Treatment of children’s teeth under narcosis | Eva Magazine | August 2015

Interview with Dr. Cvetelina Ducheva from DENTAL CLINIC PETAR DUCHEV
By Mariana Antonova

She spares the children and their parents the stress from hours of work on multiple cavities, pain and damaged teeth.

Dr. Ducheva, in what cases do you recommend general anesthesia in the process of treatment of children’s teeth?

Usually it is the parents who look for us because they know their child has a serious problem, or they have been referred to us by colleagues of ours. 90% of the cases are of physically and mentally healthy little patients between 2 and 7 years, with numerous cavities, destroyed chewing teeth as a result of an inherent problem with the enamel and dentin, or because of incorrect eating habits and oral hygiene. The children experience pain, sleep and eating problems. Sometimes it happens that when the parents take their child for a routine check or for a check for a specific problem, we find that the problem is multiple or very advanced. Then I explain that narcosis is preferable and has indications, since for an hour and a half and without the child feeling anything, we can perform many manipulations. The remaining 10% are children with autism or with inherent chronic diseases or allergies that require treatment under strict medical control.

Do the cases requiring general anesthesia become more common?

Cavities are pandemic and the children are most affected, this is why I call for prophylaxis from the earliest age. General anesthesia spares the stress of hours of work in the dental office, but it is not a cure-all, prevention of cavities is best for our children.

Aren’t the parents stressed when you suggest that their child should sleep?

Most of the parents who have not come to us with this idea in mind, are really shocked at first. But when we show them what we do precisely – we take photos during every stage of the treatment of a child under narcosis, when they see the place where the procedure takes place and when they meet the experts from the anesthesiologist’s team, in 80% of the cases they agree to proceed. А conversation with a family whose child has already made this step, is really reassuring for them, as well.

In Germany and the USA laughing gas is used in 90% of the cases of treatment under sleep.

According to recent research, however, it affects the future psychological development of children. We have selected the intravenous anesthesia with the most purified medicaments currently on the market. The procedure is performed under strict medical control. Unlike the medical sleep of the adult patients, the swallowing reflexes of children are turned off and their sleep is deeper. The goal is to have the child sleep during the intervention without any risk of waking up. The breathing is sustained in its normal rhythm. During the treatment the child does not feel pain, does not cry, does not pull back and salivates very little. A special isolating system is used, which protects the mouth and the throat of the little one and does not allow the saliva to break the hermetic bond between the photopolymer and the tooth, which prevents the formation of a secondary cavity around these restorations.

Do you follow up on these children after the procedure?

As a rule I do – at the first week, at the third month and afterwards I request to meet them every six months. It is not narcosis-related, but rather intended to further motivate the parents to take care of the good oral hygiene of the child. Sick teeth make children aggressive and hypersensitive. After we have solved the problem, they are calm, smiling and happy.

How do the children perceive this procedure?

Usually before the narcosis I tell the child – when you wake up, the tooth fairy will have fixed your teeth and they will be healthy, white and clean. The children fall asleep in their mothers’ arms and wake up there again. They tell us that they have dreamt of princesses and knights, and strangely enough, I become the tooth fairy for all children afterwards and they call me Dr. Cveti.

What was your most shocking case of narcosis?

The most difficult one was of a child I worked with for 4 hours. It had not yet turned 5 and 19 of its 20 primary teeth were damaged.
The most shocking case was of a two-year-old child whose pacifier had been dipped in honey since its infancy. All 16 primary teeth that had erupted, had cavities as a result and the upper front were so decayed that they were hidden by the gum. The child could only have mashed and liquid food.

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