Surgery performed on pediatric patients involves a number of special considerations. Children are not small versions of adults; their anatomy and physiology are quite different, so specialty care is essential. Our doctors and staff are specially trained in pediatric dentistry, including oral surgery; and provide services to children of all ages throughout San Luis Obispo County, including the communities of Atascadero, Paso Robles, Templeton, and San Luis Obispo. Several critical issues should be addressed, including the following.
Important considerations in treating a pediatric patient include obtaining a thorough medical history, obtaining appropriate medical and dental consultations, anticipating and preventing emergency situations, and being prepared to treat emergency situations. It is important to perform a thorough clinical and radiographic preoperative evaluation of the dentition as well as extraoral and intraoral soft tissues. Radiographs can include intraoral films and extraoral imaging if the area of interest extends beyond the dentoalveolar complex.
Behavioral guidance of children in the operative and peri-operative periods presents a special challenge. Many children benefit from modalities beyond local anesthesia and nitrous oxide/oxygen inhalation to control their anxiety. Management of children under sedation or general anesthesia requires extensive training and expertise. Special attention should be given to the assessment of the social, emotional, and psychological status of the pediatric patient prior to surgery. Children have many unvoiced fears concerning the surgical experience, and their psychological management requires that the dentist be cognizant of their emotional status. Answering questions concerning the surgery is important and should be done in the presence of the parent.
Growth and development
The potential for adverse effects on growth from injuries and/or surgery in the oral and maxillofacial region markedly increases the potential for risks and complications in the pediatric population. Traumatic injuries involving the maxillofacial region can affect growth, development, and function adversely. Surgery for acquired, congenital, or developmental malformations may, in itself, affect growth adversely. This is seen in the cleft patient, for example, where palatal scarring following primary palatal repair may result in maxillary constriction.
Surgery involving the maxilla and mandible of young patients is complicated by the presence of developing tooth follicles. Alteration or deviation from standard treatment modalities may be necessary to avoid injuring the follicles. To minimize the negative effects of surgery on the developing dentition, careful planning using radiographs, tomography, cone beam computed tomography, and/or 3-D imaging techniques is necessary to provide valuable information to assess the presence, absence, location, and/or quality of individual crown and root development.
Metabolic management of children following surgery frequently is more complex than that of adults. Special consideration should be given to caloric intake, fluid and electrolyte management, and blood replacement. Comprehensive management of the pediatric patient following extensive oral and maxillofacial surgery usually is best accomplished in a facility that has the expertise and experience in the management of young patients.