Pediatric sedation
Pediatric sedation is a dental procedure that is rapidly becoming more common in practices around the country. Some dentists think it’s because there are more young children showing up with decay, others say it’s because we have an ADA push to get children to the dentist by their first birthday. Personally, I think both are contributing factors, but I also believe there are an increasing number of Pediatric Dentists who recommend sedation as indisputable treatment for cavities in toddler baby teeth.
It’s a fact that the US currently has an out-of-control epidemic of decay in children’s teeth, and many kids have 4 or more cavities before the age of 2. This kind of disease in young children is known as Early Childhood Caries (ECC). The Center for Disease Control (CDC) recognizes early childhood tooth decay as the #1 chronic childhood disease, affecting over 6 million American children under the age of 6. This is a shocking statistic for anyone who knows that dental disease is completely preventable and how xylitol, in a few delicious Zellie Bears, could eliminate 98% of the germs responsible for these cavities. (learn more about how to use xylitol to prevent dental disease by reading our e-booklet: Zellies Xylitol for Ultimate Oral Health)
A scary dental visit
I consult with many parents who call me in a state of desperation after a scary dental visit where numerous cavities have been diagnosed in their toddler’s tiny teeth. Everyone understands that doing traditional fillings or placing crowns on these teeth would be virtually impossible without strapping the child to the chair (which does happen in some offices). In light of this, it seems to make sense that the humane recommendation is to work under a general anesthetic in a hospital, or use in-office sedation. Most of the parents with whom I consult are distraught and ask me if there is an alternative to avoid such a serious event, and can they fix these teeth naturally?
Obviously there are cases where sedation or anesthesia is the best idea and warranted, but I believe many cases could be treated less completely, or not at all, providing the disease is stopped and preventive advice is implemented. Ozone therapy may be an option, the use of glass ionomer as a temporary cement, or simply the application of xylitol and fluoride products in a good home regimen. I advise patients that my benchmark for this is “if this were my grandchild….” In almost every case I have suggested families wait and have no treatment done, returning for evaluation in a month or two, but making every effort to postpone treatment until the child is old enough to cooperate without sedation.
No treatment – an option
In my opinion “no treatment” is a “treatment” option, but one that is rarely given to parents of these children. If damaged teeth remain untreated, it is essential that steps are taken to stop the disease (the reason for cavities) and prevent more damage (with dietary changes and the use of xylitol and fluoride products in daily care). It is true that these simple steps do not “fix” tooth damage like a filling, but they stop the progress of the cavities and allow time for the child to develop, and for the dentist to evaluate (at future appointments) the worth of treatment, and if it is even necessary.
Fortunately it’s rare for decay to cause deep internal problems in a child’s tooth before age two, and abscesses, although a concern, are quite rare. Decayed adult teeth show extensive ability to repair and re-mineralize under correct conditions, but baby enamel does not appear to regenerate in the same way. The goal of “no treatment” is to stabilize damaged teeth and prevent future damage to them or any new ones erupting into the toddler’s mouth.
What does ECC look like?
The picture of ECC that I observe is usually damaged or stained front teeth, frequently with a brownish streak, close to the gum line, across all the front incisors. Sometimes there are additional white spots or de-mineralized patches on the flat surface of these same teeth and also on the baby molars. None of these defects seem sufficiently severe to suggest 
the child needs urgent treatment under sedation, although I agree that they do need urgent preventive education. One family, waiting for a sedation appointment, showed me pictures of their child’s teeth and there was no decay at all. The damage was erosive from a habit this child developed – sucking lemon wedges. All that was needed was to stop this habit and learn about foods that protect teeth, like xylitol.
The question is really whether it is OK to leave discoloration and chipped enamel without treatment. Providing the child is not experiencing discomfort, the poor esthetics is not, in my mind, a reason to risk his or her life with anesthesia. There is no standard recommendation when to “wait” or “not treat” decay in teeth. Similarly there is no standard to gauge at what stage should you decide to risk using anesthesia. My observation is that today’s Pediatric Dentist rarely promotes the old-fashioned “wait and observe” approach. My argument is that this should be an option when it exists.
