By: J. Shahangian, DDS, MS- San Diego Board Certified Pediatric Dentist
Numbing Your Mouth
I will use an anesthetic to numb your child’s mouth to pull out a tooth, or to take out a cavity.
I will rub a cotton ball dipped in a “local anesthetic” on your child’s gums on the area where I will be operating. The local anesthetic will numb the surface of the mouth and gums. Sometimes, I may need to apply more local anesthesia, and may have to give your child a small injection of more powerful medicine to really numb the area of the mouth. The shot may sting a little, but it is only because the local anesthetic that was rubbed on.
The more powerful anesthetic is called Lidocaine or Novocain. I may inject this anesthetic with a very fine needle. In about two minutes, your child’s mouth will feel slightly tingly, and eventually will go numb. Your child may experience a feeling of having a swollen or fat lip and mouth, but this is just a side effect of the anesthetic.
The rapid advancements in dentistry have almost made pain a thing of the past.
Powerful anesthetics alleviate patients of discomfort during the dental procedures and also post-operation.
Dosages of anesthetics vary from person to person, with some people requiring higher doses than others.
List of pain-killing medications:
- Analgesics – These pain killers are the common over the counter medications such as aspirin and ibuprofen. Analgesics are prescribed after tooth extractions or root canals because they alleviate mild pain and discomfort.
- Anesthetics – Anesthetics are used to numb the area where I will operate. There are two main types of anesthetics: topical or injected. Topical anesthetics are dipped in a cotton swab and are placed on the area where I will operate. I usually use topical anesthetics. I may also inject an anesthetic such as Lidocaine or Novocain. The injections numb the nerves and prevent the nerves from sending pain signals to the brain.
- Sedatives – Sedatives are powerful relaxants that block pain. There are two main types of sedatives. One type of sedation is using nitrous oxide which is commonly known as laughing gas. During this type of sedation, the patient is awake and alert. On the other hand, the second type of anesthesia places the patient in a state of unconsciousness. The patient is monitored during this time
Types of sedatives include:
- Inhalation is a type of sedation where a mask is placed over the face (such as nitrous oxide)
- Intravenous (IV) sedation is a type of sedation where a small needle gives the patient a tranquilizer. The patient is awake during this type of sedation.
Here is a quick list for alleviation oral pain
- Do not sleep on your back
- Use ice pack on the site of pain
- Do not eat candy and avoid ice
Here is a quick list of tools for pain management:
- Analgesics such as ibuprofen and aspirin
- Anesthetics such as Lidocaine and Novocain
- Sedation which can mean “conscious sedation” or deep sedation (also known as general sedation)
I may prescribe medications to prevent infection or to alleviate discomfort and pain after an operation. I may do this for more invasive procedures such as oral surgery or teeth extractions.
It is important to share your child’s medical history because some of the medications that I prescribe could conflict with medications that your child may be taking.
Lastly, make sure to carefully follow all the instructions for the medications that I prescribe. Even if your child is feeling better, finish all of the instructed medication.
It’s never easy making the decision to have your child sedated for a procedure. It’s important that parents do their homework in advance and develop a comfort level with their child’s provider. I’ve seen it time and time again when a parent has “decided not to decide” and typically caries continue to progress, requiring more invasive procedures. If developing that comfort level means getting a second opinion, then more power to you. Parents frequently approach our office asking “what are my options with sedation?” Here are the more common routes of anxiolytics and sedation.
1- Nitrous Oxide:
Also called laughing gas. This method is mostly useful for the older child who has some minimal anxiety and will be able to be coached through the procedure. The child MUST be calm enough to breathe through her/his nose. If not, the dentist will get more of the gas than your child. This procedure is known for its safety (only commonly reported issue is possible nausea).
2- Conscious Sedation:
This is also referred to as Oral Sedation. Here, the child is given an oral dose (or in rare occasions may be given as a nasal spray) of one or more sedative drugs. There are many different medications and combinations of medications that your doctor may use based on the degree of sedation required and the child’s weight. This is done in the dental office and the procedure generally requires a healthy child. The child’s tonsil size (and airway) are amongst many factor that need to be evaluated to ensure a safe procedure. Some medications used have amnesic effects. This method requires rigid NPO (nothing by mouth) guidelines to be followed and insufficient and or paradoxical reactions (opposite of expected sedation) could occur in a minority (but significant) percent of children.
3- IV sedation:
Here, an anesthesiologist is brought along to start an IV that allows quick and direct access of medications to your child’s blood stream. This is the common choice for children that are youngest, most anxious, and or have extensive treatment needs. While with increased depth of sedation, the chances of something bad occurring increases, many consider this option the “gentlest and most predictable’ option. The cost tends of be mores as an anesthesiologist bill will accompany the dental cost. However, since all treatment is done is one sitting (in oppose to as many as 4 visit with Conscious Sedation), once the cost of missing work is calculated into the picture, IV sedation may be more cost effective. Some dentists schedule children who need this treatment in a hospital operating room (the terminology used often is General Anesthesia). This will commonly increase the costs drastically, unless the medical benefits can be used to cover the hospital bill.
In short, there are several options and each have pros and cons that require careful consideration. Please advise your dental professional for more information and consult a licensed practitioner before proceeding with any of the options discussed.