• Pre-Appointment Instructions: In-Office Conscious Sedation
• Post-Treatment Instructions
• Conscious Sedation
• Dental Emergencies
• Trauma to Baby Teeth
• "Tooth Fairy Tips" - What to do after extractions
  

Pre-Appointment Instructions

Pre-Appointment Instructions: In-Office Conscious Sedation

It is important for your child’s safety that you follow these instruction carefully! Failure to follow these instructions could result in LIFE THREATENING complications!

As defined by the American Academy of Pediatric Dentistry, the goals of sedating the pediatric dental patient are to:

1. Facilitate the provision of quality dental care.
2. Minimize extremes of disruptive behavior
3. Promote a positive psychological response to treatment.
4. Promote patient safety and welfare.
5. Return the patient to a physiologic sate in which a safe discharge is possible.

Our goal at Healthy Smiles for Kids is to provide quality care as safely and efficiently as possible. For this reason and the equipment required for monitoring your child, we ask that parents remain in the reception room or pre/post-sedation room during the treatment. There are large glass windows in the doors to the operatories and you may be escorted to view your child’s treatment if desired. We understand that you may have concerns and will work with you to help alleviate them.

YOUR CHILD MUST HAVE AN EMPTY STOMACH.
NO FOODS OR LIQUIDS…EVEN WATER!!

The medications given to your child may make them feel drowsy within minutes to half an hour depending on the type and route given. Your child may fall asleep before, during and after the dental treatment, but they should be easily awakened. As with any sedative medication, your child may experience an opposite effect and become excited and/or irritable (a paradoxical reaction).

Because each child’s metabolism is different and there is no 100% guarantee with ANY sedative medication, there is a possibility your child’s sedation will need to be aborted before the treatment has started or prior to treatment being completed. If this situation occurs, there will be a $50.00 charge to cover the costs of the medication and time of the appointment.

Day of Appointment

• DO NOT give your child any medication unless cleared by Dr. Ritchie first!
• You should expect to be at our office for at least 2 ½ hours. Upon arrival, you will be asked if any health changes have occurred; we can NOT sedate a sick child. PLEASE INFORM US as soon as possible if your child experiences a cold or fever within 2 days prior to the sedation appointment. A new appointment will be made for your child’s safety if this occurs.
• Please DO NOT allowe your chilled to have anything to eat or drink after midnight. We ask that your child wears comfortable, loose-fitting clothes. If possible, please bring a change of clothes in the event your child experiences an adverse effect, such as nausea/vomiting. We also ask that a second adult accompany you to the appointment to help care for your child while driving home from the appointment.
• Once treatment is completed, please join your child in the pre/post sedation room. This area was created for you and your child to help alleviate any anxiety while your child is waking up from the sedation. Dr. Ritchie will discharge your child into your care to leave once he feels that he/she has returned to an appropriate level. Constant supervision is needed for the remainder of the day as the medications can have a lasting effect for several hours. Your child should NOT return to school, daycare or play outside after the appointment.

Post-Treatment Instructions

Thank you for helping us create a beautiful and healthy smile for your child!

In order to keep your child's dental experience pleasant, we have provided you with the following guidelines to help them after the completion of their dental treatment. Please do not hesitate to call us if you have any questions (903) 531-9000.