Balancing the risk
Perhaps some dentists think cavities must be treated or fixed. Some may not be aware that stopping the disease will stop the cavity. Maybe they are not familiar with xylitol and the value of effective education. It does take time to talk with families about how/why this happened. On the other hand, this is a serious subject and pediatric deaths under sedation are on the rise according to several sources. Here is an article that was published in 2012: http://www.huffingtonpost.com/2012/07/13/dental-sedation-child-deaths_n_1671604.html
In most cases I find these families are very health conscious, eat a sensible diet and provide great care for their children. These are educated parents and often moms who have breastfed in excess of a year. Experiencing such a “dental failure” often leaves them confused and dismayed. In some cases the dentists have put icing on their “misery-cake” by blaming them for night nursing or inadequately flossing their toddler’s teeth. Both accusations are wrong and not based on any science, and should stop.
Risks of breastfeeding
Old breastfeeding studies were inaccurate and of very poor quality with vague definitions that confused (and even reversed) results, in some instances transposing the data for formula milk with human milk. The only worthwhile studies did not take the “disease process” into consideration, nor did it document dietary habits or other possible influences (called confounding factors). The message is that no studies indicate extended breastfeeding or night nursing is a problem. On the other hand it is very wise to eliminate cavity bacteria from your mouth during pregnancy and begin caring for your baby’s teeth (wiping them with a solution of xylitol) as soon as teeth erupt.
I will try to expand this subject in future blog articles but if inaccurate advice on breastfeeding has been given to you or someone in your family – please print the PDF of the JADA article (linked below) and highlight the last complete paragraph in the first column on page 148. You can deliver or mail it to the office with a note about how they can also purchase my book, The Power of Xylitol from our website!
http://jada.ada.org/content/144/2/143
http://jada.ada.org/content/144/2/143.full.pdf+html
Below is a link to detailed article about sedation and anesthesia, which provides a history of sedation in dental and medical offices. If you are contemplating sedating your child, this may be something you want to read for a more complete overview.
http://www.anesthesia-analgesia.org/content/99/5/1355.full
Learn More:
What To Do If Your Child Has ECC?
What Moms Need to Know About Oral Health
A Testimonial Letter from a Grandmother (and Her Follow-Up Letter!)
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Hi!
My son is 3 1/2 years old and we just found out he has small cavities between his 2 top teeth. I guess it spread. First thing the dentist said was a filling wouldn’t hold there, so she recommended oral sedation [of course] and then 2 caps. This was extremely upsetting. I asked for other options and she mentioned the silver diamone floride but said it would stain his teeth black. Plus she said its only to help until he is old enough to do the work. Research showed that his tongue and gums can’t be exposed to this and they have to be padded with gauze? This was scary, plus I doubt he would allow any of that to happen.
My older daughter had bad reactions to oral sedation so we want to avoid this..even if this means letting his teeth rot.. I know it sounds awful, but I think that is better than risking death. Of course we don’t actually want his teeth to rot so I have been researching how to heal them naturally. What are your thoughts on cold liver oil and butter oil? I am worried because our family has shellfish allergies among others..so I *always* worry about allergic reactions. How much xylitol a day for my son? And is using xylitol toothpaste, candy, and gum too much?
Thank you so much for taking the time to read and answer this.
I would never suggest sedation for a couple of small cavities. The most important thing is for you and your family to understand that cavities are a family problem. Xylitol is an amazing ally for you. Learn as much as you can about xylitol for children’s teeth and try to find a dentist who believes in xylitol. My suggestions are currently found in my book Kiss Your Dentist Goodbye or on my website http://www.DrEllie.com – check out all you can and learn, learn, learn how xylitol can help you!
Thank you for replying! I have implemented your suggestions and use act on his toothbrush and then crest kids anticavity and apply that daily on the spot. I do this after brushing his teeth with xyitol. I also give him about 6 of your zellie mints everyday. I am trying to improve his diet, but he is VERY picky. We have cut down on sweets significantly. It has been almost two weeks and I took a picture of his teeth, I have a before one too. I would love it if you would look at them and tell me if you notice any changes. It looks better to me, but I don’t want it to be wishful thinking. I can’t upload it here, is there any way to send the photos? Thank you so much!!
