Nitrous Oxide Sedation in Pediatric Dentistry
Sometimes, the pediatric dentist may recommend nitrous oxide for your child’s dental treatment. Here is a brief overview.
What is it? Nitrous oxide, or laughing gas is a colorless, nearly odorless, non-flammable gas. It is mixed with oxygen to reduce anxiety in children (and adults). Used for over 100 years, it has proven to be safe and effective as a sedative agent in dentistry.
What is it used for? The American Academy of Pediatric Dentistry recommends it for a variety of procedures including:
(1) patients who are fearful, anxious or uncooperative
(2) certain special needs patients
(3) patients with a strong gag reflex that interferes with dental care
(4) patients who have difficulty getting numb
(5) young patients undergoing lengthy procedures
How does it work? The gas is administered by a small mask that fits over the patient’s nose. Patients are asked to breathe normally through their nose. The effects are fairly quick. Typically the patients start to feel light headed, more relaxed with tingly sensations in their fingers and toes. Children are not asleep and respond to directions from dentist. They can become talkative and occasionally laugh during the appointment. After the procedure the child is given 100 percent oxygen, the nitrous oxide is rapidly breathed away so the patient is not dizzy when they leave the office.
Is nitrous oxide used for every anxious child? The use of nitrous oxide is NOT for every anxious child. Certain, rare medical conditions prohibit its use. Some patients do not like the feeling of losing control or find the nasal mask confining and unpleasant. Nitrous oxide will not work for children who cannot breathe through their nose due to skeletal defects or nasal congestion.
Are there any side effects? The most common side effect is nausea and vomiting in a very small percentage of cases (.5-1.2 % of patients). Some patients do not like the feeling of losing control or find the nasal mask confining and unpleasant.
Nitrous oxide is a safe, effective way to help the vast majority patients ease their anxiety.
Top 5 Worst Food for your Braces
1. Popcorn: Those kernels get trapped everywhere in your gums and around your teeth even without braces! Those brackets and wires give them more spaces to hide which can lead to pain and swelling. Additionally, those hard kernels can easily break your bonded appliances.
2. Caramels, Gum, Sticky Candy: Those chewy, gooey, gummy snacks can easily break a brace and cause unwanted extra visits and prolong your treatment time. They are often full of sugar and can lead to complications such as cavities. Stay away.
Toothbrushing Tips for Tots
Brushing a little one's teeth can be a real challenge sometimes. What kind of toothpaste should I be using? What do I do when my child bites the toothbrush? How do I even get in there?! Your pediatric dentist is here to help.
- The American Academy of Pediatric Dentistry recommends using a smear of fluoride toothpaste for brushing teeth twice a day as soon as the first tooth comes in. The smear of toothpaste should be about the size of a piece of rice -- very small! When your child learns to spit out the toothpaste reliably (usually between ages 3-6), you may start using a pea-sized amount of toothpaste. We always recommend using toothpaste containing fluoride. Children thrive on routines, so making toothbrushing a consistent part of their morning and bedtime routines will make toothbrushing easier for your child over time when they know what to expect.
- When your child is a baby, the easiest way to brush their teeth is to lay their head in your lap, similar to how we position patients in the office.
- If your child is fighting the toothbrushing, brushing in a "knee-to-knee" position is especially helpful. You and another adult will sit facing each other with your knees touching. One adult will have the child's legs around their waist and will hold their hands, and the other adult will stabilize the child's head and do the brushing.
- Is your child biting the toothbrush? Try using two toothbrushes: use the squishy silicone handle of the second toothbrush for the child to chew on. That will help keep their mouth open for brushing on the other side.
- Is your child rushing toothbrushing? We recommend brushing for 2 minutes, 2 times a day. Use a timer! You can set a timer for 2 minutes, or use a toothbrushing timer app on your phone. Another great option is an electric toothbrush such as Sonicare for Kids, which has a timer built in.
- Still dealing with gingivitis despite a cooperative brusher? Make sure your child is brushing well along the gumline. Plaque tends to build up where the tooth meets the gums, and this is an often-missed area for children. Help your child practice getting along the gumline in a small circular motion.
- Still having trouble? Humor is one of our best tools with children. Sing a song they know and love, but substitute in funny words! For example: "Bah bah black sheep, have you any broccoli?" Keeping things light and fun can go a long way to making the job easier.
Why are soft drinks bad for teeth?
Soft drinks deliver a “double whammy” when it comes to teeth.
First, they have high amounts of sugar in them. The average 12 ounce can of soda contains an astounding 9 teaspoons of sugar. Oral bacteria use sugar to create acids making holes in teeth.
Second, there are acids in soda that weaken the enamel or outer portion of a tooth making it easier for cavities to form. Bathing teeth in acid erodes the enamel. This is why diet sodas or those without sugar added are harmful to teeth.
The fizz in soft drinks is made by dissolving carbon dioxide in water. The result is carbonic acid. Other acids used in soft drinks are citric acid, phosphoric acid and tartaric acid. These acids are almost as damaging to teeth as battery acid.