• Sealants: Sealants are a protective plastic-like covering placed in the grooves of your child's teeth to help prevent cavities. They are usually placed on the teeth without the use of local anesthesia. Your child may feel that their teeth do nor fit together properly. Your child should NOT crunch ice or eat sticky or crunchy foods for a few hours to avoid breaking the sealant. Even after sealants have been placed, kids can still get cavities between their teeth so daily brushing and flossing is recommended.
• White Faced Silver Crowns: White Faced Silver Crowns are used for small cavities on the biting surfaces and in between the teeth. They may or may not be placed using local anesthesia depending on the size of the cavity. Your child may feel that their teeth do not fit together properly for a few hours. Your child should NOT crunch ice or eat sticky crunchy foods for a few hours to avoid dislodging the filling. You may not be able to see the filling body, but over time the filling will become more visible. Children can still get cavities around these fillings so daily brushing and flossing is recommended.
• White Composite Fillings: White Composite Fillings are used for small cavities on the biting surfaces and in between the teeth. They may or may not be placed using local anesthesia depending on the size of the cavity. Your child may feel that their teeth do not fit together properly for a few hours. Your child should NOT crunch ice or eat sticky crunchy foods for a few hours to avoid dislodging the filling. You may not be able to see the filling body, but over time the filling will become more visible. Children can still get cavities around these fillings so daily brushing and flossing is recommended.
• Silver Stainless Steel Crowns: Silver Stainless Steel Crowns are used for very large cavities, cavities that require nerve treatments, and in children with a lot of cavities. Crowns are always done using local anesthesia so your child's mouth will be numb. The gums surrounding the crowns will appear very irritated. Children's Motrin or Tylenol should take care of any soreness your child is experiencing. Avoid foods that are super hot or super cold because your child may experience sensitivity for a few days. The crowns are glued on with sticky cement. Crowns can be dislodged with sticky candy such as taffy, Now & Laters, and caramel so please avoid these and most other candies. You will notice a number on the side of the crown that will disappear if your child is doing a good job brushing their teeth. The crown and tooth will be lost naturally as they are replaced by permanent teeth.
• Nerve Treatments/Pulpotomy: Nerve Treatments/Pulpotomy are performed when the cavity is large enough that it involves the nerve and the nerve became sick. We remove the nerve, place a medication to calm the nerve and cover the medication with a silver crown. Crowns are always done using local anthesia so your child's mouth will be numb. Sometimes the body does not react well to the nerve treatment so these teeth will need to be monitored by x-rays during recall visits.
• Indirect Pulp Caps: Indirect Pulp Caps are placed over the nerve of your child's tooth because the cavity was close to the nerve but the nerve was still healthy. A base layer was applied and the tooth was restored with a white filling, silver filling, white crown or silver crown. Your child's tooth may be sensitive for a few days. Children's Motrin or Tylenol should take care of any soreness your child is experiencing. Avoid foods that are super hot or super cold because your shild may experience sensitivity for a few days.
• White Composite Crowns: White Composite Crowns are used for large cavities that involve the front teeth. Crowns are always done using local anesthesia so your child's mouth will be numb. The gums surrounding the crowns will appear very irritated. Children's Motrin or Tylenol should take care of any soreness your child is experiencing. Avoid foods that are super hot or super cold because your child may experience sensitivity for a few days. These crowns are very fragile and require a great amount of care. For the first few days, your child should avoid tearing food with their front teeth. Caution should be actually be used for the entire time the child has the crown. If your child is active in sports, an athletic mouth guard is suggested. Children can still get cavities around these fillings so daily brushing and flossing is recommended. The crown and tooth will be lost naturally as they are replaced by permanent teeth.
• Space Maintainers: Space Maintainers are used to hold spaces for un-erupted permanent teeth if the baby teeth are lost too early. They are cemented with sticky glue that can be washed away by saliva over time. They may or may not be placed using local anesthesia. Spacers can be dislodged with sticky candy such as taffy, Now & Laters, and caramel so please avoid these and most other candies. Your child should also not pick at the spacer with his/her fingernails. The continued need and fit of the spacer will be evaluated at each recall visit. We will eventually need to remove the space maintainer to allow eruption of the permanent tooth.
• Local Anesthesia: Local Anesthesia is the medication that we use to numb your child's mouth. Depending on where it was applied, your child's teeth, lips, cheek and/ or tongue may be numb. The involved area will be numb from 1 to 4 hours. Children often respond differently to the numb feeling. It is very important that you monitor your child to avoid biting or playing with the number area. DO NOT allow your child to eat food that has to be chewed for at least 3 hours. Yogurt and smoothies are great treats if your child is hungry. Some children do not respond will to having a numb lip and will cry or complain of pain. Please reinsure your child that their lip is just sleeping. The numb area often tingles or itches when the medication wears off. Children's Motrin or Tylenol should take care of any soreness your child is experiencing.
• Nitrous Oxide/Laughing Gas: Nitrous Oxide/Laughing Gas was used to help relax your child and make our work a little easier. After breathing the laughing gas, your child was allowed to breathe oxygen that cleared all the nitrous oxide from his/her lungs. Some kids experience a slight dizziness after sitting up and a few kids experience nausea and vomiting. Please monitor your child and help them when walking out to your car.

Conscious Sedation

• What is conscious sedation? Conscious sedation is a way of using medication to relax a child without the loss of consciousness.
• Who should be sedated? Dr. Ritchie recommends that those children with severe anxiety and/or the inability to relax are candidates for sedation. Usually these children are young or have trouble managing their anxiety.
• Why does Dr. Ritchie use conscious sedation? Conscious sedation aids in calming a child so that he or she can accept dental treatment in a more relaxed state. This can prevent injury to the patient and provide a better environment for delivering quality dental care- it's hard to do dentistry on a moving child!
• What medications are used? Dr. Ritchie has many different agents that are used for conscious sedation, from inhalation agents (laughing gas) to medicines that are drunk from a cup. None of these sedatives render the child unconscious. Dr. Ritchie will base her recommendations of medications to be used based on the child's age, level of anxiety, amount of dental work that needs to be completed and length of appointment.
• Is sedation safe? Dr. Ritchie has had 3 years of advanced training to administer, monitor and manage sedated patients. He also exceeds the standard of care in his monitoring and emergency equipment. Dr. Ritchie is trained and certified in Pediatric Advanced Life Support.

