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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.

Enjoy Your Dentists and the Dentistry Your Parents Never Had

What did your parents tell you about going to the dentist? Did they talk about how your dentists could help you take care of your teeth, gums and even your smile? Instead, they probably emphasized the negative: "It won't hurt much," or "Your toothache will be gone."

For most of us, the stories we heard about visiting dentists described how the person in the white jacket helped relieve tooth pain. We didn't hear about the dentists creating opportunities for good dental health and an attractive bright smile.

Comparing the dentistry your parents knew with the new dentistry that has emerged over the past ten to fifteen years is like comparing the computers of the 1950's with today's powerful desktop machines. The differences are vast. Yet, as dental care consumers, most of us have not updated our old stories. You haven't added new chapters about the great possibilities for dental care and dental well-being that the new dentistry offers.

You can experience these new possibilities for oral and dental health by creating partnerships with your dentists and their dental teams. You can take advantage of innovations and advances in:

• Treatment technologies and equipment
• Specialization
• New materials
• Preventive techniques
• Scientific knowledge
• Cosmetic enhancements like invisible fillings
• Integrated multi-specialty treatment teams

Today's dental care teams have the knowledge, skills and information to help create a positive dental health future. A partnership is based on communication and mutual responsibility, and you can actively foster that first communication.

You can begin to partner with your dentists and their dental care teams by:

• Asking about advancements in treatment technologies and materials.
• Finding out what steps you can take to maintain healthy teeth and gums.
• Creating a positive dental future through the recommended steps of flossing and brushing.
• Taking an active role in contacting your dentists and dental care team at the first sign of any concern about teeth or gums.
• Using your curiosity to make sure you understand the reasons for a referral to a specialist such as a periodontist or endodontist and the outcomes your dentists are seeking.

Your parents didn't have the choices or the opportunities that you have today for optimal dental health. The new dentistry can create more than a warm bright smile; it can improve your overall health.

The future of your dental health is in your hands just as the future of your bodily health is. Taking steps to increase your knowledge about the new dentistry will provide great benefits for you today and tomorrow.

By Brian DesRoches, PhD

+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.