Dr. Janet Southerland Talks Safe Dentistry Sedation

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Published on Wednesday, 22 August 2012 02:29

Written by Jackie Jones, BlackAmericaWeb.com

Got a question about pediatric dentistry? Text it to "646464" (OHOHOH).

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In ABC News investigation raised questions about the safety of pediatric dentistry sedation.

The report said more than a dozen children had died after sedation by dentists who were not properly trained to respond to emergencies that could arise through the use of sedatives. In some cases, the dentists used substantially more sedative than normal for the age and size of the child being treated.

Oral sedation dentistry – often referred to as pain-free dentistry – has become a booming business for dentists who offer the service to ease patients’ anxiety about going to the dentist, as well as for major procedures.

Some dentists even offer sedation for routine teeth cleanings and filling cavities.

Regulations vary by state, with some calling for minimal sedation, while others give dentists greater latitude in deciding when sedation is called for.

Weekend workshops in oral sedation are being offered around the country and the ABC report said that in the past five years more than 18,000 dentists had taken such courses, which promises to add tens of thousands of dollars to the bottom line of the dentists’ practices.

Dr. Indru Punwani of the University of Illinois, a spokesman for the American Academy of Pediatric Dentistry (AAPD), told ABC that a weekend course would be "inadequate" for preparing dentists to deal with emergencies that can arise through the use of oral sedatives.
"I don't believe it can be done," Punwani said.

He also said that dentists who follow AAPD sedation guidelines have never been tied to a death.

AAPD guidelines say that sedation can be used safely and effectively and has issued guidelines for dentists to follow.

The decision to use sedation, according to the AAPD, must consider:
•    Whether there are other treatment options
•    What are the dental needs of the patient
•    What will the effect of sedation be on the quality of dental care
•    What is the state of the patient’s emotional development
•    Whether there are medical and physical considerations that might be affected by sedation

Sedation is usually recommended for fearful, anxious patients for whom traditional treatment has not worked, patients who lack the emotional or psychological maturity to be cooperative and in cases where it might reduce medical risk.

It is discouraged for patients with minimal dental needs or who have medical and/or physical conditions that would make sedation inadvisable.

Janet Southerland, dean of the Meharry Medical College School of Dentistry, has used sedation dentistry on young patients, noting in a previous interview, that issues of pain-free and cosmetic dentistry are areas that will become increasingly important to patients in the future.

Southerland’s research interests include the study of the relationship between diabetes and periodontal disease and early detection and interventions for oral cancer as well as oral manifestation of HIV/AIDS.

Southerland, who previously has served as chair, Department of Hospital Dentistry and Chief of the Oral Medicine Service, both at University of North Carolina Hospitals, as well as the head of hospital dentistry, said she used sedation dentistry for 11 years before joining Meharry last year.

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What should we do about bad breath besides the obvious care?
I do not know if this is obvious but have you tried brushing and scrapping the tongue regularly?

My daughter is a thumb sucker from birth. When is it age-appropriate to have a device placed to help with preventative shifting of the teeth? She is four now.
I would take her to be evaluated now. The pediatric dentistry specialist should be able to help you determine if this is the right time to try to intervene with a device.

What can I do in the case where I need oral surgery but don't have enough money and my insurance won't cover it?
I would contact the local dental society to inquire about practitioners of centers in the area that might provide this service on a sliding scale or reduced rate.

I had a tooth rebuilt and the dentist stated I need a crown.  I have a 12-month waiting period on my secondary dental insurance.  Is it okay to get the crown later?
Yes, I would be careful biting down on very hard foods until you can have the crown fabricated as the tooth may be somewhat more fragile.

Where can a female in Seattle , WA get some dentistry care with no insurance? My mouth is hurting me and it is extremely painful.
I would contact the local dental society to find out what safety net dental services are available in your area. Also I would try your local community health center.

How do I get my 4 year old to want to brush his teeth?
I would try to make it fun. Some kids are very independent. So I would try letting them do it first and then I would finish up. If you have not taken them to the dentist, then I would  make an appointment and let the dentist assist me by showing some effective techniques that might help.

Could diabetes medication cause your gums to grow over your teeth and what can be done to prevent it?
There are a number of medications including blood pressure medications that can cause this problem. I would have my dentist evaluate the problem. If the gums have grown too much then it is possible they may need to be trimmed back.

I breastfeed my 4-month-old baby at night. Is it important to start wiping or brushing her gums now? With or without toothpaste and what type of water?
Once a child has teeth it is important to wipe or brush them. Toothpaste is not necessary.

