PAEDIATRIC DENTISTRY - 3rd Ed. (2005)

(John Hannent) #1

There is also the risk that these items may be lost in the patient's mouth and
swallowed or even inhaled and there are reports in the literature to substantiate this
risk.


Risk of cross-infection


In addition, there is considerable risk that the use of high-speed rotary instruments
distribute an aerosol of the patients' saliva around the operating room, putting the
dentist and staff at risk of infection. Again, a risk that has been substantiated in the
literature.


Nitrous oxide sedation


If this is used it is quite likely that mouth breathing by the child will increase the level
of the gas in the environment, again putting dentist and staff at risk. The use of rubber
dam in this situation will make sure that exhaled gas is routed via the scavenging
system attached to the nose piece. Usually less nitrous oxide will be required for a
sedative effect, increasing the safety and effectiveness of the procedure.


8.6.2 Benefits to the child


Isolation


One of the reasons that dental treatment causes anxiety in patients is that the
operative area is very close to and involved with all the most vital functions of the
body such as sight, hearing, breathing, and swallowing. When operative treatment is
being performed, all these vital functions are put at risk and any sensible child would
be concerned. It is useful to discuss these fears with child patients and explain how
the risks can be reduced or eliminated.


Glasses should be used to protect the eyes and rubber dam to protect the airways and
the oesophagus. By doing this, and provided that good local analgesia has been
obtained, the child can feel themselves distanced from the operation. Sometimes it is
even helpful to show the child their isolated teeth in a mirror. The view is so different
from what they normally see in the mirror that they can divorce themselves from the
reality of the situation.


Relaxation


The isolation of the operative area from the child will very often cause the child to
become considerably relaxed⎯always provided that there is good pain control. It is
common for both adult and child patients to fall asleep while undergoing treatment
involving the use of rubber dam⎯a situation that rarely occurs without (349HFig. 8.10).
This is a function of the safety perceived by the patient and the relaxed way in which
the dental team can work with its assistance.

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