Only novocain for extraction?

My 2 yr son needs his four front upper teeth extracted due to bottle decay. The dentist explained that he doesn't use oral sedation, only novocain. He will numb the gums before the injections, but my son will be awake. At 31 yrs old, I know I would be scared to death! I can't imagine him going through the procedure fully alert. The dentist said if he gets "fussy," his assistants will hold his hands down, which worried me even more. What are your opinions on oral sedation for such a treatment? Should I consult another dentist?

Question:

Dear Cathy,

Consulting with another dentist is a good idea for several reasons. I would even advise that you consult with a pedodontist if the dentist to whom you refer is not a children's dentist. Many general dentists are perfectly capable to treat children, but occasionally it is good to at least get an opinion from a specialist. While I do not know the condition of your son's teeth, the pedodontist may determine that the teeth are restorable and not recommend extraction. If they are severely decayed, however, extraction and replacement with some type of prosthesis may be the only option. In addition, some pedodontists have extra training in the sedation of children and may be more willing to sedate your son, if necessary.

While sedation generally works well, there are some risks associated with any type of sedation. A health history must be carefully evaluated to help determine that your son has no allergies or adverse reactions to the type of sedation which might be used. There are several types of sedation possible, including nitrous oxide gas, oral sedation, intravenous sedation, and general anesthetic. Perhaps your current dentist does not want to take any risks, or perhaps he has noted something in your son's history which precludes the use of oral sedation. If any sedation is used, careful monitoring of your son's condition should be done throughout the procedure.

Be careful not to express your fear to your son because this will only increase his anxiety level. Communication from the dentist and/or the dental assistant to your son will be important to help the procedure run smoothly. Occasionally, it is necessary to hold a child's hands to avoid injury, especially during the injection process.

If extractions are necessary, keep in mind that the roots on these upper anterior primary teeth are generally conical in shape and are relatively short. In addition, the alveolar bone which houses the primary teeth is has more plasticity than the alveolar bone in older individuals. These factors allow for easier, quicker extraction of primary teeth; therefore, the procedure may not be as traumatic as you envision.

Because it will be several years before the permanent teeth erupt, I recommend you discuss some type of prosthetic device to replace the missing teeth. This will be important for several reasons. While prematurely extracted incisors do not present as much a concern for space maintenance as the posterior teeth, this is one function of primary teeth. They help hold the space for the permanent teeth. The anterior teeth also are necessary for cosmetics and phonetics.

Good luck, and please keep me posted on your son's progress.

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