Pediatric Sedation & Early Childhood Caries

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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For more information on oral health and xylitol, please visit all of Dr. Ellie’s web-sites:

Zellies.com – learn more & order your Zellies Xylitol & the Complete Mouth Care System
Dr. Ellie.com – a great resource for learning more about oral health & Dr. Ellie
Dr. E Oral Health Coaching – articles, resources and videos to help you learn more

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