Sounds like you have 2 questions: one about your 3 year old and cavities, and the other about anesthesia and your little one.

I'll start with dental care and children. The first thing I should say is that your little boy is perfectly normal. The average 3 year old can have at least 2 cavities. Most people don't necessarily know that because they don't take their children in to see the dentist until they are older and have a problem.

Your child's dentist should be a pediatric dentist or a dentist who does a lot of children. Your precious treasure should be cared for by a professional who knows his or her stuff on kids.

What can help prevent cavities?

• Most of a child's primary teeth come in by 2 1/2 to 3 years of age. Your dentist may start applying a topical fluoride to your child's teeth. This essentially hardens the enamel, and helps to prevent cavities.

• If your water is not fluoridated (supplemented with fluoride) your dentist may need to put your child on fluoride supplements.

• Children as young as 2 or 3 years of age can begin to use toothpaste (not more than a pea size amount). They should be taught to spit out the toothpaste, not swallow it. Brushing twice a day should be emphasized.

• As children grow, and their permanent teeth come in, your dentist may want to apply a "sealant" to the molars to prevent decay.

• Cavities need to be addressed whether they are in the "baby" teeth or "adult" teeth. Cavities can lead to bigger and worse things if ignored.

Now the BIG question is "Should my child receive anesthesia for a cavity?"

I am very familiar with anesthesia and sedation practices in children (I used to be the director of pediatric sedation, and supervised the care of children while "asleep").

Let me define the 3 main terms used in the relaxation and pain relief of children:

• Local anesthesia - an analgesic (pain medicine) is injected into the site to be worked on, e.g. suturing of a wound in a finger.

• Conscious/Deep Sedation - medicine is administered orally, intravenously, or intramuscularly and your child is put in a very relaxed state. He still can swallow, cough, and gag (these are normal protective mechanisms, which we all possess).

• General anesthesia - medicine is administered orally, intravenously, intramuscularly, or by gas and your child is placed into an unresponsive state. He no longer possesses his protective mechanisms; he cannot cough, swallow, or gag. General anesthesia therefore has the highest risk of the 3 options.

General anesthesia when performed in the dentist's office, should be supervised by a trained anesthesiologist or oral surgeon. At least 1 person trained in basic life support should be present. General anesthesia should only be used if the first 2 options (local anesthesia and/or conscious/deep sedation don't work).

I think it would be in your child's best interests to get a second opinion from another dentist who does a lot of children (preferably a pediatric dentist). I know many dentists who are very good with children, put them at ease, and can fill  a cavity without putting the kids "to sleep".

Remember, any type of sedation or anesthesia should be administered by a professional who does it for a living, and there should be a strong reason for its administration. Ask questions and get answers. Your child is your treasure...get the BEST!

I hope that puts you in the right direction. Dr. Mike

This article was reviewed 04/23/2010 07:24 AM

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