When you're a dentist, working with children means dealing with lots of wiggling, a certain amount of protest and occasionally some tears. That means working fast.

The younger the child, the greater the likelihood for wiggling, protest and tears, and the greater the need for fast work. This is especially true when a very young child has a mouth full of cavities.

A pediatric dentist with the FirstHealth Dental Care Centers now takes certain children -- those too young or too medically or mentally challenged to tolerate extensive dental office work -- to the operating room, where they can be treated quickly while under general anesthesia. FirstHealth Moore Regional Hospital and the Surgery Center of Pinehurst (SCoP) have cooperated with Dr. Christina Powers and the Dental Care Center program to provide the service.

"It's in the children's best interest to get this done all at once, before they have serious problems," says Dr. Sharon Nicholson Harrell, director of the FirstHealth Dental Care Centers.

Most of the children with dental problems so extensive that they need operating room procedures are typically under the age of 4, although fewer numbers involve youngsters who, for various reasons, can't deal with the work in a typical dental office setting. All have "rampant" tooth decay -- multiple cavities requiring fillings, crowns or extractions.

Instead of having to sit in a dental chair for a long time or over several visits, they have all of their problems addressed at one time while under anesthesia. Before Powers joined the Dental Care Center team, these patients -- who comprise 2 to 3 percent of the children seen at the FirstHealth clinics -- were referred to an out-of-county specialist for care.

"We've always had the service," Harrell says, "just not locally."

Powers examines patients at the FirstHealth clinics in Southern Pines, Raeford and Troy to determine if they are operating room candidates, and procedures are scheduled according to OR availability at either Moore Regional or the SCoP.

Depending on the complexity of the work, Powers can do several procedures a day, many of them on Saturdays, when operating room space is more likely to be available. Her patients have been as young as 18 months old -- some with 12 teeth and cavities in eight of them. Ordinarily, it would take four or five visits to a dental office to address that kind of dental disease.

"A child's behavior deteriorates with multiple office visits," Powers says. "Completing all treatment in one visit prevents the need for multiple negative experiences."

When Powers takes a child into the operating room, she is accompanied by two dental assistants from the Dental Care Center program. A nurse from the Moore Regional or SCoP operating room staff is available to assist if needed, and anesthesia is administered by a staff CRNA (certified registered nurse anesthetist) or sometimes an anesthesiologist.

All of the procedures are done on an outpatient basis. In most cases, the cost has been covered by Medicaid or Health Choice.

"We also want to thank Terry Reynolds and the Moore County Partnership for Children and Families for their support of our Dental Care Access project," Harrell says. "The local Smart Start program was very helpful with some of the early funding for our children."

A native of Highfalls, Powers has been around dentistry all of her life. Her father, Darrell Powers, has had a dental practice in Robbins for many years. She became interested in pediatric dentistry during community rotations at the FirstHealth clinics while she was a dental school student at the University of North Carolina at Chapel Hill.

"That's how I got to know Dr. Harrell really well, and she got me interested in only working with children," she says. "The FirstHealth centers treat children with limited access to dental care due to lower income, and historically this population of patients has more dental disease that more frequently requires OR service."

After earning her DDS degree from UNC, Powers completed a two-year residency in pediatric dentistry at the University of Kentucky. She has worked part time with the FirstHealth centers since last summer, and plans to continue that work even after opening her own pediatric practice in Aberdeen this month.

This story was submitted by FirstHealth of the Carolinas.