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laser - international magazine of laser dentistry No. 2, 2017

case report | Fig. 1: Primary upper anterior tooth 61 with fistula. Fig. 2 & 3: Zinc oxide eugenol obturation was done followed by GC Fuji IX base fill and composite fill on top. Fig. 4: Primary upper anterior teeth after treatment. laser 2 2017 07 Fig. 1 Fig. 2 Fig. 3 Fig. 4 Option 1: Extraction followed by fixed space maintainer. Option 2: Root canal treatment with uncertain prognosis. Cotton role: Tooth pillow Irrigation of canals: Wash the sugar bugs Obturation: Putting cream in the tooth Filling: Close the hole The child’s mom was informed that after the endo dontic treatment of tooth #61, the tooth will be observed for three months and an X-ray will be repeated in order to check the healing of the periapi- cal region. In case that the tooth does not take the treatment successfully and there is a recurrence of the infection, an extraction followed by space main- tainer should be planned. The mom understood both of the options and decided to go with option two. Certain behaviour modelling tools of neuro-lin- guistic programming were used in order to get the child’s attention and cooperation. Since the child was able to listen and agree in the best manner; the steps for next visit were informed. She was very fond of Barbie princess stories, so we agreed on telling the princess stories and watching the same in the next visit. The child then left the surgery with a small reward as a positive reinforcement of good behaviour and good listening. Dental behaviour The child was young, thereby, apprehensive and fearful towards the dental treatment. The Dental Behaviour Management was as following: It was suggested to use the conscious sedation with nitrous oxide. On the first visit, no treatment was performed. The child was acquainted with the dental chair, basic dental tools, water, air syringe, nasal mask and laser. Euphemisms involved in the treatment were explained as follows: Nasal Mask: Happy air Laser: Popping light Dental caries: Sugar bugs Dental cavity: Hole Water: Washing the sugar bugs Before leaving, the “Next Time Behaviour” message was given and reinforced with small stickers. This was done to serve as a reminder for the child to be brave next time as well. Nitrous oxide sedation Nitrous oxide is a friendly gas that helps to relax the receptors in the way that the child acts more receptive to the instructions during the dental procedure. It does have an analgesic or anxiolytic effect that causes temporary depression of the central nervous system with very little effect on the respiratory system. It gets absorbed rapidly but stays relatively insoluble into any tissues in the body. At the end of the procedure, 100 per cent oxygen is used to flush out nitrous oxide. There is minimal impairment of any reflexes, thus cough reflex is protected.5

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