Paediatric dentistry · Berlin-Mitte
The question parents ask most before a treatment is not what it costs, but: will my child feel the injection? Our answer is a staircase of five steps – from flavoured numbing gel to nitrous oxide. We only ever take the lowest step that is enough.
Starting point
They often get lumped together, but they need different answers. Pain can be switched off reliably – that is what local anaesthesia is for, and it works well in children. Fear cannot be switched off that way: a child who is afraid of the appointment is still afraid once the tooth has long gone numb.
That is why we work on both separately. Against pain stand the numbing gel and the local anaesthetic. Against tension stand announcing every step, taking our time, an agreed pause signal – and if that is not enough, nitrous oxide or hypnosis. Serve only one of the two sides and you get either a bravely silent but frightened child – or a relaxed child that still flinches.
What we do not offer: sedation. No calming syrup, no twilight sleep. In our paediatric dentistry we deliberately keep to three paths – nitrous oxide, hypnosis and, when nothing else works, general anaesthesia. Everything in between that makes a child drowsy without truly protecting it we consider the worse compromise.
Guidance
The following steps build on each other. Each one is only taken when the one below is not enough for your child, for the tooth and for the procedure. Most appointments end on step one or two.
Costs nothing, achieves the most: every step is explained beforehand, in words a child understands – shown first, then done. Raising a hand means pause, and this signal applies just the same on every further step.
A gel on the gum so the needle prick cannot be felt. Your child picks the flavour. For small fillings this alone is often the whole difference between a good appointment and a bad one.
The actual pain control at the tooth. It comes after the numbing gel, not instead of it – and it is the reason a treatment can be pain-free at all.
For when the tension is too great for words and pacing alone. Both paths keep your child awake and responsive. They stand side by side – which one fits depends on the child, and they can be combined.
The last resort, after medical assessment: for very extensive treatment needs, for very young children, or when everything else has failed. An anaesthetist takes over the anaesthesia and monitoring.
This order is not a ranking from brave to fearful. Which step fits depends as much on the procedure as on the child: a chalky tooth can require a higher step than a calm child would ever need.
Numbing gel
Before any injection, we numb the spot where it will go. We apply a gel to the gum – usually on a small cotton pellet pressed right onto the spot. After one to two minutes the surface is numb and the prick can no longer be felt.
The active substance is the same as in the injection, just in a form that soaks through the mucosa instead of passing through a needle. The technical term is topical anaesthesia. For your child it means: the cotton bud with the flavour comes first.
The gel is mixed for us at the pharmacy, and the flavour can be chosen in the process. Your child picks.
It sounds like a side note, but it is the point where the appointment turns: a child who gets to choose the flavour makes the first decision of the visit itself – before anything happens that it cannot control. Whoever chooses is no longer waiting passively. And there is the practical effect: a gel that tastes good is not swallowed away or wiped off, it stays where it is supposed to work.
It does not replace the injection. The gel numbs the top few millimetres of the mucosa, for a few minutes – enough for the prick, not enough for treating the tooth. Anyone promising that treatment works entirely without anaesthesia as long as the gel tastes good enough is promising too much.
And it needs time. One to two minutes sound like nothing, but in a treatment room they are long. This is exactly where people cut corners when rushed – and exactly then the child feels the prick after all. We wait out the time. It is planned into the appointment.
Local anaesthetic
In the treatment room we do not talk about syringes, needles or pricks – but we do not lie either. Your child learns that the tooth is now being put to sleep, that pressing can be part of it, and that raising a hand is allowed.
Gel on the pellet, pellet on the spot, one to two minutes of pause. That time is perfect for explaining what happens next.
Most of the sting comes not from the needle but from fluid flowing in too fast. Numbed slowly means numbed almost unnoticed.
Only when the tooth is safely numb do we continue. We ask and test instead of assuming.
The most common complication after anaesthesia in children is not a medical problem but a curious one: the numb feeling lasts much longer than the treatment – often two to three hours – and feels strange. Children explore it by chewing on their lip or cheek. Because they feel nothing, they do not stop in time. The wound only shows in the evening, when the anaesthetic wears off.
What helps: nothing solid to eat and nothing hot to drink until the numbness is gone – a yoghurt or a cool drink are fine. And give your child a task instead of a ban: checking together in the mirror whether the lip is "still there" works better than "don't bite it". If something did happen: a bitten lip looks worse on day one than it is and usually heals by itself. If there is major swelling, call us.
Nitrous oxide
Nitrous oxide is a gas your child breathes in through a small mask on the nose, mixed with oxygen. It eases tension, dampens the gag reflex and lowers pain sensitivity. The nickname "laughing gas" is misleading: children do not laugh under it, they become calm. At our practice the treatment is carried out by our dentist Inke Supantia.
A wakeful state: your child has its eyes open, listens, answers and can ask for a pause at any time. The amount can be adjusted up and down at any moment, the effect follows within seconds. And it is gone again quickly: nitrous oxide does not enter the metabolism, it is breathed out unchanged.
Not anaesthesia – your child does not sleep and does not lose consciousness. Not a substitute for the local anaesthetic – what would hurt still hurts under nitrous oxide, the injection stays. And not sedation in the sense of drifting away: the technical term is "minimal sedation", and the word minimal is exactly the point. A child drifting off under nitrous oxide has received too much.
For context: the machines in a dental practice deliver at most 50 percent nitrous oxide, the rest is oxygen. This limit is not caution but a requirement of the professional societies – higher concentrations can lead into deep sedation and belong in the hands of an anaesthetist. In practice, 20 to 30 percent is often enough for children.
First comes just the nasal mask, without gas. Your child may touch it, put it on, take it off again. A child who does not like it does not get nitrous oxide – nothing is forced here.
