Childhood caries of primary teeth: treatment without drill and drilling

Treatment of caries of children's primary teeth

Caries of primary chewing and front teeth has long been treated without the slightest pain.
New modern techniques have reduced the use of drills and drilling to a minimum, and timely scheduled examinations make it possible to detect the disease at a very early stage. The doctors at Aza&Buka Pediatric Dentistry who work with young patients are distinguished by an amazing sense of tact and constant positivity. Knowledge of the child’s psychology allows doctors to build communication and dialogue in such a way that children sit in the dental chair without the slightest fear. If the child already has some dental phobia, then adaptation techniques can solve the problem.

Caries on baby teeth in children is treated using the following technologies:

Types of sedation in pediatric dentistry

Sedation for children has a number of features, since not all methods and drugs are suitable for the child’s body.

• Inhalation method (nitrous oxide).
  Nitrous oxide sedation is a very common technique in pediatric dentistry. There are several reasons for this. First, nitrous oxide is safe and can be used even on children under 5 years of age. Secondly, dental treatment with gas for children does not require a special license for the use of psychotropic substances. Nitrogen has a minimal effect on the body's systems, and the child recovers very quickly after the procedure. On the other hand, expert reviews of this method are mixed. Many people consider nitrous oxide not the best means for sedation, and sometimes individual intolerance occurs. Dental treatment for children with nitrous oxide cannot last long: the duration of action of laughing gas is very limited.
• Oral method.
  The effect of sedation is achieved by oral administration of drugs from the benzodiazepine group (Valium, diazepam and similar drugs). This type of sedation is not recommended for children under 5 years of age, and the dosage must be calculated very accurately.
• Intravenous method.
  The most powerful type of sedation that causes significant depression of consciousness. The drugs are given through a vein, and the patient may require an oxygen mask to maintain breathing. This type of sedation is not given to children.

Classic filling

requires a special approach when treating young patients, since the doctor has to use dental equipment, which often causes fear in children.
Aza&Buka dentistry uses both traditional and modern methods of treating caries of primary teeth, selecting a method taking into account the age of the child and the degree of neglect of the process.

Plaksina Margarita

“Modern parents are great! They themselves are not afraid of dentists, and children are taught the same thing: to come on time for preventive appointments and examinations. In such cases, doctors can intercept the very beginning of a cavity infection and prevent tooth decay without drilling.”

How is dental treatment performed for children under sedation?

Specific preparation measures are selected depending on the type of sedation, but the preparatory stage cannot be avoided. This is especially true for deep sedation, when it is necessary to take blood tests and determine possible allergic reactions to drugs. Before the procedure, you need to completely give up smoking and alcohol (although this requirement is not so important for a child), and also not eat food 8-10 hours before treatment. During inhalation sedation using nitrous oxide, a light breakfast is possible. After all the necessary preparatory measures have been taken, the entire treatment process is divided into four stages:

• final examination of the oral cavity;
• introduction of a sedative into the body;
• anesthesia;
• treatment.

Treatment of baby teeth and tooth extraction usually does not take much time. The more extensive the treatment, the longer the sedation should last. In some cases, treatment is divided into two stages.

Superficial sedation does not require additional measures to emerge from drug-induced sleep. Deep sedation often involves the use of special antidotes.

Milk caries: initial, superficial, medium, deep

Doctors distinguish 4 stages of the formation of carious areas:

• Initial caries - tooth enamel becomes covered with small spots of white or yellowish tint.
• Superficial caries - the enamel begins to deteriorate, small and light cavities are observed.
• Medium – the layer of tooth enamel is destroyed, the affected area extends deeper.
• Deep - the layers of dentin have already been affected, and the pulp is under threat.

It is necessary to treat milk caries at the very first stage, although it does not cause any discomfort in the child. The fact is that the enamel and crowns of temporary teeth are subject to rapid destruction, and the development of caries occurs very quickly. Deep caries often provokes irreversible changes, which leads to premature removal of the baby tooth.

