomfort in children during dental treatment.

EDA is a dental modification of Transcutaneous Electronic Nerve Stimulation (TENS), which is used by medical patients who suffer from chronic pain.

EDA works by increasing the pain threshold in dental patients. The mechanism for this action is not clear, but it may be explained by a combination of three theories:
the neurological "gate control", the "endorphin release", and the "serotonin release" theories.

The EDA device used by dentists is similar to the TENS device, but it has been modified to produce lower currents and higher frequencies. The EDA device sends electrical impulses to the oral tissues.

Professor of pediatric dentistry at Ohio State University, Dr. Stephen Wilson, has done research on EDA. According to Dr. Wilson, "The EDA--which produces a pulsating, tingling sensation--numbs the (oral) tissue or distracts the patient..."

The EDA device consists of a battery operated control unit, which is connected to two disposable electrical pads. The electrical pads are placed on the gum tissue of the dental patient, and the impulses from the EDA device can be controlled by either the dentist or the patient.

EDA is not useful, however, for controlling very painful stimuli associated with invasive dental procedures.

For an exhuastive bibliography on the subject, please refer to:
Electronic Dental Anesthesia.

What Is Nitrous Oxide?
Nitrous oxide is a colorless, ordorless, inert gas, which is administered to dental patients to reduce anxiety. It produces a sense of well-being and relaxation. It is always administered with oxygen.

Nitrous oxide, whose chemical formula is N₂O, was first used in England, in 1800, by Sir Humphrey Davy to control the pain associated with a wisdom tooth.

Nitrous oxide/oxygen inhalation is one of the safest sedation techniques used in dentistry today. Children stay fully conscious when the inhalation mixture is administered.

Nitrous oxide works by depressing activity in the part of the brain called the cerebrum - thus creating an altered state of awareness. It is eliminated from the body through normal breathing.

The inhalation mixture is administered via a soft nosepiece and the mixture of gases is inhaled through the nose. The nosepiece is attached by small hoses to the regulator connected to the nitrous oxide and oxygen tanks.

Inhalation sedation works best for mildly apprehensive children. It is ineffective for children who: physically resist dental treatment, have extreme situational anxiety, have nasal congestion, have cognitive impairments, or are obligate mouth breathers.

The inhalation mixture is not used in children who have: bronchitis, upper respiratory infections, a cold, earache, or multiple sclerosis.

Children receiving nitrous oxide/oxygen should eat lightly before the appointment, and should avoid consuming a full, heavy meal. This will prevent the occasional episode of nausea and vomiting during dental treatment.

Learn more about Nitrous oxide.