Hello, my daughter is 16 months and has cavities on her top molars. She has dairy & soy allergies and many food intolerances. We avoided fluoridated water until she was 13 months and she’s night nursing. The pediatric dentist recommended silver diamine fluoride but I’m torn about pursuing this option to treat her cavities because it will stain her molars black. I bought xylitol from your website and crest cavity protection toothpaste (xylitol should arrive this week). Would your dental care plan be enough to protect her teeth? Should I proceed with the silver diamine fluoride treatment?
Hi Megan, I’d suggest you use Crest and xylitol for an allocated period of time (maybe 4-6 weeks). Perhaps take before and after photos to help you decide if you think her mouth is getting healthier. You may also want to discuss the situation again with your dentist.
If you believe there have been positive changes – then delay and keep working – maybe increasing the xylitol frequency. If there is not much change – then SDF may be something to consider.
Is your daughter being monitored for vitamin D? Does she take digestive probiotics?
I just took by 2-year old twins to the dentist yesterday for the first time. One of them has cavities on two front teeth. The dentist immediately said that he would need to be fully sedated and have the cavities filled and what not. I came back home a mess and started Googling. Found your products and website and ordered a bunch of items. I am going to try xylitol for a while and see how it goes. I am so hopeful that the cavities will go away and my tiny tot will not need to be sedated. I don’t mind the procedure as such but administering anesthesia on a 2 year old just petrifies me.
You should apply a little Crest Cavity Protection toothpaste to these cavities as well as wiping the teeth often with xylitol. For a two year old, you can dip a baby toothbrush in xylitol crystals – and let him suck the sweet xylitol off the brush at the end of meals. Also try to ensure you cut down on any juice and try to give a little xylitol after any juice or sugary drinks. If the dentist continues to talk about fixing these – check into silver diamine fluoride – there is a lot of information about this now – and the old products used to turn the teeth black – but I am told they can prevent this now.
My daughter just turned 2 on January 3. We went to the dentist and was told she needed her lip tie cut and also that two of her front teeth are decaying and will need two caps put on. Also that from sucking in her nuk side ways the cap should help straighten everything out so that her adult tooth will come in better. Worried about her going under also worried about for she will be with two caps put on. We aren’t sure what to do at this point.
Many parents come to me with this concern because children do die under general anesthesia – it’s a fact.
My book, Kiss Your Dentist Goodbye, was dedicated to a child who died having her teeth cleaned under sedation. If her family had known and used xylitol and a better home-care program I believe this would never have happened and beautiful Raven Blanco would be here today.
Many dentists give only one option – but you need to think what is the worst that will happen if you start a preventive program today and do NOT have this treatment done?
Lip ties are NOT the reason for decay – cavity bacteria cause cavities. Xylitol gets rid of cavity causing bacteria.
You will need to aggressively use xylitol and a tiny amount of Crest Cavity protection paste wiped on these teeth twice daily to clean them.
Keep juice to mealtimes and use xylitol during the day. Try to get your daughter to drink water with xylitol in it during the day if she uses a sip-cup or bottle. Why not wait a few months. Take pictures to ensure the teeth are not getting worse – but getting stronger-looking.
I’d search for an older Pediatric or family dentist who does not work for any “Big-Box” dental company.
You do have options. Another one is silver diamine fluoride – which is controversial but something to consider. Here is a link. Let me know if you need more help. LINK
Hi Michelle, Did you do the surgery and lip tie? Everyone I know is being told they need this done these days. As a pediatric dentist for decades – I think I only ever recommended two lip tie surgeries in my entire career. If you are using xylitol to wipe and clean the teeth – stagnation in this area is not a bad thing – and decay will not happen.
Hi Dr. Ellie,
I wonder if you have personally noticed any correlation between upper lip tie and dental carries? Is this something dentists usually consider?
Thank you for your informative article!
The science does not support that there is any additional risk from having a lip ties – provided you have a healthy mouth.
Many people have lip ties – and this is a neat laser treatment that “seems” to make sense and brings income to pay for expensive lasers!
If you have no cavity bacteria – you cannot get caries/decay….with or without a lip tie.
A lip tie can make cleaning this area more difficult….but not impossible….
