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While many younger patients in the dental care office are cooperative and manageable without the need for sedative drugs, there are a significant number of children who cannot tolerate dental care without the use of these techniques.
For older, mildly apprehensive children, the use of oral conscious sedation may prove effective during dental care. Drugs such as chloral hydrate, Vistaril, Phenergan and Versed are frequently used either alone or in combinations selected by the sedation dentist for dental care.
Inhalation conscious sedation, using nitrous oxide, or laughing gas, is also highly effective in a mildly apprehensive older child who is older than six years.
In some instances, the use of a physical restraint (known as a Papoose Board or PediWrap) may be necessary to minimize excessive movement (which could be dangerous) during dental care treatment.
Naturally, many younger children are not mature enough to understand the need for their cooperation during dental care treatment. In this situation, the techniques described above have little chance for success. Deep sedation or general anesthesia may be required for dental care treatment to be successfully provided.
When this is necessary, the sedation dentist will employ a highly trained and certified dentist anesthesiologist, medical anesthesiologist, or, in some cases, nurse anesthetist, whose sole responsibility is to ensure the safety of the child while the dental care is being done.
Dentists trained to administer general anesthesia have received a minimum of two years of specialized advanced training and have been certified by their state Board of Dental Examiners.
Monitoring devices, some of which evaluate breathing, blood pressure and heart rate, will be employed by the sedation dentist to help ensure the safety of the procedure.
All aspects of the child's medical history, including any drugs he/she may be taking, should be disclosed to the dentist before any dental care.
It is suggested that the parent ask the following questions of their dentist prior to signing an informed consent granting permission for the administration of conscious sedation, deep sedation or general anesthesia to a child:
The administration of local anesthetics (commonly known as Novocain) is needed whenever potentially painful dental care procedures are performed (even during conscious sedation dentistry and general anesthesia).
The administration of local anesthetics to children by a trained sedation dentist is extremely safe and represents the ideal means of providing comfortable dental care treatment.
The following are some of the procedures the doctor might use to make this procedure more comfortable for the child:
The duration of the numbness varies from drug to drug - some providing a short duration (two to three hours), with others remaining effective for up to twelve hours. The sedation dentist will select a drug for the child that is appropriate for the planned dental care procedure.
Since a child's tongue and/or lip may remain numb for several hours after the completion of their dental care treatment, the parent should carefully watch the child to prevent them from accidentally biting and injuring their lip or tongue during this period of time.
Properly administered, local anesthetics are safe and effective in almost 100% of younger patients. If a child is unable to tolerate the injection of the local anesthetic in their mouth, it may be necessary to use one of the techniques of conscious sedation, deep sedation or general anesthesia.
Local anesthetics can safely be administered by a trained sedation dentist to patients receiving sedation or general anesthesia during their dentistry visit.
By Stanley F. Malamed, DDS
Patient comfort and care is a top priority for a sedation dentist. They recognize that dental anxiety or discomfort can be associated with some dentistry procedures. Fortunately, a variety of dental procedures using dental anesthetics are available to relieve both anxiety and discomfort. Talk with your dentist to find out which is right for you.
This is the most frequently used type of dental anesthetic for sedation dentistry procedures. Although often referred to as "Novocain," this once popular painkilling drug has actually been replaced by more effective anesthetics such as Lidocaine for a comfortable dental care treatment. It also works very well for temporary relief of a tooth ache.
However, the name has become so much a part of the American vocabulary, it's now used in generic terms. Prior to injecting the local anesthetic, the dentist often swabs a topical anesthetic over the injection site to prevent the patient from even feeling the needle.
Patients seeking comfortable dentistry can consult with their dentists to choose anti-anxiety agents either administered by mouth, inhalation or injection. Nitrous oxide, often referred to as laughing gas, helps to ease patient anxiety. The gas is inhaled by patients, inducing relaxation, so they can approach dental procedures with less stress.
This may be required for complex procedures or for dental patients with special needs. With the administration of general anesthesia, the patient is unconscious; with deep sedation dentistry or sleep dentistry, dental patients are deeply relaxed and not fully aware of their surroundings during their dental treatment.
Prior to treatment, your dentist will need to know a few things regarding your health history such as:
Some medicines may interfere with the efficiency of an anesthetic requiring an adjustment in your medication schedule. Your health history is very important information for the dentist. During the consultation, you can ask questions about any dental procedures that may be of concern during your dental procedure.
The drugs used as dental anesthetics are approved by the Food and Drug Administration and are safe. Anesthetic providers are professionals with a commitment to patient safety and comfort.
A dental anesthetic can be administered by a general dentist, a dental anesthesiologist or an M.D. Certification is required and is regulated on a state-by-state basis. Discuss sedation with your dentist at your next visit.
By Brian J. Gray, DDS, MAGD, FICO