2711 N. Duke Street   Durham, NC 27704


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Duke Oral Health

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Treatment Options


Our goal is to complete your child’s dental care in a safe and comfortable environment.  We need your child to be able to follow specific instructions and sit still in order to provide quality care.  We reserve time every morning for special dental procedures, because children are more cooperative in the morning hours.  We want to avoid your child having a bad experience and becoming scared of the dentist.  Therefore, we need your guidance in selecting the best option described below.  If your child is unable to sit or follow instructions, then fixing their teeth is like a car upside down in the dark going 100 miles per hour - in other words this situation becomes not only dangerous but the quality of the dental care is severely compromised.


Local anesthesia only: To restore or extract any tooth, local anesthesia is usually necessary.  This technique involves injecting a small needle into the gingival (gum area or skin) near the tooth to be fixed.  The needle delivers the lidocaine to the tooth.  This option is good for the cooperative child.  However, for younger children, this method can be very unpredictable --- because young children can become restless and fearful for a variety of reasons such as the noise from the dental drill.  Also a child who is anxious may metabolize (use up) the local anesthetic much faster than is needed.


Local anesthesia and nitrous oxide & oxygen: Nitrous oxide is a very safe sedative inhaled by the child breathing through their nose.  After breathing the gas, the child usually feels relaxed and less anxious.  It is important that your child understand that throughout the procedure, they will need to breathe through their nose and avoid mouth breathing.  This approach is very helpful with minor surgeries and restorations for children older than 4 years old.  Note--- most insurance companies DO NOT cover nitrous oxide.


Local anesthesia with Versed sedation: This regimen involves your child sipping medication from a cup.  We mix the sedative with Children’s Tylenol or Children’s Motrin to improve the taste.  Your child will continue to remain conscious (awake); therefore, it is not possible to ensure that your child will be quiet and calm during the entire treatment.  Versed oral sedation is the preferred approach for young children, between the ages of 2-4.  Poor results can be expected when treatment time extends past 25-30 minutes.  Children who have severe asthma are not candidates for this type of treatment.  In addition, a child that has been sedated with Versed is requested to return home for the remainder of the day with appropriate supervision.


Local anesthesia with Valium sedation:  This option involves your child sipping or swallowing the medicine. The prescription for Valium is filled at the pharmacy and administered by the parent at home 30 minutes prior to the child’s appointment.  This option is most effective for children older than 4 years old.  The benefit characteristics include decreased anxiety and longer acting sedative (> 30 minutes).  Children who have been sedated with Valium are requested to return home for the remainder of the day with appropriate supervision.


General Anesthesia: This technique renders your child asleep and unaware of any treatment being preformed.  This is the same technique used to put tubes in children’s ears or to have their tonsils removed.  Our team goes to the Operating Room at Duke North Hospital every Wednesday and Friday to fix children’s teeth under general anesthesia.  A down side to this technique is the cost.  This procedure requires a medical anesthesiologist – so there will be a bill from the hospital, the anesthesiologist and the dentist.  General anesthesia is a wonderful option for the fearful child, a child with complex dental needs or a child with complex medical needs.


Questions about General Anesthesia


Who should receive general anesthesia?

Children with severe anxiety and /or the inability to sit still for dental care are candidates for general anesthesia.  Usually, these children are young or have compromised health issues.


Is general anesthesia safe?

YES! In addition, to ensure the best possible care of your child, our doctors request that all of their general anesthesia cases be covered by a pediatric anesthesiologist.  The anesthesiologist is the medical doctor who is responsible for delivering the general anesthesia and caring for your child while he or she is unconscious.  Many precautions are taken to provide safety for the child during general anesthesia by anesthesia personal who are highly trained to manage complications.  We will discuss the benefits and risks involved with general anesthesia and why it is recommended for your child’s treatment.


What special considerations are associated with the general anesthesia appointment?

Most of the time, your child’s surgery will be done on an “outpatient” basis.  This means they will have their surgery in the morning and be allowed to go home in the afternoon.


Physical examination – is required prior to a general anesthesia appointment to complete dental care.  This physical examination provides information to ensure the safety of the general anesthesia procedure. Dr. Keels will advise you about any evaluation appointments that may be requested.


Prior to surgery –Talking with your child about the appointment will reduce the anxiety.  Explain they are “going to go to sleep and when they wake up their teeth will be fixed.”


Eating and Drinking - It is IMPORTANT NOT to have a meal or snack past midnight before anesthesia.  You will be informed about food and fluid intake guidelines at the time of the pre- op appointment.


Changes in your child – If your child is sick or running a fever the day or night before the surgery appointment PLEASE CALL DR. KEELS IMMEDIATELY! It may be necessary  to arrange another surgery date.


Usually, children are tired following general anesthesia. You may wish to return home with minimal activity planned for the remainder of the day.  The following day your child can return to their normal everyday routine.