Nitrous Oxide
Conscious Sedation
Outpatient General Anesthesia
Care of the Mouth After Extractions
Orthodontic Care

Nitrous Oxide

Some children are given nitrous oxide/oxygen, or what you may know as laughing gas, to relax them for their dental treatment. Nitrous oxide/oxygen is a blend of two gases, oxygen and nitrous oxide. Nitrous oxide/oxygen is given through a small breathing mask which is placed over the child’s nose, allowing them to relax, but without putting them to sleep. The American Academy of Pediatric Dentistry, recognizes this technique as a very safe, effective technique to use for treating children’s dental needs. The gas is mild, easily taken, then with normal breathing, it is quickly eliminated from the body. It is non-addictive. While inhaling nitrous oxide/oxygen, your child remains fully conscious and keeps all natural reflexes.

Prior to your appointment:

• Please inform us of any change to your child’s health and/or medical condition.
• Tell us about any respiratory condition that makes breathing through the nose difficult for your child. It may limit the effectiveness of the nitrous oxide/oxygen.
• Let us know if your child is taking any medication on the day of the appointment.

Conscious Sedation

Conscious Sedation is recommended for apprehensive children, very young children, and children with special needs. It is used to calm your child and to reduce the anxiety or discomfort associated with dental treatments. Your child may be quite drowsy, and may even fall asleep, but they will not become unconscious.

There are a variety of different medications, which can be used for conscious sedation. The doctor will prescribe the medication best suited for your child’s overall health and dental treatment recommendations. We will be happy to answer any questions you might have concerning the specific drugs we plan to give to your child.

Prior to your appointment:

• Please notify us of any change in your child’s health and/or medical condition. Do not bring your child for treatment with a fever, ear infection or cold. Should your child become ill, contact us to see if it is necessary to postpone the appointment.
• You must tell the doctor of any drugs that your child is currently taking and any drug reactions and/or change in medical history.
• Please dress your child in loose fitting, comfortable clothing.
• Please make sure that your child goes to the bathroom immediately prior to arriving at the office.
• Your child should not have solid food for at least 6 hours prior to their sedation appointment and only clear liquids for up to 4 hours before the appointment.
• The child's parent or legal guardian must remain at the office during the complete procedure.
• Please watch your child closely while the medication is taking effect. Hold them in your lap or keep close to you. Do not et them "run around."
• Your child will act drowsy and may become slightly excited at first.

After the sedation appointment:

• Your child will be drowsy and will need to be monitored very closely. Keep your child away from areas of potential harm.
• If your child wants to sleep, place them on their side with their chin up. Wake your child every hour and encourage them to have something to drink in order to prevent dehydration. At first it is best to give your child sips of clear liquids to prevent nausea. The first meal should be light and easily digestible.
• If your child vomits, help them bend over and turn their head to the side to insure that they do not inhale the vomit.
• Because we use local anesthetic to numb your child’s mouth during the procedure, your child may have the tendency to bite or chew their lips, cheeks, and/or tongue and/or rub and scratch their face after treatment. Please observe your child carefully to prevent any injury to these areas.
• Please call our office for any questions or concerns that you might have.

Outpatient General Anesthesia

Outpatient General Anesthesia is recommended for apprehensive children, very young children, and children with special needs that would not work well under conscious sedation or I.V. sedation. General anesthesia renders your child completely asleep. This would be the same as if he/she was having their tonsils removed, ear tubes, or hernia repaired. This is performed in a hospital or outpatient setting only. While the assumed risks are greater than that of other treatment options, if this is suggested for your child, the benefits of treatment this way have been deemed to outweigh the risks. Most pediatric medical literature places the risk of a serious reaction in the range of 1 in 25,000 to 1 in 200,000, far better than the assumed risk of even driving a car daily. The inherent risks if this is not chosen are multiple appointments, potential for physical restraint to complete treatment and possible emotional and/or physical injury to your child in order to complete their dental treatment. The risks of NO treatment include tooth pain, infection, swelling, the spread of new decay, damage to their developing adult teeth and possible life threatening hospitalization from a dental infection.

Prior to your appointment:

• Please notify us of any change in your child’s health. Do not bring your child for treatment with a fever, ear infection or cold. Should your child become ill, contact us to see if it is necessary to postpone the appointment.
• You must tell the doctor of any drugs that your child is currently taking and any drug reactions and/or change in medical history.
• Please dress your child in loose fitting, comfortable clothing.
• Your child should not have milk or solid food after midnight prior to the scheduled procedure and clear liquids ONLY (water, apple juice, Gatorade) for up to 6 hours prior to the appointment.
• The child’s parent or legal guardian must remain at the hospital or surgical site waiting room during the complete procedure.

