Dentaltown January 2023 - 56

" The key to successful outcomes
depends not only on the right
technology but also on being prepared
for the surprises our youngest
patients might hold in store. "
Advantages of
laser-assisted surgery
Tongue-tie has traditionally been
treated with surgery; scissors, scalpels and
even fingernails have been used. However,
surgery can cause a lot of bleeding, stress
and unnecessary risk. In recent years, many
providers have turned to laser-assisted surgery
as a minimally invasive alternative. Laser
surgery requires no sutures, causes virtually
no bleeding or inflammation, and minimizes
the risk of pain and infection. Newborns can
even nurse immediately after the procedure,
which takes less than a minute.
Studies have demonstrated the benefits
of laser surgery over conventional surgery.
These include reduced perioperative bleeding,
shorter operative times, minimal pain,
reduced need for analgesics, and a decrease
in functional discomfort while chewing
and speaking. While laser surgery has
advantages over conventional approaches,
to ensure the best results it's important to
take preoperative factors that may affect
patient outcomes into consideration.
In some cases, the pediatric dentist
may be a newborn's first encounter with a
medical professional outside of the obstetrics
unit. In my practice, it's not uncommon
for newborn patients to be referred directly
from the hospital. Because many pediatric
dentists may be unaccustomed to dealing
with newborns, I offer the following tips
for identifying, managing and avoiding
some of the surprises these pint-sized
packages-and bigger ones-may present.
54 JANUARY 2023 // dentaltown.com
Professional tips
* Vitamin K status. At birth,
infants have naturally low levels
of Vitamin K, which helps with
coagulation, so newborns can
be at risk for a condition called
Vitamin K deficiency bleeding.
Infants are usually given a
Vitamin K booster shot within
24 hours of birth, but to prevent
spontaneous bleeds, it's important
to screen patients to ensure that
they have received this booster.
* Anesthetics. The use of topical
anesthetics for patients under
12 months of age should be either
eliminated or used very cautiously
because of infants' higher risk
of the blood disorder acute toxic
methemoglobinemia. Similarly,
injections of local anesthetics such
as lidocaine HCL should not be
administered to infants under six
months of age.
* Floppy airway. A weak airway, also
known as floppy airway (congenital
tracheomalacia), occurs when the
walls of the windpipe collapse.
Though the symptoms-which
include noisy breathing, especially
when there is increased airflow,
for instance when the baby is
crying-normally resolve by 18 to
24 months, the condition poses an
aspiration risk during the procedure
and postoperatively.
* Gagging and vomiting. While
frequent vomiting is normal in
patients under the age of 12 months,
it is not normal in older children
and can be a symptom of tonguetie.
Whatever the age, however,
a higher risk of vomiting during
the procedure puts the patient at
increased risk of aspiration.
* G-tube patients. Infants who are
fully or partially fed through a
gastrostomy tube, which delivers
nutrition directly to the stomach, or
even those who are being considered
for a G-tube, are naturally at higher
risk for aspiration. In some of these
cases, the failure to thrive may be
because of tongue-tie.
* Bleeding conditions. Bleeding
conditions such as hemophilia,
thrombocytopenia, von Willebrand
disease, liver disease and some
medications pose bleeding risks
that require careful management,
as well as special precautions
before and after the procedure.
Consultation with a specialist such
as a hematologist is recommended.
* Anatomy. When it comes to
bleeding risks, it's important to
familiarize yourself with the ducts
and blood vessels of the mouth
(i.e., lingual arteries and veins)
so you know what to avoid. While
a laser is safer than a scalpel because
it has a small active zone and you
can turn it off instantly, it's still
best to be prepared.
Conclusion
I believe the future of dentistry lies
with dental lasers, and as they become
more commonplace, they will emerge as the
gold standard treatment for frenectomies
and many other procedures. However, as
I've pointed out here, the key to successful
outcomes depends not only on the right
technology but also on being prepared for
the surprises our youngest patients might
hold in store. n
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Dentaltown January 2023

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