Today, Michael Roberts, a distinguished professor in pediatric dentistry at UNC-Chapel Hill, fields this questions from a mom whose toddler needs major dental work.

The Question: I am the mom of a 21-month-old little girl. Most of the enamel on her upper front teeth has come off (they look yellow and are sensitive). One molar has a black area in it. This condition has been for four months now. She has about 12 teeth right now and four more (canines) are showing up. Recently she started complaining of toothaches now and then (not severe though, she is not crying). She doesn't like brushing and I force brush her in the morning and night. And she resists it and cries.

Our pediatric dentist in Durham has recommended cleaning and putting crowns on most of her teeth. Since the child is very young and will not cooperate, she said she will do the procedure under general anesthesia. And it might take a minimum of three hours. The dentist has assured me it is quite safe. I am fine with the treatment. But I am worried about the anesthesia. Is it safe for a child of 21 months to undergo a general anesthesia for three hours?

Roberts' answer: By its very nature, general anesthesia has higher risks but the patient is in a much more controlled environment which reduces that risk. You have an anesthesiologist administering the anesthesia, multiple monitors are in place and an IV is in place to give emergency drugs if needed. You can make the analogy of NASCAR racing. They go very fast, but if they hit a wall, they have tremendous safety equipment around them to minimize the effect of the accident.

The worse risk of any medical procedure is death. Statistically speaking, the number of deaths associated with general anesthesia is very low and it is hard to get solid data, but it has been reported to be less than 1:25,000. When considering the alternative of sedation, where there are not as many safety features around you, the risks are relatively the same. General anesthesia is a very reasonable alternative to provide extensive comprehensive care to a very young, pre-cooperative child.

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