We do our best to ensure that the teeth treatment is comfortable for patients of any age, especially the children. In our clinic an appointment with the paediatric dentist is adapted to the age of each child.

In order to ensure painless treatment without stress, various types of anaesthesia are used in the paediatric dentistry.

Types of pain relief in the paediatric dentistry

There are several pain relief methods at our clinic’s disposal which can be used for our small patients. They can be divided into three broad groups:

• Local anaesthesia: preparations have a local effect in the oral cavity within the limits of one tooth or nerve;
• Medical sedation (laughing gas): it is not anaesthesia, but it allows for the reduction of negative psychological reactions to manipulations;
• General anaesthesia (narcosis) – the small patient falls asleep until the treatment is over.

The selection of the methodology is done individually taking into account such small patient’s data as:

• Child’s age (there are preparations which are not suitable for the use by children)
• Body weight (for the calculation of the required dose)
• Health condition (existence or non-existence of diseases that restricts the use of particular medicine as well as the allergy risk);
• Psychological features (some children are categorically against any injections);
• Type and duration of the anticipated manipulations (it is important to understand how long the effect of the anaesthesia should last).

Local anaesthesia for children

Local anaesthesia is the most popular pain relief method for children and adults. It can be divided into the types of application (on the surface) and injections.

Application anaesthesia for children in dentistry

Application anaesthesia is often used in the paediatric dentistry since it does not need injections. The essence of the technique is spreading of the anaesthetic on the gums and/or mucous membrane in the form of gel. The active substance absorbs through the upper layer of the gums and considerably lessens the sensitivity. The whole process takes no more than 5-10 minutes. These anaesthetics have pleasant smell and taste. Our physicians call it the sweet jam!

The efficiency of such anaesthesia is fully sufficient in order to perform simple manipulations: the child will not feel pain from an injection in the gums or extraction of such milk-teeth which already move heavily.

Injection anaesthesia in the paediatric dentistry

Local anaesthesia is the most widespread pain relief method in the paediatric dentistry. It is performed in several stages by combining application and an injection. The gel is spread on the gums in order to make the site of injection insensitive. Under the influence of the anaesthesia gel, insensitivity occurs within a few seconds and the dentist can move on to the second stage and inject an anaesthetic in the gums.

Small patients notice the injection anaesthesia more easily therefore the paediatric dentist has their tricks for its administration: not to show the syringe to the child, the physician tells about magic drops that make the tooth fall asleep and the like. Usually a proven interaction mechanism between the physician and the assistant is used. Play elements are certainly used switching child’s attention to other items and beneficial verbal and tactile contact is not less important.

Medical sedation (laughing gas or nitric oxide)

Nitric oxide sedation calms down children, which is important for long-lasting manipulations. For instance, a 3-year old child’s patience and quiet sitting limit is 5-7 minute but under the influence of laughing gas the child sits quietly up to 30 minutes. Whereas restless teenagers’ patience increases even up to 40-60 minutes. Respectively, the physician can treat several teeth during one visit thus reducing the number of visits.

An interesting fact! The laughing gas sedation reinforces the effect of the local anaesthesia, which allows for comfortable treatment of the small patients. The child’s nose is covered with a mask through which a mixture of oxygen and nitric is supplied; while breathing, the anaesthetic spreads throughout the body reducing the sensitivity to pain. At the same time fear from the light, noise and sounds diminishes and the small patient is fully conscious, they can answer questions and watch their favourite cartoons.

At the end of procedure pure oxygen is supplied and respectively “laughing gas” is drained immediately and without any impact on health.

“Laughing gas” effect

Depending on the peculiarities of the body, children can have various reactions. They can be sleepiness and slowed-down reaction, euphoria and feeling of happiness, absolute peace and slight lethargy.

In which cases the treatment of teeth with nitric oxide has contra-indications?

There are several factors due to which the use of laughing gas is not suitable or has contra-indications.

Firstly, they are respiratory diseases: allergic rhinitis, sinusitis, adenoiditis, including cold which is accompanied with a runny nose; chronic otitis at its acute stage.

Preparation for the treatment during which nitric oxide is used

It is not allowed to eat two hours before the procedure.

A lot of attention is paid to the psychological preparation. At home the parents can tell the child that it is interesting and funny to treat the teeth with laughing gas. At the clinic the physician will “introduce” the child with the device, will give him/her to hold the mask through which he/she will breathe and will explain that, while using this mask, the child will be able to watch cartoons.

General anaesthesia (narcosis) in the paediatric dentistry

Narcosis is artificial patient’s immersion in sleep by using appropriate preparations. The main advantage of narcosis in the paediatric dentistry is a possibility of performing a large amount of work without a psychological trauma to the baby and administration of large doses of local anaesthetics. The child does not remember the manipulations because he/she had been sleeping as of the beginning of the treatment procedure. The lack of pain during the manipulations allows for reduced stress regarding the visit to the dentist and prevents the development of phobia before going to the clinic.

The preparation for general anaesthesia is injected intravenously or inhaled through a special mask. During the treatment the child’s condition is supervised by the paediatric anaesthetist/reanimatologist. After waking up from the narcosis the child still spends several hours under physicians’ supervision until the medication is completely discharged from the body.

Indications for general anaesthesia in the paediatric dentistry:

• Children with limited physical capabilities
• Simple caries and complications for patients under the age of three
• Uncontrollable fear from the dentist
• For children who do not contact with the physician but are in need of caries treatment or immediate help from the dentist
• Patient’s tendency to faint
• Face jaw traumas
• Increased irritation of the throat – vomiting reflex
• Bronchial asthma
• Allergy against medicine;
• Very low pain threshold
• Insufficient opening of the mouth
• Chronic adenoiditis
• Cardio-vascular pathologies, namely, slight development pathologies
• Increased convulsive readiness, for instance, a brain trauma in the background, epilepsy in the medical history, etc.

The contemporary anaesthesia preparations are safe and reliable, however, there are contra-indications that restrict the use of general anaesthesia including:

• Decompensated heart disease
• Cases of renal insufficiency and liver diseases
• Diabetes mellitus at the decompensation stage
• Severe forms of rachitis;
• Right after eating

In case of increased bleeding and reduced blood clotting, prior to the anaesthesia the patient must consult with the haematologist and must provide specialised dentist’s permission for the use of this pain relief method.

Preparation for the general anaesthesia

The preparation stage includes the following procedures:

• Orthopantomogram or digital panoramic X-ray
• Examination of the oral cavity
• Drawing up a treatment plan on the basis of X-ray examination data
• Summary of the medical history using a questionnaire filled in by the parents
• Family doctor’s referral
• Consultation with the paediatric anaesthetist and paediatrician
• The required laboratory tests
• Written voluntary consent to the procedure

Prior to the anaesthesia the child must refrain from food and drink for a certain time in order to prevent the vomiting reflex. 6 hours before the anaesthesia it is not allowed to eat any food and 4 hours before the anaesthesia it is not allowed to drink any liquid.