Hospital / 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 in order for treatment to be performed safely.
- 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 in an outpatient setting.
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.
A physical examination before receiving general anesthesia is required to ensure your child 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 guidelines of the doctor providing the anesthesia gives you regarding 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 them about the hospital visit and treatment several days before the appointment, to give them time to think about it and to ask questions. Also, each parent will have his or her ideas on how best to prepare their child.
- Let your child rest quietly at home after the procedure. He will probably be ready to resume his normal schedule the next day.
IV Sedation, also known as Deep Conscious Sedation is usually used by Oral Surgeons and dentists with specialized training and special certification. With this type of sedation, medications are administered directly into the blood stream. The greatest advantage of IV Sedation is that if someone is not sedated enough, the doctor can administer more medication and the effects are instantaneous. IV Sedation is not used commonly in most dental offices because of the specialized advanced training required and the requirements for certification by the State Board of Dentistry. The drugs used for IV Sedation are more effective then the same drugs taken orally. There is a more profound amnesia associated with this technique.
Oral Conscious 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.
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 always delivered mixed with oxygen. To prevent overdose, nitrous oxide machines are designed to stop the flow of nitrous oxide if the oxygen concentration drops below 30 percent.
When the treatment has been completed, the nitrous oxide is turned off and pure 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.
