Oral Sedation Pediatric Dentistry

Sedation reduces anxiety during dental procedures that may be uncomfortable for patients. It is especially important when it comes to performing procedures on children who are less able to deal with the discomfort that may result from a dental procedure. It is commonly prescribed where complicated procedures are necessary, for multiple procedures or where a child has an increased gag reflex.

Often, sedation will be recommended for a child during a dental procedure that an adult can undergo with a local anesthetic that numbs only the site where the procedure is being performed. It is used to calm pediatric patients and is commonly used in conjunction with a local anesthetic which provides relief from pain that may be associated with the procedure.

What Types Of Sedation Are Available?

There are 4 basic types of sedation that are used in pediatric dentistry:

– Nitrous Oxide
– Conscious Sedation
– I.V. Sedation
– General Anesthesia

While each of these types of does has certain risks associated with them, the risks are always carefully weighed against the benefits of performing the procedure under it. Parents or guardians must provide consent for any type of it and should be made aware of the risks involved. It is important to inform the dentist and/or anesthesiologist of any medication (natural and pharmaceutical) that the child is taking as well as any other relevant health information such as allergies, health conditions and history of sedation.

1. Nitrous Oxide

Nitrous Oxide, commonly referred to as laughing gas, provides mild sedation allowing the child to be entirely relaxed and sleepy but conscious and able to follow instructions during the procedure. The gas, mixed with oxygen, is delivered through a mask placed over the nose and mouth and breathed in through the nose. The sedative should take effect within about 5 minutes. The patient’s breathing and ability to follow instructions will be carefully monitored while they are sedated.

Before The Procedure

It is recommended to provide only light meals and restrict fluids as nitrous oxide can cause vomiting. A child should also be prepared for what to expect from the process and how they will feel.

After The Procedure

Nitrous Oxide wears off quickly and the child will be ready to leave the dentist’s rooms directly after the procedure. They may feel a little nauseous and may vomit as the sedation begins to leave their system. Keep the child well hydrated – preferably with water or diluted fruit juice. If the child received a local anesthetic, their cheeks and lips may be numb for a few hours after the procedure. Be careful not to let them bite themselves.

2. Conscious Sedation

Conscious sedation provides a deeper state of relaxation than Nitrous Oxide and is normally administered orally as a drink or in pill form. The child will, however, remain conscious and able to follow instructions. It wears off relatively quickly and is therefore suitable for short, uncomplicated dental procedures. This type may need to be administered by an anesthesiologist who will monitor the patient throughout the procedure. A local anesthetic may be injected to numb the mouth after it has taken effect and before the procedure begins.

Before The Procedure

It is not necessary for a child to fast before conscious sedation although light meals and restricted fluids are recommended. It is advisable to prepare the child for the conscious sedation. Parents should be aware that it is less likely to be successful in patients who don’t cooperate with the sedative. It will take some time for it to take effect as it is delivered orally.

After The Procedure

It wears very quickly and the child will be ready to leave the dental rooms shortly after being monitored for a short period. The child may still feel slightly relaxed or sleepy until the sedation has entirely left their system. Hydration is important preferably with water. The child may not remember the procedure or what happened after the sedation has taken effect. The child may experience mild nausea or vomiting. Be aware that the child may bite their lips or tongue due to the lack of it caused by the local anesthetic.

3. I.V. Sedation

I.V. sedation administers drugs intravenously or into a vein and therefore directly into the bloodstream. This type must be administered by an anesthesiologist who will monitor the patient’s vital signs, breathing and other factors throughout the procedure and after. While the child may appear to be awake with open eyes, they are unaware of their surroundings or of the procedure. I.V. sedation blocks pain and local anesthetic to numb the area is not necessary.

Before The Procedure

It is recommended for a child to fast for a few hours before I.V. sedation is administered. The child should also be prepared for what to expect from it. In some cases, an adverse reaction resulting in crying and agitation may result. In this event, the procedure may be postponed or other medications administered to calm the child.

After The Procedure

The child will need to be monitored for a period after the sedation. Recovery can take anywhere from 45 minutes to an hour and in some cases longer. Their breathing and vital signs will be monitored during this time. The child will be sleepy and woozy for a few hours after recovery. They may experience some nausea and vomiting. The child should be given light food and water/clear fluids as soon as recommended by the nurse or anesthesiologist monitoring the patient.

4. General Anesthetic

General Anesthetic is administered through a mask and I.V. drip and may require oral sedation before the anesthetic is given. The anesthetic results in a total state of unconsciousness and the child will experience no pain or memory of the procedure. General anesthesia is, however, the riskiest and therefore the last resort for dental procedures in children.

Before The Procedure

The child must fast for a period of 8 hours. The child should be prepared for what to expect. A parent may be required to hold the child while the anesthesia is administered but will not be allowed to remain in the procedure room. The child will experience no pain during the procedure.

After The Procedure

The child may seem disoriented and confused as the anesthesia begins to wear off. They will be monitored in a recovery room until they are able to react and follow simple instructions. The child will be allowed to leave the hospital or clinic when they have been able to eat solid food without vomiting and are able to stand and walk. They will feel tired and woozy for a few hours after the anesthetic and may experience symptoms for a few days. It can take up to 6 weeks for general anesthesia drugs to completely leave the body.

In general, children do better with mild sedation than general anesthesia or I.V. sedation. It is important to discuss and consider the different sedation options available with the dentist relative to the procedures that need to be performed and the individual child. If there is any concern regarding the side effects or breathing after a child has been sedated, get emergency medical assistance immediately.