After the appointment:

• Your child will be drowsy and will need to be monitored very closely. Keep your child away from areas of potential harm.
• If your child wants to sleep, place them on their side with their chin up. Wake your child every hour and encourage them to have something to drink in order to prevent dehydration. At first it is best to give your child sips of clear liquids to prevent nausea. The first meal should be light and easily digestible.
• If your child vomits, help them bend over and turn their head to the side to insure that they do not inhale the vomit.
• Prior to leaving the hospital/outpatient center, you will be given a detailed list of "Post-Op Instructions" and an emergency contact number if needed.

Care of the Mouth after Extractions

• Do not scratch , chew, suck, or rub the lips, tongue, or cheek while they feel numb or asleep.  The child should be watched closely so he/she does not injure his/her lip, tongue, or cheek before the anesthesia wears off. 

• Do not rinse the mouth for several hours.

• Do not spit excessively.

• Do not drink a carbonated beverage (Coke, Sprite, etc.) for the remainder of the day.

• Do not drink through a straw.

• Keep fingers and tongue away from the extraction area.

Bleeding - Some bleeding is to be expected.  If unusual or sustained bleeding occurs, place cotton gauze firmly over the extraction area and bite down or hold in place for fifteen minutes.  This can also be accomplished with a tea bag.  Repeat if necessary.

• Maintain a soft diet for a day or two, or until the child feels comfortable eating normally again.

• Avoid strenuous exercise or physical activity for several hours after the extraction.

Pain - For discomfort use Children's Tylenol, Advil, or Motrin as directed for the age of the child.  If a medicine was prescribed, then follow the directions on the bottle.

Please do not hesitate to contact the office if there are any questions.

Orthodontic Care

---

Braces Care / Appliance Care / Elastics Care / Proper Diet

Braces Care

You will be shown the proper care of your braces when your orthodontic treatment begins. Proper cleansing of your mouth is necessary every time you eat. Teeth with braces are harder to clean, and trap food very easily. If food is left lodged on the brackets and wires, it can cause unsightly etching of the enamel on your teeth. Your most important job is to keep your mouth clean. If food is allowed to collect, the symptoms of gum disease will show in your mouth. The gums will swell and bleed and the pressure from the disease will slow down tooth movement.

BRUSHING: You should brush your teeth 4-5 times per day.

1. Brush back and forth across……between the wires and gums on the upper and lower to loosen any food particles.
2. Next, brush correctly as if you had no brackets or appliances on.
3. Start on the outside of the uppers with the bristles at a 45 degree angle toward the gum and scrub with a circular motion two or three teeth at a time using ten strokes, then move on.
4. Next, do the same on the inner surface of the upper teeth.
5. Then, go to the lower teeth and repeat steps 1 & 2.

Look in a mirror to see if you have missed any places. Your teeth, brackets and wires should be free of any food particles and plaque.

Note: If your gums bleed when brushing, do not avoid brushing, but rather continue stimulating the area with the bristles. Be sure to angle your toothbrush so that the area under your gum line is cleaned. After 3 or 4 days of proper brushing, the bleeding should stop and your gums should be healthy again.

FLOSSING: Use a special floss threader to floss with your braces on. Be sure to floss at least once per day.

FLUORIDE RINSE OR GEL: May be recommended for preventive measures.

Appliance Care

Clean the retainer by brushing with toothpaste. If you are wearing a lower fixed retainer be extra careful to brush the wire and the inside of the lower teeth. Always bring your retainer to each appointment. Avoid flipping the retainer with your tongue, this can cause damage to your teeth. Place the retainer in the plastic case when it is re-moved from your mouth. Never wrap the retainer in a paper napkin or tissue, someone may throw it away. Don't put it in your pocket or you may break or lose it. Excessive heat will warp and ruin the retainer.

Elastics Care

If elastics (rubber bands) are worn intermittently, they will continually "shock" the teeth and cause more soreness. Sore teeth between appointments usually indicate improper wear of headgear or elastics or inadequate hygiene. Wear your elastics correctly, attaching them as you were told. Wear elastics all the time, unless otherwise directed. Take your elastics off while brushing. Change elastics as directed, usually once or twice a day.

Proper Diet