| Conscious Sedation
Some children become anxious in the dental office and can't relax or sit still
long enough for the dentist to treat them. For these children, the dentist
may suggest forms of medication that allow the child to relax and/or become
sleepy. This is called conscious sedation, since the child is still responsive
to conversation or stimulation and all his or her protective reflexes are working.
It may involve inhaling a gas, taking an oral medication, getting an injection
or receiving medication intravenously. Conscious sedation also may be used
when a child requires extensive dental treatment or has special needs. Your
dentist will recommend which type of conscious sedation is best for your child.
Nitrous Oxide
Nitrous oxide, also known as laughing gas, is most often used for children
who are mildly or moderately anxious or nervous. It eases their fears so
that they can relax and receive treatment comfortably and safely. Nitrous
oxide is administered by placing a small mask over your child's nose. Your
child will be asked to breathe through his or her nose and not through the
mouth. As the gas begins to work, the child becomes calm, although he or
she is still awake and can talk with the dentist. When the gas is turned
off, the effects of sedation wear off almost immediately. As the child gets
older and becomes more comfortable with the dentist, nitrous oxide may not
be needed.
Nitrous oxide is safe, easily taken and always delivered mixed with oxygen.
When the treatment has been completed, the nitrous oxide is turned off and
oxygen is delivered for 5 to 10 minutes to help flush the child's body of
the gas. The effects of nitrous oxide should disappear as oxygen is breathed.
Sometimes, nitrous oxide can make a child feel nauseous. It's best that
a child not eat too much beforehand. Also, if your child is congested or
has trouble breathing through the nose, nitrous oxide may be less effective.
Oral Sedation
Children who are more anxious may need an oral medication that is stronger
than nitrous oxide. Several medications have a significant calming effect.
When choosing a medication, the dentist will consider your child's anxiety
level, his or her ability to cooperate and the treatment required.
With oral sedation, your child may be sleepy but can be aroused if necessary
and can respond to simple commands. Minor side effects such as nausea or
vomiting can occur with some medications.
Before a visit in which your child is to receive oral sedation, you should
receive instructions about eating and drinking, what to expect and what to
watch for after treatment. You may need to carry your child home after sedation.
Your dentist should also discuss how your child will be monitored while he
or she is sedated. You will need to stay for a short time after dental treatment
has been completed so your child can be observed for full recovery and possible
complications.
Other Methods of Conscious Sedation
In addition to oral medications, other methods can be used to deliver sedative
medications to a child. They can be given through the nose, by suppository,
by injection or intravenously (into a vein).
These methods require more experience to be administered and monitored properly.
Injections and intravenous medications should be used only by dentists with
extensive training in these techniques.
General Anesthesia
Sometimes it's necessary for a child to be unconscious in order for the dentist
to safely complete needed dental treatment. General anesthesia puts a child
into a deep sleep. He or she is unable to feel pain or to move around. This
is the same kind of sleep a child would have if he or she were to have ear
tubes placed or tonsils removed. Your dentist may recommend general anesthesia
if your child:
- Can't relax or calm down enough for treatment to be performed safely,
even with conscious sedation and other behavior management techniques
- Needs oral surgery or other dental treatment that would be difficult
for the child to tolerate while awake
- Needs a lot of dental work that can best be done in one long appointment
rather than many shorter visits
- Has a medical, physical or emotional disability that limits his or her
ability to understand directions and be treated safely as an outpatient
Although general anesthesia is often the best choice in these cases, it
also carries some risk. Your dentist should discuss the risks and benefits
with you and explain why it might be right for your child.
General anesthesia for dental procedures can be provided by an anesthesiologist,
dental anesthesiologist or oral and maxillofacial surgeon. These professionals
are trained to deliver the medications and monitor the child during the procedure
and handle any complications that may occur.
Your child will need a physical examination before receiving general anesthesia
to make sure he or she doesn't have any conditions that could interfere with
or be affected by the anesthesia. If your child is sick on the day of the
scheduled procedure, call to see if the appointment should be rescheduled.
On the day of the appointment:
- Follow the doctor's guidelines about food and fluid intake before and
after the procedure.
- Briefly discuss the procedure with your child. Use simple terms that
he or she can understand. Talk to your child about the hospital visit and
treatment several days before the appointment, to give him or her time
to think about it and to ask questions. Parents also will have their own
ideas on how best to prepare their children.
- Let your child rest quietly at home after the procedure. He will probably
be ready to resume his normal schedule the next day.
Meeting With the Anesthesia Provider
Meet with your child's anesthesia provider before the procedure. This will
give you a chance to ask questions and go over some of the risks and benefits
you may already have discussed with the dentist. Here are some questions you
may want to ask:
- What is your training? Are you board certified?
- How often do you administer anesthesia to children?
- What type of anesthesia will be used and how it will be administered?
Why is this type of anesthesia better than another?
- What types of problems might arise using this type of anesthesia?
- Will you use any premedications (such as lollipops that contain mild
sedative) to lessen my child's anxiety?
- Can I be with my child when the anesthesia is administered and when she
wakes up?
- Will you physically be present or will one of your associates administer
the anesthesia?
If you are unhappy with the anesthesia provider’s answers or you don't
feel that this person is the right doctor for your child, ask your dentist
or the hospital to make arrangements for another doctor. Be sure to meet
with this person ahead of time, too.
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