Convenience for cleaning, or aesthetics, is the ONLY reason I would condone the use of this surgery.It is not painful and may help – but don’t spend your life savings to get this done. Instead invest in Zellie’s or xylitol to eliminate harmful bacteria that cause cavities!
Remember, there are many people without lip ties who GET cavities …..and many people WITH lip ties who don’t!
Hi.
My daughter just turned 1 on oct 30,2015.she been going to the dentist since she was 4 months. She had 6 teeth when she was 6 months. She never had juices only breastfeeding. In sep she saw dentist then in October I saw a brown dot. I took her and they said she has cavities on all four upper teeth.
Now the procedure the are going to do on her is first (laughing gas then numb the area, then sedation (versed).
I am so nervous she is so tiny only 19 Lbs.
I cancelled one oppiontment already but made another one but still I am very scared of outcome.
This is not good.
I personally can only tell you what I would say if I was your mother.
I would start immediately using granular xylitol to wipe onto these teeth every day – as often as you can.
You can also use a tiny amount of Crest Cavity Protection toothpaste – the original paste (found in Walmart at about $1.95 a tube). Rub this on the brown dots every day.
If you can send me a photo from your phone – please use my email ellie@zellies.com and I will take a look. If you want to include your phone number – maybe we can discuss when I see these “dots”. I would advise you to wait – but ask your dental office to explain to you “how urgent” is this…..and ask them “can it wait”……I would be interested in the response.
Hi. My daughter had the.same thing however I could not stop it from.growing irrespective of what I did cos she is a picky eater and I could not keep a persistent diet for her. What helped her was green pastures fermented cod liver oil.which I found very late as it was not available here and it slowed it down. It started growing her enamel.back but then I ran out of it and wasn’t able to get more. Putting your child through this trauma is always scary and I went against it. Only if I found the Fermented cod liver oil on time. Use the one with butter oil which you can Google and get more informed about. I am not a dentist but a mother who went thru the same thing.
Hi, my little grandson who is 3 has been using your xylitol products and also the crest toothpaste and act rinse now for about 4 or 5 months. His top front 4 teeth were really bad breaking off and everything when he started on them. And unfortunatly they have got rel bad decayed down to his gums. We took him to an oral surgeon today,not wanting to do it at all, but he is so scared the medicine they gave him wouldnt relax him enough to take them out. So now they just want to put him in the hospita and remove them. This is something his mother and I are so worried about. Our question to you is,what do you think could happen to him or even his permanent teeth if she just waits and lets them go? They actually dont even hurt him. Is there any hope of them coming out on their on or maybe his permanant teeth pushing them out? Or will it cause damage to them or not even come in correctly. We need your advice desparetly!!! Thank You
Hi .. My daughter has the same problem since she was 1.5 yrs old.. The only thing that stopped her tooth from decaying further is cod liver oil and bone broth every single day. The help to regenerate teeth. Best choice for cod liver is green pastures. however as it is not available here so we are using scotts with orange flavor.
Hope this helps…
Thank you, we will be sure and check into this.
Hi I have been trying to maintain good oral hygiene for my toddler since i noticed that her front upper teeth have signs of decay. we brush twice a day and wipe with xylitol wipes before going to bed.
But I am extremley worried regarding her oral health .. she is a very picky eater. However is still being breastfed… I dont know what to do.. A good dentist is hard to get appointment with..
Can you suggest something. I could send you a photo of her teeth for you to have a look..
I have lost sleep over it..
Xylitol is helpful to prevent tooth problems – and xylitol wipes are good. When you have cavity problems it is good to increase the amount of xylitol by adding a few Zellie Polar Bears to your xylitol wipe routine. A Polar Bear is a great ending for meals, and will help to protect teeth from juice drinks or any sugary or acidic snacks. You may also want to eat some yourself, to ensure that you are not infecting your daughter with cavity bacteria from your own mouth.
