Dr. M.ª Cecília Miranda

Dentist

Pediatric dentistry in an operating room?
Yes. Because the smile of a child deserves everything

HPA Magazine 23 // 2025

In the year 2025 we may think that early childhood cavities are no longer a frequent reality, as society is more aware of the importance of oral hygiene in childhood. However, in my daily paediatric dentistry clinical practice, this is not what happens.

Unfortunately, it is common to receive children between two and six years old with more than 4 decayed teeth, already suffering from episodes of pain and/or tooth abscess. The causes are mainly the early introduction of sugar into the diet (often before the age of two), the high consumption of foods with large amounts of sugar, namely gum, chocolate, biscuits and ultra-processed cakes, but also the difficulty in correct dental hygiene. Parents often report that the child does not allow or cooperate with tooth brushing, and as a result, there ends up being some permissiveness, with insufficient brushing being carried out or simply letting the child brush alone.
Now, tooth decay in baby teeth progresses quickly, so when children come to us, they already need extensive and complex treatments, requiring several treatment sessions with repeated administration of local anaesthesia.
As you can imagine, in the first six years of life there is not always enough collaboration on the part of the child to undergo the necessary treatments in a normal dental office context. It is also common to receive children with behavioural changes associated with the autism spectrum or syndromes, which do not allow for chair-based treatments. When, after the second or third intervention attempt, there is no collaboration at all, it is necessary to think of new strategies.
If the child is 4 years old or older, the first option is to try using conscious sedation, available in most HPA Group Dentistry units. It is a mixture of nitrous oxide and oxygen administered through a nasal mask, which is inhaled by the child during the dental procedure. It causes a state of minimal depression of consciousness, allowing the child to be calmer and less reactive to their surroundings. The level of gas administered can be reduced or increased by the Dentist, depending on the child's level of cooperation. Recovery is quick, taking just 10 minutes for the medication to be completely eliminated by the body.
However, there are cases in which conscious sedation is not sufficient to allow the child to cooperate, and until the age of 4 this technique is not effective.
The solution then involves carrying out dental treatments under general anaesthesia, in a surgical centre, at the HPA units in Alvor and Gambelas.
In the pre-operative dentistry consultation, dental X-rays are performed to plan the treatments to be carried out. If this is not possible, the X-rays will be performed in the operating room. The Dentist will then provide an approximate plan/budget for all dental treatments as well as an estimate of the time and cost of using the surgical centre.
Once this plan is accepted by the child's parents, pre-operative exams and consultations will be scheduled, namely blood tests, electrocardiogram, chest X-ray and pre-operative nursing consultation, necessary so that the feasibility of carrying out the procedure can be assessed by the anaesthetist. General anaesthesia safely.

After being anesthetized, the child is constantly monitored by the Anaesthetist and at least one nurse throughout the intervention.
The conditions are then met so that the Dentist can carry out treatments in a methodical and sequential manner, on all affected teeth.
We begin by performing the aforementioned X-ray to confirm which procedures will be performed. Due to the depth of the cavities found, it is often necessary to carry out pulp treatments (treatments of the pulp or nerve of the tooth).
In these cases, we choose to rehabilitate the teeth with pre-formed paediatric crowns, rather than performing composite resin restorations. This will allow the tooth structure and function to be maintained until the baby teeth fall out, as restorations in very damaged primary teeth fracture easily.
As the child is undergoing general anaesthesia, we will try to offer treatments with the greatest durability and predictability possible. If they are posterior (back) teeth, these crowns will be made of steel. In the case of anterior (front) teeth, we choose to place zirconia (ceramic) crowns due to aesthetic requirements.
In smaller cavities, composite resin restorations are performed.
However, in teeth with very deep destruction or a repeated history of tooth abscess, the option could be to extract the tooth. In this case, the Dentist will be able to advise the placement of a space maintainer.This is a small device placed on the tooth adjacent to the extracted tooth in order to allow the maintenance of the space of the tooth removed early until the corresponding permanent tooth erupts.
The great advantage of dental treatments in a surgical centre is that it allows a large number of treatments to be carried out in a short space of time. In a recent intervention, in just 3 hours it was possible to carry out the treatment of 12 primary teeth, with the placement of the aforementioned steel crowns on some of the molars. Treatments are, in this way, carried out safely and in good working conditions, which are often difficult to achieve in an office environment.
Many will ask: “Is it worth all the effort to treat teeth that are going to fall out?”
The answer is a clear yes. The child suffers from frequent pain and the parents are often desperate not knowing what to do. Typically, they have already seen several dentists without success. The maintenance of repeated abscesses can affect the structure of permanent teeth and the early loss of baby teeth can lead to eruption disorders in permanent teeth and serious problems with a lack of space. Carrying out the necessary dental treatments will allow you to maintain the masticatory, phonetic and even social function of the child's teeth.
Dental treatments under general anaesthesia are not the first option, but they can be the solution for many children and their families. No phobias, no traumas, safely and effectively.
After all, a child's smile deserves everything...