Are primary teeth less sensitive to pain?

My dentist says that children's primary teeth are not as sensitive to pain as adult's permanent teeth. He says that dentists generally do not give shots to children before drilling their cavities for filling. I am afraid that my six-year-old daughter will feel pain, even if she is under sedation, which I don't think blocks pain. (Does it?)

Background: My daughter has cavities between her "Ds and Es" in all four quadrants of her mouth, which we discovered when she complained that crunchy food hurt her teeth. (So I know she feels something! Me? I'm mostly feeling guilt -- over assuming her teeth were fine because she brushes daily, and kids don't get cavities any more due to fluoridation. Wrong.) After a hopeful beginning with a quite cooperative and brave little girl, and without trying to administer lidocaine first, or use sedation or restraint or blocking her mouth open, my dentist had to give up abruptly when he bloodied her tongue with the handpiece as he started to drill, and she was too afraid to let him continue after that point. He says she started flinching before the drill touched her tooth, and that she got her tongue in the drill before he could really get started.

So he says we have to take her to a pediatric dentist to restrain or sedate her. Because my daughter is autistic and is tactilely defensive about the head and face, I can see us opting for intravenous sedation, and doing the whole mouth in one trip if possible. But wouldn't it be unconscionable to sedate her without using local anesthesia to protect her from traumatizing pain? What a nightmare, to be in agony without any ability to react or protect oneself! Makes me shudder to think of it.

Question:

Dear Sylvia,

Research has shown that it is a myth that children do not feel pain in general as we adults do. In dentistry, it is sometimes difficult to understand exactly what a child is feeling as some treatments cause different sensations such as pressure, which children may have difficulty differentiating from "pain". In addition, anxious children may be actually anticipating the pain more than they are actually feeling it. So, we must be careful to not assume anything when it comes to treating children.

It is true that I sometimes am able to treat shallow cavities or decay that is quickly removed without administering local anesthetic. If this is possible, I will do it because it prevents having to give the "dreaded shot". If I feel the child is able to understand, I do instruct the child to raise their hand if they feel any pain (I try to define the pain for them, such as "if it feels like pins and needles"), and I will stop immediately and administer local anesthetic if necessary. This at least gives them some feeling of control. If they do not seem to understand these instructions, generally watching their eyes and their body language gives a clue as to what they are feeling. I also have some children and adults who tell me they would rather feel the discomfort of dental work rather than to be numb.

Although I tell the child to stay still either during treatment or the injection, they do move occasionally, causing damage, and, sometimes more pain. These movements can be difficult, if not impossible, to predict.

Sedation generally helps to relax the patient, increases cooperation from the patient, and in some cases, decreases or eliminates memory of the treatment. It does not completely remove the painful stimuli, however. If necessary, local anesthetic should be used in conjunction with sedation for both children and adults.

Given your daughter's experience and medical condition, treatment from a pedodontist may be the best option. Not only does a pedodontist have extra years of training, but the environment in the office will be strictly geared toward children. This alone may help to alleviate the anxiety now (understandably) felt by your daughter.

Answer:
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