Increasing the amount and frequency of xylitol is good. Hard cheese is tooth-protective -and so is whole-milk dairy ( if your daughter likes yogurt or Kafir).My other suggestion is to wipe the damaged teeth twice a day with a rice-grain amount of Crest Cavity Protection toothpaste. This toothpaste contains silica and ingredients that can help rebuild and strengthen teeth. Regular use of Zellies Polar Bears and this kind of Crest paste, will improve the condition of your daughter’s teeth. You should keep a photo journal of them, so that you watch and see if they are improving. You should begin to see results in 6-8 weeks. I’d be happy to take a look at your photos, but I would especially like to see your progress after a few weeks. You can email these to me at ellie@zellies.com
I hope you can avoid fillings and keep your daughter’s teeth safe, so that you feel comfortable and continue to breastfeed. You can help your child more than a dentist at this time.I’d be happy to try and connect you with a dentist that will guide you – but many want to fill cavities – which may not be necessary.
Hi,
My son has signs of ECC like on the second picture you have up on your site. I am super worried about him. I scheduled our first appointment to see the dentist in like 2 days. I can’t sleep or do anything I am so worried about his teeth. I use to put him to sleep with his bottle but the herbal teas I made for him were never to sweet and I rarely would give him juice(he never wanted to drink milk after I stopped breastfeeding so herbal teas for kids was my only option). My son just turned 2. I don’t know what the dentist will tell us, but I know for sure that my son will not cooperate with him. He even wouldn’t let me peak into his mouth. I am so worried about our coming appointment and what will dentist tell us. I really don’t want to put him through sedation. But I do understand that his teeth need to get fixed. Is it even safe for 2 year old to get sedation. I don’t know what should we do.
Hi worried Mom!
The first thing you need to do is breathe, sit down, and have a cup of tea – yourself!
The great news is that you already know your son has a problem with his teeth – sadly many Moms first discover this at the dentist. Now you can prepare yourself in advance of this visit – so congratulations!
Go to this visit empowered – you have options – and you need to know them. The only option that makes sense to many dentists is to sedate and fill baby teeth like this, but it is NOT the only safe or acceptable choice. Yes, it is common practice for dentists to suggest fillings for baby teeth, because it is the treatment that makes them feel as if they have done their job. Many dentists are worried about leaving you to take care of these teeth – but if you want to – you should have that choice.
I suggest that your entire extended family get on a xylitol program ( and I will link you to our new booklet – which explains the important things you need to know about xylitol). I also suggest you try to wipe these teeth at least twice a day with a tiny ( rice-grain) amount of Crest Cavity Protection paste on a cloth or brush – and if the taste is too spicy – mask it with a drop of bubblegum ACT rinse over the top. The choice of paste is of vital importance – there appears to be no other paste that works like this one – plain, original Crest.
Your goal is to stop the progression of disease – to stop ( arrest) the decay. If you do this, you can afford to wait and see. Ask your dentist if he or she is prepared to check these teeth with you – and assist you. Take photos when you can – keep them and compare photos as time passes. Let me know if you have any other questions – but I would definitely try to avoid sedation. Other options to consider when you have co-operation from your son as he grows, would be the application of a fluoride varnish and the use of ozone therapy.
Here is the link to the booklet: “Zellies Xylitol Guidebook”
Thank you so much for calming me down a little bit. The link is missing but I am very interested in trying out the xylitol program. Please post me the link again. Thank you very much. I am going to talk with pediatric dentist and see if we can avoid fillings for now.
Hi Dr. Ellie,
First off, I want to thank you so much for your wonderful system. I bought your book and my husband and I both use it daily. Actually, 2.5 years ago, my dentist told me that I had 4 cavities – 3 that needed filling and 1 that just needed monitoring. I started using your system immediately after I heard that. Since then, I’ve gone through a pregnancy, which has always wreaked havoc on my teeth. After my pregnancy, I went to the dentist to get my cavities checked again and all 4 cavities were GONE! I couldn’t believe it. My husband has also had a lifetime of bad teeth and the last 2 visits to the dentist were the only 2 visits in his life that he’s ever been complimented on his teeth AND come home cavity-free!
Now my question is about children. I have a 1 year old, a 3 year old and a 5 year old. They rarely drink any juice and after any juice or snack, they always have xylitol gum. I brush them morning and evening with a drop of the ACT Fluoride for Kids. When I went to the dentist with the older two, both of them had cavities. The younger one they would monitor but my older one needs a filling. There is a black spot in the molar where they found the cavity in the older one. I also have 2 x-rays from them. Can you tell me what I’m doing wrong with them and what I can do to prevent more cavities?