Rodikova Tatyana

“Medium and deep caries most often occurs in schoolchildren, almost teenagers. Children brush their teeth poorly, and they talk about problems only when caries has already affected the pulp. In this case, the treatment turns out to be more unpleasant, since removal of the pulp cannot be avoided. That’s why I always ask parents to carefully monitor their teenagers’ hygiene and bring them to appointments on time.”

What is rehabilitation like after treatment under anesthesia?

After waking up from anesthesia, in the vast majority of cases, children feel well. Most often, the only thing that bothers them is numbness in the areas where the local anesthetic was injected.

As for behavioral changes, there are three types:

1. excitement - the baby may be capricious and cry. This is accompanied by increased activity. But it quickly gives way to fatigue;
2. fatigue - the child wants to sleep, refuses to eat, sits in the arms of the parents;
3. no behavioral changes after waking up.

The first two scenarios are typical for children under the age of 7-10 years, the third - for adolescents and adults.

Hyperactivity and agitation upon awakening are unpleasant for both the child and those around him. To avoid it, we try to implement the second scenario; to do this, we put the baby to sleep and wake him up gently.

The child can eat immediately after waking up, unless the anesthesiologist gives other recommendations.

Very rarely, recovery from anesthesia is accompanied by nausea or a feeling of motion sickness. This lasts no longer than 2-3 hours. This reaction is typical for children who get motion sickness in transport. In this case, you will be able to eat and drink within an hour or after the nausea has passed.

There is no need to worry about the postoperative period - the anesthesiologist will always be in touch.

Reasons for the development of caries in temporary teeth

When visiting a dentist, parents are invariably interested in the reasons for the appearance of such an unpleasant disease. This is important because it helps prevent damage to new teeth. Sometimes it is enough to change eating habits and hygiene patterns so that the child forgets about fillings for a long time, and only comes to the dentist for examinations.

Causes of caries:

• Poor or insufficient oral hygiene. Food remains in the interdental space and on the enamel are an excellent environment for the development of carious bacteria.
• An unbalanced diet with a preponderance of sweets and carbohydrates - during the fermentation of simple carbohydrates, acids are formed that provoke the destruction of enamel.
• The lack of solid foods in the menu leads to a decrease in the frequency of chewing, reduces salivation and becomes a common cause of caries of primary teeth in young children.
• Long-term use of nipples, including on bottles and sippy cups, increases the risk of developing single or multiple bottle caries of the anterior milk teeth in children.
• Rickets is a pathology that provokes the destruction of dental tissues.
• Genetic predisposition of the child.
• Problems with bite – various anomalies in the formation of the dentition.
• Decreased natural immunity due to frequent acute respiratory viral infections, chronic diseases, and taking various medications.
• Damage to tooth germs in the prenatal period - due to maternal illness or neglect of health in the first trimester.

At what age can you treat

There are no strict age limits regarding the age at which children can have their teeth treated. Indications for visiting a doctor are:

• carious foci of infection in the oral cavity;
• inflammation of periodontal tissues;
• baby has bad breath;
• enamel fluorosis.

What happens if dental problems are not treated? A chronic source of infection can lead to premature tooth loss and other health problems - pharyngitis, laryngitis, disruption of the functioning of the intestines and stomach. Children with untreated caries become vulnerable to viral, fungal and bacterial pathogens due to the fact that their immunity cannot work at full strength.

Caries can spread not only to enamel and dentin, but also to the rudiments of permanent elements, provoking the development of periodontitis. One of the serious complications of dental disease is pulpitis, accompanied by acute pain.

Pulpitis has several stages of progression, and the most complex of them lead to complete destruction of the tooth and involvement of the neurovascular bundle of the unit in the pathological process. An infection through the bloodstream can spread throughout the body and cause a malfunction of the respiratory system and heart.

Untimely loss of dentition elements leads to improper chewing of food due to unevenly distributed load between different parts of the jaw. Insufficiently processed and crushed food is poorly absorbed by the gastrointestinal tract. Therefore, children should be shown to dentists at the moment when they show the first signs of dental disease, regardless of age.

