Children (and adults) often times experience a high level of anxiety when they see a dentist, especially if they need a lot of procedures done at once. Some children also have a high “gag” reflex and / or they could have some form of nervous reaction which could result in a safety issue during the procedure. This is where advanced behavior management techniques can really come to the rescue!
While mild sedation does not control all discomfort or anxiety, it does calm children enough to make the administration of anesthetic (shot) much more comfortable and limits untoward movements that complicate safely removing cavities with a handpiece (drill). Sedation also allows for more time of cooperation, keeping the child relaxed and capable of handling larger treatment plans. Any time an advanced behavior management technique is utilized, children will need to be monitored closely by an adult for an extended period of time after. Although sedation can be very useful for most situations, there are times when health considerations, amount of treatment required, safety of the staff and child, and to protect the developing psyche of a child, general anesthetic is the only safe way to complete treatment. Fortunately, both Dr. Kahn and Dr. Wiley are on staff at St. Vincent Hospital and Carmel Ambulatory Surgery Center, and very experienced in treatment under surgical conditions.
Administered through the mouth and sometimes the nose, Oral Sedation can be used to help calm the your child if they are nervous, but cooperative. The medication is administered after a physical exam and history rules out the risk of complications. If your child is having oral sedation, he or she should have nothing to eat or drink after midnight the night before the appointment.
General Anesthesia (GA)
General Anesthesia requires coordination with a hospital or surgical center to administer the medication. GA is performed under the most controlled conditions possible, which allows a very safe working environment for both the doctor and your child. After a thorough medical history and physical the morning of the procedure, the child is eased into the sedation and is intubated once unconscious. They wake up following completion of the entire procedure, not knowing what has happened. Confusion, nausea/vomiting and sore throat are among the most common post operative complications. Most children are back to normal activities later that day.
When the procedure is done, you will remain with your child as the medication wears off. The length of time it will take for the medication to wear off will vary, as some children take longer than others to become alert. Children coming out of sedation react in different ways. Your child might cry, be fussy or confused, feel sick to his or her stomach, or vomit. These reactions are normal and will go away as the sedation medication wears off. When your child is discharged, he or she still might be groggy, dizzy, or nauseous, and should take it easy for the rest of the day.
Commonly referred to as “laughing gas”, Nitrous Oxide is a very popular, effective and safe form of mild sedation that allows your child feel very relaxed and calm during their dental procedures. This form of sedation is usually given through the use of a “space mask” that delivers a constant combination of nitrous oxide and oxygen throughout the entire procedure. We calmly ask the child to gently breathe through their nose, not their mouth. At this point they will smell a sweet aroma and immediately begin to feel a little faint, with the full feeling of the sedation taking effect in about 5 minutes. At this point they tend to describe the sensation as feeling happy inside, and may say some pretty funny things as they stay awake for the entire procedure. (See funny video below) Once the procedure or procedures are complete, the combination of nitrous oxide and oxygen ceases and becomes pure oxygen for about 5 minutes to ensure that all the remaining gas has been cleared from their system. Since most children feel a little dizzy during this process, we recommend limiting your child to a very light meal like toast or a bagel so that their system isn’t empty, but also not extremely full.