Here are some common questions we often get about brushing for our youngest patients
Q: When should I start brushing my child’s teeth?
A: When the first tooth comes into the mouth! Before then, gently wiping your infant’s mouth/gums with a wet cloth is also encouraged.
Q: When should I start using fluoride toothpaste for my child?
A: Right away! However, you must be careful with how much toothpaste you use, as young children are unable to spit well. For those under age 3, just a rice sized smear is enough. For those 3-5, a pea sized amount is perfect.
Q: Until what age should I help my child brush?
A: Every child is different. Generally speaking, kids don’t have the dexterity required to brush well until around the same time they can tie their own shoes. At that point, it becomes a matter of focus and interest. We encourage parental help with brushing as long as it takes. Many children require some help through age 6 or 7, and some beyond.
Have additional questions? Give us a call to schedule a consultation!
My child’s tooth got knocked out! What do I do?
Remain calm! While dental and facial injuries can be scary, put your anxiety aside and reassure your child things will be okay.
Next, try to figure out if it was a baby or permanent tooth. Baby teeth tend to be smaller, whiter in color and flat on the biting edge of the tooth. On the other hand, permanent teeth are larger, darker or a bit yellower in color and may have bumps or ridges at the tip.
Avulsed Permanent Tooth
∙ Try to find the tooth and gently rinse off any dirt by holding the crown of the tooth NOT the root
∙ Place the tooth in milk or water (in a plastic sandwich bag or a sealed container) to bring with you to the office. Call the office immediately
∙ Try to control any bleeding with a moist cloth applied to the area. Ice the area to reduce swelling
∙ At the office, the dentist MAY be able to re-implant the tooth (based on multiple factors) back into its original position
Avulsed Baby Tooth
∙ Gently clean the affected area with a moist washcloth. Apply ice to reduce swelling
∙ Check the adjacent teeth and see if any are loose, displaced and/or fractured
∙ If you find the tooth, there is no need to place in milk or water. No attempt will be made to re-implant the baby tooth to avoid damaging the developing permanent tooth. It is a good idea to bring the avulsed tooth to the office (before the tooth fairy comes) to help us assess the injury
∙ Call the office to review the situation
The hope is this NEVER happens to your child. Unfortunate events occur and it is always good to know what to do when a tooth is knocked out.
RETAINERS 101: WHAT YOU NEED TO KNOW
Congratulations, you did it! You made it through your orthodontic journey and now you can finally enjoy your beautiful smile! No more wires or brackets, aligners and attachments… bring on the gum and selfie stick, PLEASE!
Wait one minute, there is one final thing you need to know to protect that perfect smile. Yup, you guessed it…retainers.
Here’s the facts:
- WHY DO I NEED TO WEAR A RETAINER?
It takes time to for your teeth to settle and bone to mature around your teeth in their new positions. Retainers are worn to hold the teeth in that straight, stable position during that immediate time after appliances are removed. In addition, as we age our teeth are more likely to shift for a variety of reasons. Wearing a well-fitting retainer regularly is what you can do to keep your smile straight for a lifetime.
- WHAT HAPPENS IF I FORGET TO WEAR THEM ONE NIGHT?
Don’t worry, life happens. If you forget to wear them one night, wear them longer the next day and night. You may notice the retainers are more snug or tight when you first put them in. That is a sign that minor shifting has started to occur. However, if you wear them more hours, the teeth will respond and go back into that perfect position. Your retainers should always feel comfortable, not tight. Tightness is an indication you need more hours of wear.
- WHAT ARE THE TYPES OF RETAINERS?
Fixed vs removable:
Fixed retainers are great because they can protect the front teeth from shifting, especially the lower front incisors that are most prone to relapse. Sounds great, right? Not so fast. With a fixed retainer you need to watch your diet to avoid breakages. A broken or bent retainer can result in unwanted tooth movement. Additionally, a fixed retainer requires meticulous brushing and flossing to prevent gum problems. Most people also don’t realize that the fixed retainer only holds straight the teeth it attaches to, in other words, the back teeth can shift as well. That means you still need to wear a removable retainer as well.
Removable retainers come in a variety of styles, designs and materials. There is a traditional wire and acrylic type and a clear plastic type (think aligner).
They both work great, but you need to remember to wear them. Generally, the wire and acrylic retainer lasts a lot longer than the clear plastic retainer.
- HOW DO I TAKE CARE OF MY RETAINERS?
Be sure to clean your retainers every time you take them out. Use a soft toothbrush and liquid soap (never toothpaste). Brush them under warm (never hot) water. Store them safely in the case, away from pets. Dogs will find them and eat them!
- HOW DO I KNOW WHEN I NEED A RETAINER UPGRADE?
All retainers need to be maintained. Like anything else that you wear every day, eventually they wear out and need replacing. Visit your orthodontist if the retainer is no longer fitting well or is bent or broken. Additionally, keep an eye on your smile. If your teeth are starting to shift, it is MUCH easier to fix it early before a more time-consuming and costly touch-up is needed.