Sedation Techniques

Some children become anxious in the dental office and can't relax or sit still long enough for the dentist to treat them. For these children, the dentist may suggest forms of medication that allow the child to relax and/or become sleepy. This is called conscious sedation, since the child is still responsive to conversation or stimulation and all his or her protective reflexes are working. It may involve inhaling a gas, taking an oral medication, getting an injection or receiving medication intravenously. Conscious sedation also may be used when a child requires extensive dental treatment or has special needs. Your dentist will recommend which type of conscious sedation is best for your child.

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 safe, easily taken and always delivered mixed with oxygen. When the treatment has been completed, the nitrous oxide is turned off and 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.

Sometimes, nitrous oxide can make a child feel nauseous. It's best that a child not eat too much beforehand. Also, if your child is congested or has trouble breathing through the nose, nitrous oxide may be less effective.

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.

In addition to oral medications, other methods can be used to deliver sedative medications to a child. They can be given through the nose, by suppository, by injection or intravenously (into a vein).

These methods require more experience to be administered and monitored properly. Injections and intravenous medications should be used only by dentists with extensive training in these techniques.

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
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 as an outpatient

Although general anesthesia is often the best choice in these cases, it also carries some risk. Your dentist should discuss the risks and benefits with you and explain why it might be right for your child.

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.

Your child will need a physical examination before receiving general anesthesia to make sure he or she 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 doctor's guidelines about 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 your child about the hospital visit and treatment several days before the appointment, to give him or her time to think about it and to ask questions. Parents also will have their own ideas on how best to prepare their children.

Let your child rest quietly at home after the procedure. He will probably be ready to resume his normal schedule the next day.

Meet with your child's anesthesia provider before the procedure. This will give you a chance to ask questions and go over some of the risks and benefits you may already have discussed with the dentist. Here are some questions you may want to ask:

What is your training? Are you board certified?
How often do you administer anesthesia to children?
What type of anesthesia will be used and how it will be administered? Why is this type of anesthesia better than another?
What types of problems might arise using this type of anesthesia?
Will you use any premedications (such as lollipops that contain mild sedative) to lessen my child's anxiety?
Can I be with my child when the anesthesia is administered and when she wakes up?
Will you physically be present or will one of your associates administer the anesthesia?