Okay. I am a parent also, so let’s be real. Despite some of my best and most deceptive efforts (bribery included), there are still things I just cannot get my two-foot tall bosses to do. Some try money. Others try candy. Others just try discipline. Yet, the thumb prevails over all. So then what? Well, unfortunately for your child (but fortunately for you), there is an alternative. If they don’t stop by age four, a trip to your dentist is recommended. You see, we have a special device made to cure thumb-sucking. It’s not pretty and it doesn’t hurt, but it will work. The appliance is called a “palatal crib” or “thumb-sucking appliance.”

The appliance looks a little like a medieval dental retainer but is painless. It is cemented to the child’s top teeth and spans the width of the roof of the mouth (also known as the hard palate). The smooth wire that makes that span does not allow the thumb to make the suction that is needed to perform the sucking motion. Voila! No gratification in sucking anymore. Eventually, (sometimes a few weeks or months) the child will no longer have the desire/addiction to suck their thumb or fingers and the appliance is easily removed. If your regular dentist is not comfortable making or placing this appliance, they may refer you to a pediatric dentist.
 

The appliance of course, should be your last resort. Your child-rearing books again are filled with a multitude of tactics and tricks, depending on your parenting style. Try a few and see what works best for your child. Some will recommend positive reinforcement or discipline while others will recommend a terrible tasting, harmless potion to place on the thumb or finger. Since each child is so different, what may work for one may not work for another. So, you will just have to be patient and persistent until you find what works for you!

Sometimes, despite what the dentist does to calm a child during a procedure, the tactics and strategies are unsuccessful. Additionally, sometimes a child needs so much dental work at such a tender age, that it just isn’t appropriate to have them completely coherent throughout the procedure. For these reasons, sedation may then become a good option.

There are many types of sedation, ranging all the way from laughing gas to putting the child completely asleep. Each type of sedation comes with different risks and you should inform yourself well and choose sedation once you feel comfortable and knowledgeable. Also, not all dentists perform sedation. Most general dentists (as discussed at the beginning of the book) do not perform the type of sedation where the child is put into either a “twilight sleep” or “complete sleep”. This requires a special certificate of training and special monitoring equipment in order to perform. It is possible, however, for a general dentist to perform partial-sleep “twilight” sedation with the proper training. The reason many generalists choose not to do this, is because of the outrageous expense of the monitoring equipment and the high cost of liability insurance to do so.

A pediatric dentist is already trained and certified and the special equipment is part of their everyday cache of inventory. The pediatric dentist may also decide to perform the treatment in an operating room under the supervision of an anesthesiologist. This typically happens when the dental treatment is more extensive and the dentist feels it is in the child’s best interest to be put under general anesthesia or completely “asleep.” In this case, an anesthesiologist is necessary, as he provides the complete care of sedation of the child during the entire length of the procedure. This allows the dentist to focus only on the dental treatment, and helps prevent any potential complications of inadequate monitoring of sedation.

Sedation can be achieved in several ways. Three sedation techniques include oral sedation (child takes an oral sedative prior to dental work), I.V. sedation (child receives sedation medication through an I.V., usually in the arm) and inhalation anesthesia (child breathes anesthetic). A combination of any of the three can also be used. All methods require special training and equipment for monitoring and reversing sedation as needed. Each have their own risks and benefits and should be discussed thoroughly with your dentist before undergoing treatment

Laws for sedation can vary by state and the dentist performing the sedation should be familiar with the requirements needed to achieve a safe and legal sedation experience. Be sure to discuss the risks and advantages with your dentist and anesthesiologist completely prior to committing to any sedation experience.