I am so happy to hear about your success – congratulations!
You could certainly add a rice-grain amount of Crest toothpaste under the drop of ACT to enhance it’s effect – providing your kids tolerate the taste. Crest has “ingredients” that are an added benefit for cavity repair.
Xylitol is really our best defense against kids’ cavities. Studies show the protective effects of xylitol are dependent on the daily dose – this means more improvement with more frequency.Strive for 5 exposures to xylitol each day – and after meals and snacks is the best time.
Also, try to calculate the total dosage of xylitol in the gum that you are using – aim for 6.5 grams as a minimum. East piece of Zellies gum has 1 gram of xylitol in it ( we made it easy for calculations!!). If you are using other brands you may want to check the true amount in each piece. Even if the nutrition label on the gum says “1 gram” this may not be the true amount – because regulations allow manufacturers to “round up” to the nearest gram. This means that 0.7 grams of xylitol will show as 1 gram on a nutrition label.
I also recommend avoiding gum that contains glycerin ( or any artificial sweeteners like sorbitol etc) because these appears to suppress the benefits of xylitol. Pure 100 percent xylitol is what you want. Zellies Polar Bears contain 1.3 grams of xylitol in each bear – which means that 5 Zellies Polar Bears each day will provide 6.5 grams of the finest European xylitol! Of course, if your kids like gum – you can mix and match to suit your lifestyle.
I hope this information helps. It sounds to me that your kids may not be getting enough xylitol or that the xylitol is possibly mixed with other ingredients that are not working to help you. Please check back and let us know how things progress in the future! We love success stories to share!
Hi I just recently noticed that my 22 month old has signs of early tooth decay on almost everyone of his teeth. They have the white line across them where the tooth meet the gum line. We immediately took him to see a dentist who told us to cut out juice and certain snacks. My son had horrible reflux and we did put him to sleep with his bottle before naps and bed just so he could keep his formula down and I’m sure that has a lot to do with this issue. I have spent days researching how to help prevent these areas from turning into actual cavities and it has lead me to you in hopes that you can shine some light on the best approach to take care of his teeth from here on out. He thankfully does not have any cavities yet and I really would like to keep it that way!
Can you give me some guidance on how to take proper care of his teeth. I keep getting mixed information on what toothpaste to use. I bought another brand of xylitol mints and they are a little too hard for him and do not dissolve quickly. Do you have any suggestions on how to take care of my nine month old teeth as well?
Keeping juice to mealtimes is definitely the first thing on a list of changes to stop white (demineralized) areas turning into cavities. Although there’s concern when young children consume toothpaste, I suggest these teeth will benefit from a rice-grain size amount of Crest Cavity Protection paste wiped over them. Crest provides “ingredients” to help strengthen damaged areas. I believe it’s important to avoid toothpaste with glycerin, since this may stop the strengthening process.
If a child will not tolerate the taste of toothpaste, either mask the taste with a drop of bubblegum ACT, or simply use the ACT rinse in place of toothpaste – brushed over teeth. This will not be quite as effective, but it will provide dilute fluoride to help these areas. ZellieBears are a wonderful product to help ensure children are getting xylitol each day. One Polar Bear has 1.3 grams of the finest xylitol and the texture is soft – designed with this age-group in mind. Besides helping your children’s teeth – xylitol appears to help with acid reflux. You may want to put a quarter teaspoon of xylitol in water for a bottle used before naps or sleep.
I was concerned about this article. A baby starts craving lemons, one fruit that some find effective to treat dry mouth, enough to cause decay. Dry mouth is a sign of diabetes, sjoegren’s and probably more than I know of. I know of dentists who have been able to diagnose childen with serious illness by abnormalities like this. Xylitol is used to help significant dry mouth syndrome. I know I am connecting the dots without full information about the child, just wanted more critical thinking presented about potential general health issues.
Thank you for your message – and yes, you are correct – when a child craves lemons or citrus to such a degree that teeth are damaged – it may be very wise for the parents to think about possible systemic connections – at least to consider why this may be happening. You have a great point – and thank you for your thoughts, your interest and for trying to “connect the dots!”