Endolaryngeal infusions

Recommended for acute laryngitis, along with nebulizers, mucolytics and much more.

The cause of acute laryngitis in most cases is a viral infection. Therefore, the main treatment here is time. The use of antibiotics is not indicated even for mild bacterial infections in the larynx, which are much less common than viral ones.

With endolaryngeal infusion, the solution enters directly onto the vocal folds at the time of phonation, which means there is a very high risk of it entering the lower respiratory tract. In cases where the larynx is poorly visible and the procedure technique is not followed, the doctor pours the solution into the esophagus, the patient swallows it, and there is no positive effect after the procedure, even temporary. At the same time, such a “blind” infusion of the solution increases the risk of aspiration (entry into the respiratory tract).

Antibiotics are used for infusions into the larynx, which, when applied topically, do not have a bactericidal effect. Oil solutions can be used, the positive effect of which is easily replaced by a home humidifier and ventilation. The effect of using hormonal agents (dexamethasone or hydrocortisone) is very short-lived. Moreover, in emergency situations, for example, for singers before a concert, preference should be given to the systemic use of hormonal therapy. The use of hormones leads to the rapid disappearance of inflammation of the vocal folds and improvement of voice quality, but one has to put up with the possible side effects of this group of drugs, so in standard situations the potential risk of their use outweighs the possible benefits.

A number of studies have shown that the voice is restored in equal time - when treated with antibiotics and when taking a placebo.

Important to know : viral laryngitis usually lasts 7-10 days and goes away on its own.

Sedation scheme

The patient puts on a mask, and 100% oxygen first enters his lungs. The oxygen mass is supplied at a speed of 4-6 liters per minute. Nitrogen is gradually mixed with oxygen. Its content is increased to 30%. When the proportions of nitrogen and oxygen are brought to a ratio of 30 to 70, respectively, the moment comes favorable for starting treatment. However, it should be noted that the concentration of nitrous oxide may vary depending on the individual patient. It is important to achieve the desired effect, and it, in turn, can occur with a different ratio of nitrogen and oxygen. Individual indicators are recorded in the patient's record.

The blood is saturated with gas in about 5-7 minutes. Nitrous oxide is completely dissolved in blood serum and is not biotransformed in any way. As soon as the supply of ZAX stops, the process of removing gas from the lungs begins. The gas is removed completely unchanged.

ZAX differs from other sedatives in that the sedative effect occurs very quickly, and the trace effect is completely absent. This is caused by nonspecific depression of the central nervous system.

Sedation manifests itself as follows: a comfortable and relaxed state; good, elevated mood; movements are inhibited; deep breathing; motor activity of the eyes is reduced; sound perception is dull; resistance is reduced.

If you plan to undergo a particularly painful procedure, you can temporarily increase the concentration of nitrous oxide to 50% (acceptable limit is 70%). Nitrous oxide has an analgesic effect, and also enhances the effect of local anesthetics. If the child is suddenly frightened and painful sensations begin to “reach” him, manipulation with nitrous oxide will quickly calm the baby down and treatment can be continued.

Thus, the use of ZAX makes it possible to carry out treatment of any complexity in just one visit.

As for removing the patient from the state of sedation, it occurs smoothly and consists of supplying 100% oxygen for 5-10 minutes. At this time, the doctor communicates with the child, trying to reinforce his positive impressions of visiting the dental office.

In general, the successful use of ZAX is impossible without the competent use of behavior management techniques. Trying on a mask by a child should be done in a playful way so that the child has time to relax before the onset of sedation. The doctor calms the child by telling him about the condition he will soon find himself in. You cannot force a mask on, as this may cast doubt on the success of the procedure.

How to prepare for the sedation procedure?

It is necessary to strictly adhere to the recommendations given by the doctor, namely:

Before performing drug sedation, it is necessary to do a general blood test, coagulogram, ECG, biochemical blood test, tests for HIV, HCV, HbsAg, Rw. These studies are required for the safety of the patient himself. General preparation for the procedure is usually carried out directly in the dental clinic itself. Patients are advised to refrain from eating and drinking 4 hours before the procedure.