My 17-month-old grandaughter has been eating ice since birth. To get her to drink water now, she has mouth pain. What can we do?
Ice can cause damage to teeth, often cause cracks. This may have occurred and can cause pain and sensitivity. She will need to be evaluated by the dentist for proper diagnosis of the problem.

I'm 45 and I wanted to know is it better to get a root canal or extract #16?
Extract.

When should wisdom teeth in your child be extracted?
It depends on the individual and the position of the teeth.

What is a milk tooth in a toddler & what is the treatment? My 2-year-old has gray tooth up front.
If a tooth is gray often it is due to some trauma (has the child fallen and bumped their mouth?) to the tooth that may have damaged the nerve in the tooth. I have not really heard the term "milk tooth," but my assumption is that the tooth has developed a cavity due to the child being put to sleep with a milk bottle.

What is the new study link between geographic tongue and gluten? I have had geographic tongue since I was 5 or 6 and recently my new dentist wants to monitor me for a gluten-free diet. I was told it was harmless.
Geographic tongue can be irritating, but for the most part it is harmless.

How bad is it when you can smell a decaying tooth with your mouth closed? From time to time, I can taste it. Should I be worried?
Yes, you should. You need to have the tooth removed as soon as possible. You could be at risk for a significant infection.

What do you do when a dentist has been paid for my night guard almost 8 months ago but it is not ready yet? Who can I complain to for resolution?
I would go to the office and request my night guard or my money back and find another provider.

I have dry mouth due to taking medications. What are some remedies? I have good dental hygiene but am starting to get cavities.
You need to have fluoride prescription, preferably Prevident 5000. See you dentist to get started. There are also over the counter products to combat the dry mouth. Check with your pharmacist.

Do the over-the-counter teeth whiteners really work? Which one is the best?
I am not sure which is best, but I have been told by my patients who use them that they do work for what they are looking for.

What mouthwash do you recommend for breath?
Any of the over-the-counter products can work. It depends on your personal preference. I would suggest that you use a product that as low in alcohol as these have a tendency to dry out the tissues in the mouth.

My new dentist is telling me I need a very expensive deep cleaning and says the state of Florida will not allow them to do a regular cleaning. Are they trying to just get my money? I want the regular cleaning and will get the expensive one when I have the money.
I would suggest that if you have questions about the recommendation you seek a second or even third opinion.

My 8-year-old has a gap between the two front teeth. I want to have it fixed. Is it painful or very expensive or even needed?
I would take your child to the dentist for an evaluation as there are a number of options including braces.

I had a root canal done months ago and chose not to cap it. I've heard that many come off & is a waste of money. Is there a problem in making that decision?
Once tooth has had a root canal it becomes fragile and can break. It is very important to have the crown placed to fully restore your tooth and prevent further damage.

My son has had his braces removed, but his teeth are stained from the glue. What can we do to get them white again?
I would speak to the dentist to examine the teeth as sometimes some of the bonding material is left behind and can stain. If this is not the case then, they can provide you information on the number whitening solutions that are available.

Are bad teeth genetic?! I brush & floss daily, use fluoride rinse, and mouthwash and still don't have a great smile. I have friends who brush occasionally, sleep with candy in their mouths and still have great teeth! How is this possible?
Unfortunately, genetics do have a role in the type of teeth you have. I would suggest that you check with your dental provider to see if you might have a genetic disorder or if there are additional things that can be done to enhance your dental health and smile. You will be amazed at the options available!

What age should I have my child's wisdom teeth extracted? They are constantly sore.
If your child is having problems, I would take them now for evaluation and extraction if recommended.

With all the sparkling, fruity flavors of paste, is there a brand of toothpaste you would recommend for children?
All are fine, just make sure they contain fluoride.

My boyfriend wakes up everyday with  a black residue around his teeth and gums. It makes his breath smell really not good and he says it tastes like sweaty gym socks and onions. I am sure it builds up throughout the day. He just doesn't notice it because he's eating and drinking. He has no health or dental insurance. And I believe he's afraid to go to the dentist. I think it's bacterial and could be affecting him throughout his system. What is it?
It sounds like he might have gum disease and that his gums are bleeding spontaneously. I would encourage him to make an appointment to see a dentist as soon as possible. This process if left untreated can lead to infection and tooth loss.

I don't eat anything sweet at all and try to brush my teeth as much as possible. I still have toothaches. What's the problem?
Most toothaches are due to cavities. I would you encourage you to visit a dentist so that they can help you to pinpoint the problem.

What is a better choice to correct crooked teeth for my teen? Invisalign or traditional braces? Which is pricier? Does Invisalign correct an overbite?
The recommendation for the type of orthodontic treatment you might need will depend on the type of bite you have, your jaws and a number of other factors. An evaluation by an orthodontist will help to answer all of your questions.