Dental Emergencies

There may be times that your child falls, hits their mouth, and in some instances, knocks a tooth out. If they have bleeding, then apply light pressure with gauze or a cold compress. If the bleeding does not slow or stop within fifteen minutes, then take your child to the hospital emergency room. If a tooth is knocked out, find the tooth and handle it by the crown of the tooth, not by the root. Contact us immediately!! You can rinse the tooth, but do not scrub the tooth or aggressively clean it. Look at the tooth for any fractures. If none are present, then reinsert the tooth into the socket and have the child hold the tooth in place by gently biting on gauze. If the tooth cannot be reinserted, transport the tooth in milk or saliva. Time is a critical factor in saving the tooth.

There may also be times when your child complains of his or her tooth hurting. If they do, then the first thing to do is clean the area thoroughly. Have them rinse vigorously with warm salt water and gently floss around the teeth. If they still complain of pain, contact us very soon. A cold compress can be used to reduce swelling and acetaminophen (Tylenol) or ibuprofen (Motrin) can be given for the pain. We don't recommend placing aspirin on the gums, because this can burn the area making the pain worse.

Dental emergencies can be upsetting for the child and the parents. Try to stay calm and help your child stay calm. We will help with any dental emergencies that your child may have and helping them feel better.

Trauma to Baby Teeth

Accidents happen as children learn to walk and sometimes the front teeth on babies get hit. There may not be any noticeable damage to the actual teeth. However, over time the teeth may start to get darker in appearance, become loose, or a bump may form over the tooth that was hit. Sometimes your child may not want to eat or complain that their mouth hurts.

When an accident involving the mouth does occur, keep your child on a soft diet for 7-10 days. They may have swelling of the lips or cuts inside their mouth. An ice pack can be used for the swelling and avoiding spicy or acidic foods will help keep the cuts from hurting. You can give your child acetaminophen (Tylenol) or ibuprofen (Motrin) to help with the discomfort after an accident.

We will want to see your child after an accident occurs, so we can evaluate their lips and teeth. We will go over what treatment is needed, if any, and answer any questions you may have. If it is after our office hours, you can call our emergency line and we will be happy to answer your questions and determine whether your child needs to be seen immediately.

Tooth Fairy Tips - What to do after extractions

Your child has had one or more teeth extracted. Here are some guidelines to help…

1. Keep the gauze in place for 20 minutes. Some bleeding is expected. If sustained or bright red bleeding continues, place new gauze over the site and bite down to apply pressure for an additional 20 minutes. If bleeding persists, please do not hesitate to call our office. Remember blood will cause all the saliva to be colored.
2. Give your child the appropriate dose of Children's Motrin, Advil or Tylenol when you take the gauze out. Your child should only need this for the next possible 12-24 hours. If pain medication was prescribed, follow the directions on the bottle. If pain persists past 48 hours, call our office.
3. Your child should only eat soft foods for one to two days. Nothing crispy or crunchy and nothing too hot or too cold due to the area may be a little sensitive. Encourage plenty of liquids (water, soups, juices, etc.). A regular diet can be started as tolerated by your child.
4. No spitting or drinking through a straw or sippy cup! This can make the area bleed again.
5. Activity should be limited with no strenuous exercise.
6. Assist your child with their oral hygiene. Use a moist cloth or light brushing to the adjacent teeth and be careful to avoid the site directly as this may dislodge the blood clot and cause bleeding to start again. A clean mouth heals faster!
7. Swelling after an extraction is not uncommon and need not cause alarm. You can apply an ice pack for 15 minutes on and 15 minutes off as needed in the first 24 hours following the removal of the tooth/teeth.
   
8. Your child's cheek, lip and tongue will be numb for approximately 2-4 hours. Please be very careful that your child does not bite, chew suck or scratch this area! Please keep a close watch on your child until the anesthesia wears off. Your child may not like the numb feeling and may state that the area feels funny when it "wakes up."

If you have any questions, concerns or complications, please call us soon at (903) 531-9000.