For many pediatric and adolescent patients, the thought of having dental procedures like fillings or extractions created a certain level of anxiety. In some cases, this is mild and in others, extreme. At Capital District Pediatric Dentistry, we treat a wide range of patients, each with their own special healthcare needs, behavioral needs and dental needs. Patients with dental phobias, low pain tolerance, major dental needs, behavioral or physical handicaps and extreme gag reflexes may not be able to tolerate the intricacies of dentistry.
At Capital District Pediatric Dentistry, we are proud to offer a large scope of behavior management techniques to help your child’s dental appointment go well. Behavior management refers to techniques used to manage behaviors to create a good outcome. They range from non-pharmacologic means to using medications to relieve anxiety. Remember we want your child to have positive dental experiences.
At Capital District Pediatric Dentistry, we use the following behavior management techniques:
Tell, Show, Do
Tell, Show, Do is used to introduce young/anxious patients to the dental world. We tell the child what we will do, we show them the things we will be using, then we do it.
For instance, we might say, “Alex, today we are going to count your teeth. First, we’ll ride in this chair, then we’ll give you some sunglasses so our exam lights won’t be too bright, then we’ll count with a mirror and my tooth counter.” We will then show Alex all of the things we will be using before we actually use them.
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Positive Reinforcement
This refers to positive verbal and non-verbal praises that reward good behavior. At Capital District Pediatric Dentistry, we provide tons of verbal encouragement, high fives, stickers, pencils, goodie bags and tokens for our Toy Tower. All of these help to provide a positive dental experience.
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Nitrous Oxide Relaxation
For many of our children, dental procedures are difficult to accomplish without the help of special medications. The very young, and/or very frightened child requires medications which make them sedated or sleepy enough to sagely treat them. Older and/or less frightened children need other medications which relax them, but not sedate them, so that the dental treatment is easier for them to tolerate. These children remain fully awake during the dental procedures. Some children benefit from nitrous oxide/oxygen inhalation (happy air).
Nitrous oxide/oxygen inhalation is used to calm and distract your child during difficult portions of the dental visit. Not only does nitrous oxide relax a child, it also reduces his or her sensation to pain. We use a low level of nitrous oxide and a high level of oxygen. The amounts are very different from what is used in an operating room. The child will be awake and relaxed during the dental procedure. At the end of the procedure, the child breathes oxygen for five minutes to cleanse the lungs of the nitrous oxide. This child is fine to resume all activities immediately following the dental procedures.
For more information, please see our downloadable sheet on Nitrous Oxide.
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Nitrous Oxide with Atarax (Hydroxizine) Premedication
For some children who are anxious or have a severe gag reflex, nitrous oxide is not enough to relax them for dental procedures. For these patients, we offer nitrous oxide with a prescription for Atarax. The generic name for Atarax is Hydroxizine. It is a liquid antihistamine, similar to Benadryl, which has three nice properties:
- It has an anti-anxiety effect. It can reduce anxiety and calm the child.
- It has a drying effect which can help reduce gagging and reduces the need to use many cotton rolls to keep a tooth dry dying treatment.
- It has an antiemetic (anti-nausea) effect. This helps reduce gagging/vomiting in large doses. Atarax can have a sedative effect, so this medication must be given as directed.
If Dr. Jason, Dr. Nancy or Dr. Jennifer recommends Atarax for your child, it will be taken before his or her appointment. You can expect your child to have a slightly dry mouth and seem less anxious. He or she will have no restrictions prior to the appointment and should be able to go about his or her normal day (i.e. go to school) after the appointment.
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Conscious Sedation
Conscious sedation is a behavior management technique that uses medications to help children cope with fear and anxiety and to cooperate with dental treatment. Children who have a level of anxiety that prevents good coping skills or are very young and do not understand how to cope in a cooperative fashion for the delivery of dental care should be sedated, especially if the amount of dental work required is extensive.
In our office, we give children a light dose of medication to drink. After about 30 minutes to an hour, the child will be mildly sedated and should be able to cooperate for dental procedures. We do not give heavy doses of sedatives. We want your child to be comfortable, but not deeply sedated. Because every child is different, it is difficult to predict how each child will react to the medication given. But our goal is that your child will fall asleep and/or be relaxed enough to get through the procedure without fear/anxiety.
To ensure that your child will not get sick, please make sure that they have nothing to eat or drink the night before the procedure. Also, please make sure your child takes their prescription of Atarax beforehand. Children who are consciously sedated will not be able to attend school or activities for the remainder of the day until their bodies clear the sedative.
Our doctors sedate over 500 children every year, and our expert staff is specially trained for these sedation procedures. The American Dental Association and the American Academy of Pediatric Dentistry both endorse the use of conscious sedation.
For more information, please read our downloadable sheet About Conscious Oral Sedation.
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General Anesthesia
For our patients with very high levels of anxiety, severe dental restorative needs, special healthcare needs, special behavioral needs and sedation dentistry is not effective, we offer general anesthesia at St. Claire’s Hospital in Schenectady and Samaritan Hospital in Troy. Dr. Jason, Dr. Nancy and Dr. Jennifer have had extensive training in order to provide this treatment option to their patients.
With general anesthesia, an anesthesiologist at the hospital delivers the anesthesia to put a child to sleep. The child is completely unconscious and the dental treatment is performed by our doctors in an operating room setting.
The appointment will be scheduled early in the morning. It is important that your child not eat or drink anything after midnight the night before. We ask that you please arrive on time. There will be some preparation necessary once you arrive and the procedure itself usually requires two hours. Once the procedure is complete, a recovery period is necessary. Your child will be able to return home on the same day. We will have specific instructions for you to take home to help your child through his/her recovery.
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