My gums are partially blackened. How can I get them pink again?
If you have natural pigmentation in your gums, this may be hard to change. I suggest you consult a gum specialist to see what might be possible.

Can teething in infants cause an ear infection?
I do not think so. I believe such an occurrence is coincidental.

I've started a overnight shift and stopped smoking cigarettes. My gums have been swollen and hurting. I have been rinsing with Listerine and salt water. Any more advice until I can be seen at a dentist?
I believe that this is all you can do until you see a dentist, particularly if you have developed gum disease.

After brushing my two year old's teeth, they still look yellow. I have to physically scrape the plaque off. Why is this? Any toothpaste or toothbrush suggestions?
Some foods can really stain babies' teeth. I would suggest taking your child to the dentist to see what else you could do other than what you are already doing. Depending on the age of your child only a small amount of toothpaste is recommended and always a soft brush.

My son who has autism refuses to brush his teeth. Any  suggestions?
You need to schedule an appointment for your child with a pediatric dentist or general dentist who specializes in treatment of special needs patients in your area.

What age does Medicaid stop using braces?
This is dependent on individual states. I would contact the state Medicaid provider.

My 9-year-old grinds his teeth while sleeping. How damaging is this to his teeth? What can I do to help?
I would consult a dentist for fabrication of a night guard that can help with the problem.

Can you please inform the people of the link of dental issues and cardiac problems?
I do this on a regular bases as I just published an article this past January on diabetes, gum disease, and cardiovascular disease. I would be happy to provide any information.

At what age should I get my child's first dental checkup?
When their first teeth come in.

My grandson lost his front teeth around 6 months ago and they still have not came in. Is this normal?
Yes, the permanent teeth will not come in until around age seven or eight.

I went to dentist with my 7-year-old grandson and was upset that he has three cavities.  What are some recommended drinks for someone his age?  He loves his fruit juices, ice tea , etc. Grandma is trying to save her grandson's teeth, plus her checkbook.
I would change him to sugar free drinks. There are a number of options. In addition, He should only be allowed to water after brushing his teeth at night.

When using a water pic system, is it necessary to floss also?
Yes.

I have a bump on my gum just behind my top K9 tooth and it hurts my face all up on the side of my nose. What can I do? You need to see a dentist. It sounds like you might have an infection. An infection in this area can spread easily and can be very dangerous.

What causes TMJ after a root canal?  How long does it last & what can one do to get rid of it?
I would seek evaluation from someone who specializes in treating TMJ problem to help with answering your questions.

What's the best way to combat bad breath? My co-worker is killing me. I'll pass along the advice.
See a dentist to rule gum disease. It is one of the most common causes of this problem.

When do we need sedation for extraction? Is it all about making money?
This depends on the patient and the extent of the oral health needs.

I have two wisdom teeth and I can't eat anything cold without it hurting and also a tooth that's cracked in the back of my mouth. Should I get them pulled immediately?
Yes, before they become infected and then it gets even more painful.

The right side of my jaw hurts when I wake up in the morning. I find myself clenching my teeth at night. What can I do to stop this?
I would be evaluated by my dentist to see if you are in need of a night guard that will help the clenching.

My daughter (age 17) was elated to have her braces removed this summer. Now there's a request to have her non- disturbing molars removed, which is more money and her downtime. I was told if they are not removed, her teeth could shift. Seriously? I didn't wear braces, but my non-disturbing molars are intact and I'm 41 with straight teeth.
I would hope that your daughter was given a retainer after the braces were removed. If she wears the retainer as instructed I would not expect her teeth to shift. If her wisdom teeth are not bothering her, I see no reason for you to have the surgery.

Is it true that when you have permanent dental implants, it can cause the jaw bone to break down? I want to get them. I hate my false teeth.
No, just the opposite research has shown that the implants actually will help preserve the bone. This is a great option!

Is Arrestin helpful long term for periodontal disease?
Depending on the type of periodontal disease it can be a solution. I believe that a gum specialist would be able to provide the most accurate information as it relates to whether Arrestin or another treatment would be the best long term solution again depending on the extent of disease.

I got a root canal started with a temporary cap. I lost my job and my insurance ended. What can I do to get a permanent tooth on to complete with no insurance now?
There are a number of entities that offer care at reduced cost or payment plans. I would contact my local dental society and they should be able to assist you in identifying local affordable dental care options.

A filling fell out of my tooth a few months ago but I can't afford a cap. What are my options?
Depending on the extent of the cavity, you may be able to have the tooth refilled. I suggest you see a dentist as soon as possible. The longer you wait the more expensive the treatment may become.

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