Minor Oral Surgical Procedures In Children
The dental treatments commonly associated with Pediatric Dentistry are orthodontic treatments for correction of malocclusions or repair of tooth decay in children. In certain cases, it becomes important to have minor Pediatric Oral Surgery procedures to maintain and improve the oral health of the child. Minor oral surgical procedures are of short duration and are often carried out under mild sedation. While oral surgery in children is similar to those done for adults, there may be a few additional steps involved. A preoperative evaluation is necessary before planning the surgery since children may not be completely sure about what their dental issues are. Even post-surgery, children may require more care and supervision to aid in faster recovery and to keep the surgery site free from infection.
Common Indications for Pediatric Oral Surgery
While surgery can sound like an intimidating term, minor oral surgical procedures are fairly routine. Common conditions that require oral surgery in children include:
- Severe Caries and Dental Infections
- Dental Trauma or Fractured Teeth
- Severe Caries and Dental Infections
- Unerupted or Impacted Teeth
Pediatric oral surgery may also be necessary for certain other conditions, as detailed below.
Supernumerary Teeth
In a condition known as hypodontia, supernumerary teeth may appear in a child’s mouth. Supernumerary teeth refer to extra teeth that are mostly found among permanent teeth (but nowadays also seen in primary dentition on rare occasions) and can appear either as a single tooth or as a cluster of multiple teeth. This may be caused due to several reasons including genetic disorders, overactivity of the dental lamina (the cells that initiate the development of teeth), or atavism (a tendency to revert to a trait that was lost during evolution). There are various types of supernumerary teeth including Mesiodens, Odontomes, and paramolars. Appearance of supernumerary teeth can cause issues like impacted (normal) teeth, malocclusions, problems with chewing and speech, formation of cysts or tumors, eruption of teeth into the nasal cavity, or interference with bone grafting required for dental implants. The extra teeth may need to be extracted through minor surgical procedures to create space for the normal teeth.
Odontoma
Odontoma are benign tumors of the jaw consisting of enamel, dentin, cementum, and odontogenic hard and/or soft tissue. They are slow-growing and non-aggressive but can cause swelling, pain, and jawbone expansion, and can hinder the eruption and development of surrounding teeth. Odontoma can be commonly spotted in children from the age of 5-7 years. It is diagnosed when teeth eruption does not happen at the expected time. The best way to treat odontoma is through oral surgery as it can progress into a follicular cyst if left untreated.
Oral Mucocele
Mucocele is a benign and painless mucous-filled cyst that forms inside the mouth and gradually goes away on its own without the need for specific treatment. It is usually a result of minor oral trauma or oral injury which causes a salivary gland to become damaged or blocked, which in turn causes the saliva to form into a cyst. A type of mucocele that forms under the tongue is known as Ranula. Mucocele can be caused by to constant habit of lip biting, chronic inflammation in the mouth due to the use of tobacco products, trauma due to oral procedures or intubation, or due to thickening of salivary ducts. While mucoceles are harmless, sometimes they can be large and may cause hindrances while chewing, swallowing, or even breathing. In case of large cysts, a surgical incision may be required to remove the cyst.
Tongue-Tie (Ankyloglossia)
A tongue tie or Ankyloglossia is a condition that develops in a child while it is still a fetus in the mother’s womb and becomes visible at birth. The lingual frenulum, or the short, thick band of tissue that attaches the bottom of the tip of the tongue to the floor of the mouth, generally separates before the birth of the baby allowing for freedom of movement for the tongue once the baby is born. In children with tongue tie, the range of motion of the tongue remains restricted as the frenulum does not separate. Posing difficulty sticking out the tongue, and tongue tie can cause difficulty in breastfeeding, eating food, or while speaking as well as in maintaining oral hygiene. A simple surgical procedure known as Frenotomy is usually carried out to treat tongue tie. In more severe cases, an extensive procedure known as Frenuloplasty may be required to be done under general anesthesia.
Lip Tie
The tissue that attaches the gums to the lips, known as the maxillary labial frenulum, may be short and tight in some babies, causing a lip tie. A lip frenulum is only diagnosed as a lip tie if it causes difficulties for the baby and hinders his / her growth and development. A lip tie can cause stronger reflux in babies due to swallowing more air, make breastfeeding sessions much longer than usual, cause irritability, and leaking of the breast milk while feeding, and can result in slower weight gain. As the child grows older, lip tie can cause difficulties in managing oral hygiene, tooth decay, malocclusions, and loss of gum between the teeth which weakens the teeth. If the baby has a severe lip tie that extends to the palate, the oral surgeon may recommend a minor pediatric oral surgery procedure called frenectomy.
Pathological Lesions
Oral lesions or mouth sores/ulcers often affect the oral cavity and are considered to be harmless. However, they could also be potentially premalignant lesions caused due to abnormal cell growth in the oral cavity which may be painful and may or may not be easily visible to the naked eye. If the pediatric dentist suspects that a child may have pathological lesions after a careful soft tissue examination, he/she will refer the child to an oral and maxillofacial surgeon who will conduct a thorough examination to assess the extent of malignancy and decide on a treatment plan. Surgical removal of a premalignant lesion may not be required unless it is critical to the recovery of the patient.
Preoperative Considerations
While planning a minor Pediatric Oral Surgery, the oral surgeon will obtain a thorough medical history of the child from his / her parents or guardians and conduct a clinical and radiographic examination of the dentition as well as the soft tissues surrounding the teeth. The surgeon will also need to anticipate emergencies so that they can be effectively prevented or treated (if required).
Just like in other Pediatric Dentistry procedures, behavioral considerations also play an important role in ensuring the success of the surgical procedure. The social, emotional, and psychological status of the child must be assessed, and any fears that they may have regarding the surgical experience must be addressed to ensure their cooperation.
Postoperative Care
With prior planning for the surgery and any contingencies, it is possible to complete minor Pediatric Oral Surgery procedures without complications. After the surgery, the child may be asked to bite on gauze till the bleeding is controlled and be given medication for pain relief once the effect of the sedation or anesthesia wears off. Swelling is normal after an extraction and will go down over the first few days. Sutures used in pediatric oral surgery are usually self-dissolving and do not need to be removed.
On the day of the procedure, the oral surgeon may advise the child to drink clear liquids using a spoon or cup (not a straw) after surgery. This can be followed by soft foods on the day after, and slowly going back to the regular food routine.
It is important to stay alert for rare complications that may occur, including post-extraction hemorrhaging, infection, dry sockets, prolonged numbness, or pain.
Pediatric Oral Surgery at Dr.Kammath’s Pediatric Dental Care
At Dr. Kammath’s Pediatric Dental Care, our dental health experts are experienced in carrying out minor oral surgical procedures for various oral conditions. Our clinic is equipped with advanced and state-of-the-art technology that enables us to carry out the surgeries effectively. We use Oral Sedation or Conscious / Nitrous Oxide Inhalation Sedation (NIOS), considered to be the safest sedative treatment for children, for our Pediatric Dentistry procedures so that our patients have a comfortable experience without anxiety. Tongue tie release procedures have been successfully carried out at our clinic under oral sedation for infants below 6 months up to 3 years of age and under conscious sedation for children aged 3 years and above.
