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The Role of the Sedation Dentist In Dental Care for Children

Conscious Sedation Dentistry

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:

• Will the child require sedation or general anesthesia for his/her dental care treatment?
• Who will monitor the child while the sedation dentist works on his/her teeth?
• What kind of monitoring equipment do you use?
• Are you and your assistants trained in resuscitation?
• Will you continue to monitor the child after the procedure, until the drug has completely worn off?

Children's Dental Care Treatment

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:

• Place the child in a reclined position during the injection.
• Place a topical anesthetic (a gel or spray) on the child's gums where the injection is to be given. This should remain in contact with the tissues for at least one minute.
• Use of a distraction technique, such as pulling or shaking the child's lip as the needle is slowly inserted.
• Injecting the local anesthetic drug slowly. This is critical to a comfortable injection.
• Permitting the local anesthetic drug time to work. Most local anesthetics will become fully effective within approximately five minutes after their injection.

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

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.

New Dental Care Technology And Your Teeth

The world of modern dentistry is embracing exciting advances in technology for increased patient comfort, care, and convenience. Here are some ways dentistry is taking oral care into the new millennium.

• Air Abrasion: High-speed delivery of "blasting particles" to a decayed tooth can replace the drill in many cases. The fine stream of air and aluminum oxide provides dentists with a more precise tool for removing decay quickly, without damaging surrounding sections of the tooth. This exciting dental treatment is also a plus for patients because it normally doesn't require any local anesthesia. While air abrasion may not be suitable for large areas of decay or the removal of silver fillings, it can be used to repair tiny cracks, remove stains, and smooth the tooth surface so that bonding materials adhere to the tooth.
• Intra-oral Cameras: A tiny camera inserted into the patient's mouth allows the dentist to show the patient the exact nature of the problem. The image is enlarged and sent to a monitor that the patient and doctor view together. When patients can see the specific area in need of treatment, they're more likely to understand and accept the dentist's recommendation.
• Lasers: Research continues at a fast pace in laser dentistry. Lasers have been used for years in a limited capacity, but their role in oral surgery is likely to increase.
• Digitized X-rays: Computerized technology will allow a small sensor inside the patient's mouth to take the X-ray and immediately display it on a computer screen, eliminating film and darkroom processing, and reducing the radiation exposure for the patient.
• Computers: There is a growing recognition of the role that computers can play in dental care. In the future, patient records may be kept on computer disks, including visual images captured on intraoral cameras. A computerized workstation beside the patient's chair will give the dentist the ability to view the patient's history from disk. The dentist might also use a voice-recognition system to ask the computer to assist in finding that data, or generate a "before and after" image so the patient can preview the result of dental treatment before it is done.
• CD-ROM: Patient education will be a snap with information stored on CD-ROM. Procedures can be explained to patients in advance and post-operative instructions can be provided for them to take home.

With a new hi-tech face on modern dentistry, patients can look forward to a new face in dentistry and greater comfort with more byte!"

By Brian J. Gray, DDS, MAGD, FICO

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.