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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.

Laughing Gas (Nitrous Oxide) During Sedation Dentistry

The most commonly employed technique used in conscious sedation dentistry is inhalation sedation with nitrous oxide and oxygen (N₂0-0₂) or "laughing gas". It is estimated that approximately 35% of U.S. dentists use this technique to relieve dental anxiety.

The goal sought when laughing gas is used is to eliminate dental anxiety, making the patient more comfortable while the sedation dentist is able to more effectively complete the planned dental care procedure while the patient is sedated. Consult with your dentist to find out if this procedure right for you.

A small rubber inhaler will be placed over the patient's nose and adjusted so that the patient is comfortable. At this time, the patient will be breathing 100% oxygen.

Some patients at their first laughing gas visit will feel that they are not getting enough "air." The patient should tell the sedation dentist and he or she will provide them with even more oxygen to breathe.

Once the patient is comfortable breathing oxygen, the dentist gradually will introduce nitrous oxide. Over the next three to five minutes, the patient will be asked, "What are you feeling?" as the amount of nitrous oxide is slowly increased.

The signs and symptoms that most patients experience when receiving laughing gas include an initial feeling of lightheadedness, which gradually leads to an all-over feeling of warmth. Many persons mention a comfortable "vibrating" or "humming" sensation. It is common to feel one's fingertips and hands become "numb."

This same sensation may develop in the mouth - a benefit to the sedation dentist (and patient) during the dental care treatment. Some patients will mention that their arms and legs feel "very light." Interestingly, other patients will say that their arms and legs feel "so heavy I can't even move them."

If either of these occurs to the patient, it is perfectly normal. The individual might notice that they are perspiring a little, too. This is a normal effect of nitrous oxide and oxygen dentistry.

The sedation dentist will talk with the patient throughout the dental care procedure and the individual will be able to respond without any problem. This is a major advantage, and a safety feature, of conscious sedation using laughing gas.

If, at any time during the procedure, the patient feels that they are getting too much nitrous oxide or if they begin to feel uncomfortable, they should tell the dentist immediately and within seconds the dentist can adjust the flow of gases, and the patient will feel more comfortable again.

At the conclusion of the sedation dentistry treatment, the patient will once again receive 100% oxygen (for a minimum of three to five minutes). At the end of this time, the person should feel absolutely back to normal. If they still feel even a little bit sedated, the dentist should give the patient oxygen for a few more minutes.

Most dentists permit the fully-recovered laughing gas patient to leave the dental office unescorted and to resume their normal activities. In some situations where a patient recovers more slowly, they might be required to have an escort (friend or relative) drive them home.

Laughing gas inhalation sedation is highly effective in the management of mild to moderate levels of dental anxiety. It also is an excellent technique in persons who are extreme gaggers; laughing gas usually eliminates or minimizes gagging in most patients.

Finally, laughing gas is highly recommended for apprehensive patients who have medical problems such as angina pectoris, persons who have had a heart attack, or persons with high blood pressure, asthma or epilepsy.

Inhalation sedation dentistry should not be used with persons who are claustrophobic or with persons who are unable to breathe through their nose. Please discuss these with your dentist before treatment using laughing gas begins.

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.