The doctor should be aware of whether the child has respiratory problems, in particular whether he has difficulty breathing through his nose. In the case of such diseases, the sedation procedure loses its effectiveness to some extent. Be sure to tell the dentist what medications your child took on the day of the clinic visit.

How to choose a doctor for your child

A child's first visit to the dentist is a very important event that should be taken very seriously. It is imperative to find a doctor who gets along well with children and to whom the child will go with great pleasure. This will determine whether he will have a fear of dentists in the future.

It is recommended that you spare no expense for the first time and take your child to a paid clinic . In such institutions, treatment is accompanied by a friendly attitude from the staff; children are often shown cartoons and given toys to play with.

Is sedation with ZAX safe?

Yes, it's safe. ZAX is completely harmless for children. Moreover, today it can be called the safest sedative. It is easy to use, is eliminated from the body without a trace, does not have a heavy or overly strong effect, and is not addictive. The child remains conscious, his breathing is not difficult, all reflexes are preserved. The use of ZACS ensures maximum safety, complete controllability and early activation of the patient.

You may have doubts about how well this technology has been tested. Despite the fact that it represents an innovation for Russia, ZAX sedation has long been used throughout the world (more than 30 years). The vast majority of pediatric dental clinics in the USA, Israel and the UK use ZAX as the main sedative. Thus, this technology can only be called new conditionally - it has long been tested and approved by professionals.

Puncture of the maxillary sinus

Practically not used in modern otorhinolaryngology. For acute bacterial sinusitis, systemic broad-spectrum antibacterial drugs are indicated, which successfully cope with the bacterial process without punctures and “cuckoos”.

Punctures for a bacterial process in the maxillary sinuses are mainly indicated if culture of the sinus contents is needed - usually when 1-2 courses of antibacterial therapy are ineffective.

Very rarely, such punctures are performed for diagnostic purposes, when it is not possible to perform radiography or computed tomography of the paranasal sinuses. Another indication is severe pain associated with the pressure of the contents on the walls of the sinus. The puncture is done once during the main treatment. Several punctures are indicated only in the case of a persistent bacterial process with two or more courses of antibiotics, and there is no possibility of performing endoscopic surgery on the sinuses.

It has been proven that puncture of the maxillary sinus does not speed up the healing process.

It is important to know : puncture, like any invasive method, can have complications, including trauma to the medial wall of the orbit, nasolacrimal duct, soft tissues of the cheek, and nosebleeds.

How is caries of permanent teeth treated in children?

Caries on permanent teeth is treated as in adults. The main method is filling. Photocomposites are the most successful for sealing the affected cavity. These are materials that do not differ in color or texture from teeth. Filling takes place in several stages:

1. Introduction of anesthesia.
2. Removing dead tissue using a drill and cleaning the cavity.
3. Rinsing the tooth with an antiseptic.
4. Air drying.
5. Application of phosphate cement insulating gasket.
6. Filling with composite materials in several layers, each of which must be dried with a special lamp.

For shallow caries, infiltration, remineralization or ozone therapy can be used. Silver plating is contraindicated.

Differences between sedation and general anesthesia

1) The occurrence of coughing, swallowing and other reflexes is excluded, which in turn allows for complete dental safety.

2) The dentist can fully control the patient’s condition, since he is conscious throughout the entire procedure. Another advantage of the action of sedatives is the fact that a person under its influence can be taken out of a state of superficial sleep at any time.

3) The patient is in a relaxed state and can communicate with the doctor.

Very often, due to anxiety, a person cannot clearly formulate his problem, and the patient’s internal tension can complicate treatment. Sedation makes it possible to relieve emotional stress without causing harm to the body. Also, when a person experiences psychological stress, hemodynamic changes occur. High blood pressure and rapid heartbeat force the attending physician to make certain changes to the given treatment regimen.