Most children are calm, comfortable and confident in a pediatric dental office. The office is designed for young people, and pediatric dentists have additional training in caring for infants, children and adolescents. Staff members choose to work in a pediatric dental office because they like children and want to cater to their special needs. These elements combine to make your child feel relaxed and special.
Sometimes, however, a child may feel anxious before or during treatment. Your child may need more support than a gentle, caring manner to feel comfortable.
- NITROUS OXIDE: multiple visits but very safe and effective
Q: What is nitrous oxide/oxygen?
Nitrous oxide/oxygen (N2O-O2) is a blend of two gases — oxygen and nitrous oxide. A fitted mask is placed over the nose and, as the patient breathes normally, uptake occurs through the lungs. At the end of treatment, it is eliminated after a short period of breathing 100% oxygen and has no lingering effects. Nitrous oxide/oxygen is a safe, effective sedative agent used to calm a child’s fear of the dental visit and enhance effective communication. Additionally, it works well for children whose gag reflex interferes with dental treatment
Q: How will my child feel when breathing nitrous oxide/oxygen?
Your child will smell a faint, sweet aroma and experience a sense of well-being and relaxation. Since it may produce a feeling of giddiness or euphoria, it is often called “laughing gas.” Children sometimes report dreaming and their arms and legs may feel “tingly.” It raises the pain threshold and may even make the time appear to pass quickly. If your child is worried by the sights, sounds or sensations of dental treatment, he or she may respond more positively with the use of nitrous oxide/oxygen.
Q: How safe is nitrous oxide/oxygen?
Very safe. Nitrous oxide/oxygen is perhaps the safest sedative in dentistry. It is well tolerated. It has a rapid onset, is reversible, can be adjusted in various concentrations and is non-allergenic. Your child remains fully conscious — keeps all natural reflexes — when breathing nitrous oxide/oxygen. He/she will be capable of responding to a question or request. We use 30% Nitrous oxide/ 70%oxygen which is more oxygen than breathing normal room air. It may also be used in combination with other sedative agents.
Q: Are there any special instructions for nitrous oxide/oxygen?
First, give your child little or no food in the two hours preceding the dental visit (occasionally, nausea or vomiting occurs when a child has a full stomach). Second, tell your pediatric dentist about any respiratory condition that makes breathing through the nose difficult for your child, as it may limit the effectiveness of nitrous oxide/oxygen. Third, tell your pediatric dentist if your child is taking any medication on the day of the appointment.
Q: Will nitrous oxide/oxygen work for all children?
Pediatric dentists know that all children are not alike. Every service is tailored to your child as an individual. Nitrous oxide/oxygen may not be effective for some children, especially those who have severe anxiety, nasal congestion, or discomfort wearing a nasal mask. Your pediatric dentist will review your child’s medical history, level of anxiety, and dental treatment needs and inform you if nitrous oxide/oxygen is recommended for your child. Nitrous oxide will only work if the child breathes in through his/her nose.
- ORAL SEDATION: 1-2 visits; child is responsive and maintains consciousness
Q: What is oral sedation?
Sedation is a technique to guide a child’s behavior during dental treatment. Medications are used to help increase cooperation and to reduce anxiety or discomfort associated with dental procedures. Sedative medications cause most children to become relaxed and drowsy. Unlike general anesthesia, sedation is not intended to make a patient unconscious or unresponsive.
Q: Who should be sedated for dental treatment?
Sedation may be indicated for children who have a level of anxiety that prevents good coping skills, those who are very young and do not understand how to cope in a cooperative fashion, or those requiring extensive dental treatment. Sedation can also be helpful for some patients who have special needs. However, there is NO GUARANTEE that the sedation will be effective for your child. Some children will sleep throughout the procedure, others may take a long time to relax and then fall asleep, and others may be combative the entire time. Every child is different.
Q: Why utilize sedation?
Sedation is used for a child’s safety and comfort during dental procedures. It allows the child to cope better with dental treatment and helps prevent injury to the child from uncontrolled or undesirable movements. Sedation promotes a better environment for providing dental care and it lengthens the attention span of the child to minimize the amount of visits. Most full mouth rehabilitation can be completed in 1-2 sedation visits.
Q: What medications are used?
Various medications can be used to sedate a child. Medicines will be selected based upon your child’s overall health, level of anxiety and dental treatment recommendations. For very young patients, we prefer to use Demerol/ Vistaril combination because Demerol has a reversal agent in case of an emergency. For the older anxious patient, we use Halcion.
Q: Is sedation safe?
Sedation can be used safely and effectively when administered by a pediatric dentist who follows the sedation guidelines of the American Academy of Pediatric Dentistry. There is a risk of respiratory depression. However, patient monitoring for the safety of your child is done with the pulse oximeter to measure how much oxygen your child is getting and a precordial stethoscope to hear the breathing sounds. We have 2 dental assistants in the room to help monitor the patient. Oral sedation is contraindicated in children with severe asthma.
Q: What special instructions should I follow before the sedation appointment?
Children often perceive a parent’s anxiety which makes them more fearful. They tolerate procedures best when their parents understand what to expect and prepare them for the experience. If you have any questions about the sedation process, please ask. As you become more confident, so will your child. Should your child become ill, contact your pediatric dentist to see if it is necessary to postpone the appointment. Tell your pediatric dentist about any prescribed, over-the-counter or herbal medications your child is taking. Check with your pediatric dentist to see if routine medications should be taken the day of the sedation. Your pediatric dentist will provide you with additional detailed instructions before your sedation visit. It is very important to follow the directions regarding fasting from fluids and foods prior to the sedation appointment.
Q: What special instructions should I follow after the sedation appointment?
Your pediatric dentist will evaluate your child’s health status and discharge your child when she is responsive, stable and ready to go. Children recover from effects of sedatives at different rates so be prepared to remain at the office until the after-effects are minimal. Once home, your child must remain under adult supervision until fully recovered from the effects of the sedation. Your pediatric dentist will discuss specific post-sedation instructions with you, including appropriate diet and physical activity.
- GENERAL ANESTHESIA: Effective, one visit, recommended for severe cases or medically compromised patients
Q: What is general anesthesia?
General anesthesia is a controlled state of unconsciousness that eliminates awareness, movement and discomfort during dental treatment.
Q: Who should receive general anesthesia for dental treatment?
General anesthesia may be indicated for children with extensive dental needs who are extremely uncooperative, fearful or anxious or for the very young who do not understand how to cope in a cooperative fashion. General anesthesia also can be helpful for children requiring significant surgical procedures or patients having special health care needs.
Q: Is general anesthesia safe?
Although there is some risk associated with general anesthesia, it can be used safely and effectively when administered by an appropriately-trained individual in an appropriately-equipped facility. Precautions are taken to protect your child during general anesthesia; personnel who are trained to manage complications will monitor your child closely. Your child will be intubated and monitored by an anesthesiologist in a hospital setting.
Q: What special considerations are associated with the general anesthesia appointment?
A physical evaluation is required prior to general anesthesia for dental care. This physical assessment provides information to ensure the safety of your child during the general anesthesia procedure. Your pediatric dentist or general anesthesia provider will advise you about evaluation appointments that are required. Parents are instructed to report to the pediatric dentist any illness that occurs prior to the general anesthesia appointment. It may be necessary to reschedule the appointment. It is very important to follow instructions regarding fasting from fluids and foods prior to the appointment. Your child will be discharged when stable, alert, and ready to depart. Patients often are tired following general anesthesia. You will be instructed to let the child rest at home with minimal activity until the next day. Post-operative dietary recommendations also will be given.