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Pediatric  Dental   Health

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General Anesthesia For Pediatric Dental Patients
Children may receive dental treatment in conjunction with general anesthesia. An anesthesiologist can provide general anesthesia, while a pediatric dentist provides dental treatment. This may be done in either a hospital or dental office.

Dentists were the first to demonstrate the usefulness of anesthesia. In 1844, a dentist named Horace Wells had a tooth extracted while breathing nitrous oxide to control pain. Later, a dentist named William T. G. Morton used ether vapor while performing a difficult extraction on a patient.

General anesthesia is defined as a controlled state of unconsciousness, accompanied by a partial or complete loss of protective reflexes, including the inability to independently maintain an open airway, and respond purposefully to physical stimulation or verbal commands.

An adequate preoperative evaluation is the most important part of the general anesthesia process.
Some of the major components of the evaluation include:
1. A thorough review of the child's medical history.
2. A complete physical examination.
3. A review of systems. This means evaluating each of the child's functional systems, such as the: cardiopulmonary, airway, hematologic, central nervous, renal, hepatic, gastrointestinal, endocrine, and metabolic systems.
4. Knowledge of the child's current medications and allergies.
5. Knowledge of the child's previous anesthetic experiences. 6. Diagnostic lab tests and additional consultations.

Adequate monitoring during general anesthesia is essential to ensure that the appropriate level of anesthesia is administered, as well to detect any developing complications.

The anesthesiologist must be able to recognize and treat airway and other complications quickly and appropriately. A thorough knowledge of the pharmacology of the drugs being administered is vital. Emergency drugs and equipment must be available, on site, at all times.

A recent article reviews the topic of general anesthesia:
Saxen M, Wilson S, Paravecchio R:
Anesthesia for Pediatric Dentistry.
Dental Clinics of North America. Vol 43, Number 2, 231-45, 1999

A recent journal article has found a causal link between the use of halothane anesthesia and ventricular arrythmias during outpatient anesthesia:
Blayney MR, Malins AF, Cooper GM:
Cardiac arrythmias in children during outpatient general anesthesia for dentistry: a prospective randomised trial.
Lancet. Vol 354, Number 9193, 27 Nov 1999

Learn more about Anesthesia.

When Do Teeth Come In And Fall Out?
Eruption and exfoliation schedules are not the same for each child, and depend on prenatal, natal, and postnatal factors.

The following eruption and exfoliation tables are based on material presented in:
Proffit WR, Fields HW: Contemporary Orthodontics.
St. Louis, 2000, Mosby,Inc.

Eruption of baby teeth
  Upper Lower
Central incisors 6-8 months 5-7 months
Lateral incisors 8-11 months 7-10 months
Cuspids 16-20 months 16-20 months
First molars 10-16 months 10-16 months
Second molars 20-30 months 20-30 months

Shedding of baby teeth
  Upper Lower
Central incisors 7-8 years 6-7 years
Lateral incisors 8-9 years 7-8 years
Cuspids 11-12 years 9-11 years
First molars 10-11 years 10-12 years
Second molars 10-12 years 11-13 years

Eruption of permanent teeth
  Upper Lower
Central incisors 7-8 years 6-7 years
Lateral incisors 8-9 years 7-8 years
Cuspids 11-12 years 9-11 years
First premolars 10-11 years 10-12-years
Second premolars 10-12 years 11-13 years
First molars 6-7 years 6-7 years
Second molars 12-13 years 12-13 years

Why Would A Young Child Need A Root Canal?
A young child may need root canal treatment in order to "maintain the vitality of the pulp of a tooth affected or infected by caries, traumatic injury, or other causes," according to the American Academy of Pediatric Dentistry.

Keeping baby teeth healthy is an important part of: preserving space in the dental arch, preserving biting and chewing power, maintaining facial beauty, preventing tongue habits, and helping with speech. Root canal treatment is also called dental pulp therapy.

Two common forms of pulp therapy for young children are the pulpotomy, and the pulpectomy.

The pulpotomy procedure preserves the vitality of the pulp within the root. The dental pulp contains the nerve tissue, blood vessels, and reparative cells of the root. Pulp therapy is usually performed "under a rubber dam," which isolates the tooth from the oral cavity during treatment. In a pulpotomy, the diseased pulp tissue within the crown portion of the tooth is removed, while the healthy tissue inside of the root is left alone. The space inside of the treated crown is then filled with a healing agent, and a stainless steel cap is usually placed over the tooth.

Another form of pulp therapy is the pulpectomy. A pulpectomy is needed when inflammation, infection, or degenerative changes have progressed into the root canal portion of a tooth. In this procedure, the diseased tissue is completely removed from the inside of the crown and root. The root canals are cleansed, enlarged, disinfected, and filled with a resorbable material. A stainless steel cap is usually placed over the tooth.

Parents should know that neither dental radiographs nor the absence of pain will always predict the need for pulp therapy. An x-ray does not provide a three-dimensional representation of the "soft" pulp tissue. Rather, it gives an imperfect, two-dimensional representation of the hard components of the tooth, such as enamel, dentin, and cementum. The absence of pain cannot be used to determine the health of a tooth, since disease may be present without any history of pain.

A journal article provides additional information on pulp therapy techniques:
Primosch RE, Glomb TA, Terrell RG: Primary tooth pulp therapy as taught in predoctoral pediatric dental programs in the United States.
Pediatric Dentistry 19:118-122, 1997.

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