The first breaths are pure oxygen. Your child notices: nothing unpleasant happens, and breathing through the nose works.
Then the nitrous oxide is added, in small steps. After about a minute a warm, light feeling sets in; some children describe tingling in their hands or feet. We stay at the amount at which your child is relaxed and responsive – no more.
Only now does the actual treatment begin – with numbing gel and local anaesthetic as always. The pause signal still applies.
At the end the ratio flips: five minutes of pure oxygen. That is not a ritual – it makes sure the nitrous oxide is breathed out completely.
After about a quarter of an hour nothing of it is left. Your child can eat and play as normal; nursery or school on the same day are no problem. The only restriction is the numbness in the mouth, not the nitrous oxide.
Limitations
Nitrous oxide is well studied and explicitly recommended by the paediatric dental societies – but not for every day and not for every child. We go through these points before every appointment.
Then from a distance nothing speaks against the appointment. The binding answer comes from the consultation – there we go through health and medication once in full.
One or more points apply – that does not mean nitrous oxide is off the table. But it does mean: please call briefly before the appointment. A rescheduled session is better than one that does not work.
Hypnosis
Dental hypnosis has nothing to do with stage shows and nothing with losing control. It is focused attention: the child becomes so absorbed in a story, an image or a memory that the treatment moves to the edge of its awareness. Children are usually better at this than adults, because they slip into imaginary worlds more easily anyway.
In practice that means: a calm voice, a story your child appears in, a place it likes to be. It stays responsive, can interrupt at any time and remembers the appointment afterwards.
Lower tension, dampen the gag reflex, make the time in the chair feel shorter – and for a child that refuses masks or equipment, clear the way without adding anything. Nitrous oxide and hypnosis do not exclude each other; some children do best with the combination.
It does not replace the local anaesthetic – what would hurt also hurts in deep relaxation. It needs a child willing to engage, and calm in the room; with acute pain and time pressure it is rarely the right entry point. And it does not work equally well for every child – that only shows in the attempt.
For parents
Your child does not have to fast – ideal is a light meal one to two hours beforehand, because children with a completely full or completely empty stomach are more likely to feel sick under nitrous oxide. Report a blocked nose on the morning of the appointment by phone. And announce the appointment casually: sentences like "it won't hurt" or "no need to be scared" plant exactly what they are meant to prevent.
Wait with eating until the numb feeling is gone – usually two to three hours – and watch lip and cheek until then. The nitrous oxide itself leaves nothing that limits the day: nursery, school, sport and playground are fine as always. And do not debrief the appointment at length – a short "you did really well" carries further than a long review.
A 2018 Cochrane review analysed fifty randomised trials with 3,704 children on calming methods during dental treatment. Its result is more sober than advertising often sounds: the studies were so different that no summary effectiveness figure could be calculated for nitrous oxide alone.
Ashley et al., Cochrane Database of Systematic Reviews 2018, CD003877 – PMID 30566228. That an effect is statistically hard to pin down does not mean the method is useless – children, procedures and measures are too different for a single number. Safety is another matter: there the data are good, and the dental and anaesthesiology societies explicitly recommend nitrous oxide for minimal sedation in children – under clear requirements for concentration, training and monitoring. That is why we promise no success rate, but explain which step we suggest and why.
Costs
Questions
More important than age is whether your child wants to cooperate and can reliably breathe through the nose – as a guideline, roughly from nursery age. A very cooperative four-year-old often does better than an eight-year-old who refuses the mask. Whether it fits is shown by the consultation – and if need be by a dry run with the mask.
Used correctly, serious incidents are very rare. The gas is not metabolised in the body but breathed out completely; after about a quarter of an hour nothing is detectable. Nausea or slight dizziness occur, mainly with too high a dose or a very full stomach. No medical procedure is entirely without risk – whoever claims otherwise is leaving something out. That is why we ask about pre-existing conditions beforehand and stay at the smallest possible amount.
No. Your child stays awake, has its eyes open, listens and can answer. All protective reflexes – swallowing, coughing – remain intact. If a child drifts off under nitrous oxide, the dose is too high; that is exactly why it is increased slowly and adjusted continuously.
Yes, as soon as work is done on the tooth. Nitrous oxide takes away tension and dampens pain perception, but it does not numb the tooth. The good news: under nitrous oxide, exactly the moment most children fear most is much easier to bear – and with the numbing gel often not felt at all.
No. Unlike before general anaesthesia, fasting is not required for nitrous oxide. We recommend a light meal one to two hours beforehand – that makes nausea least likely.
Usually two to three hours, depending on amount and site. Until the feeling is fully back, your child should not eat anything solid or drink anything hot – not because of the treatment, but because it would otherwise bite its lip or cheek without noticing.
It can be down to the tooth. On chalky teeth (MIH) and on heavily inflamed teeth, local anaesthesia demonstrably works less well. Do tell us if earlier appointments were painful for this reason – then we plan differently: with other anaesthesia techniques, if need be with nitrous oxide or general anaesthesia. More on our page about chalky teeth.
Yes, and that is often the best entry. We put the mask on without gas, your child breathes through the nose twice and then decides for itself. An appointment that ends with a mask test is not a lost appointment.
Yes. An adult companion stays with the child. What helps: being there, holding a hand, staying calm. What rarely helps: talking along while the child is talking with us. We tell you beforehand how you can support best.
No. In our paediatric dentistry we deliberately work without sedation. There are three paths: nitrous oxide, hypnosis and, when nothing else works, general anaesthesia under the care of an anaesthetist. Making a child half drowsy without truly monitoring it is, for us, the worse compromise.
Which step fits your child we clarify in peace: in an appointment where nothing is done. Your child gets to know the room, may try the mask and pick the flavour – and you ask all the questions that are open.
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