Two year-old needs extensive dental work

My 2 year old daughter is going to have major work done on her, and I wondered if it were too much for one sitting. She is to have...resin, one surface; amalgam, one surface; 2 therapeutic pulpotomies and crowns on those 2 teeth; and one extraction. She has baby bottle "mouth". She will receive oral sedation and nitrous oxide with oximetry. Is this too much? How much pain will she have? I was told that working on baby teeth is different in the fact that the dentist doesn't get so far down in the root, therefore, the pain is "different". Having had extractions and root canals done myself, I am concerned about the pain the next few days after.


Dear Anne,

While it does sound as if this is quite a bit of treatment to complete in one appointment, it is difficult to predict if this will be too much for your daughter. Everyone responds differently to the time and amount of treatment accomplished. If the dentist is experienced in completing this amount of treatment at one time, and your daughter responds well to the sedation, she should do fine. One large advantage to having the treatment completed in one sitting is that she does not have to return for further treatment (at least until her next checkup).

Personally, I try not to complete too much treatment in one appointment for children because they generally seem to respond better if they are not overwhelmed. However, I sedate very few children in my practice, and I suspect the sedation in addition to the nitrous oxide may help your daughter tolerate more work. The dentist treating your daughter should be aware of her reactions, and if he sees she is not tolerating further treatment well, he may stop and have you return for completion of treatment at another time.

When I find sedation to be necessary, oral sedation accompanied by nitrous oxide does seem to work well for most patients (i.e. it effectively reduces pain). The oximetry to which you refer in your question is a monitoring device. A pulse oximeter monitors heart rate and the oxygen saturation in the blood. Monitoring the blood gases, such as oxygen can provide a more detailed analysis of the effectiveness of breathing rather than just watching respiration. While heart rate monitoring is suggested during oral sedation and nitrous oxide administration, oximetry is not essential.

As far as pain is concerned, while it is true that pulpotomies are not as involved and can be fairly quickly completed, especially in comparison to "regular" root canals on adult teeth, your daughter may experience some postoperative discomfort. You should discuss with your dentist what he recommends for any postoperative pain. If your daughter's health history shows no signs of allergies, baby Tylenol or baby Motrin may be helpful. Keeping the extraction site clean will also be very important.

I am encouraged to know that you are having her conditions treated and are taking an active interest in the procedures that are to be performed. If you have not done so already, it is critical that you discontinue placing milk or juice in her bedtime bottle. Thank you for the question, and good luck.

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