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Remember getting a tooth pulled as a kid? Or a whopper of a cavity filled? No fun, was it? Nowadays, anxious kids or children who need extensive dental work can be spared the anxiety that goes with having cavities filled or teeth pulled if they’re sedated. But dental sedation is not without risks, and serious complications, although rare, are possible. That’s why it’s important that the dental team sedating your child is well-trained and equipped to respond to any situation that doesn’t go as planned.
We asked Max Sulla, DDS, pediatric dentist with Tender Smiles 4 Kids in Freehold, and Gregory A. Bauman, MD, general and pediatric board-certified anesthesiologist with St. Joseph’s Healthcare System in Paterson, to weigh the benefits and risks. Both stress the importance of taking measures to ensure a safe procedure.
What is dental sedation?
Dental sedation uses medication to help a patient relax during procedures. It’s recommended when a child is extremely nervous or uncooperative, or when a lot of dental work needs to be done.
“Most children do not require sedation for dental procedures,” says Dr. Sulla, president of the New Jersey Academy of Pediatric Dentistry. Although rare, serious complications from sedation can occur, which is the case with all procedures involving anesthesia. But thanks to preventive dentistry, these situations are far from the norm. “Parents are bringing children to the dentist at an early age—ideally when they’re a year old. This helps children establish a dental family, someone they visit every six months and learn to trust,” says Dr. Sulla. With frequent visits, dentists can detect and repair small problems before they become big ones.
What are the advantages?
“Under sedation, the child is at ease and psychologically unaffected by sounds, sensations or feeling,” says Dr. Sulla, “so the dentist can work on multiple teeth and provide quality care in a short period of time.” And that means fewer visits.
What types of sedation are available?
Oral conscious sedation puts kids in a twilight or groggy state, but they’re still conscious. About 20 minutes before a procedure begins, the child is given oral medication to relax. After the medication kicks in, nitrous oxide is administered. You can be with your child until the procedure begins. Note that nitrous oxide (laughing gas) and oxygen inhalation are used to reduce anxiety and pain, but won’t sedate your kid.
If your dentist plans to do deep sedation by IV, make sure it’s administered by a qualified anesthesiologist following the guidelines of the American Association of Pediatric Dentists. Sedation and general anesthesia should only be administered in a hospital or ambulatory surgical setting following the guidelines of the AAPD, which can be found at aapd.org.
What are the risks?
“All children face risks with any sedation,” says Dr. Bauman. To minimize these risks, the facility should be staffed and equipped per AAPD standards to handle emergencies. While less than .5 percent of patients get nauseated when using nitrous oxide, it does happen, according to the AAPD. “With nitrous oxide, a child can vomit, leading to aspiration and complications,” explains Dr. Bauman.
“Secretions may irritate the vocal cords, leading to contraction (known as laryngospasm) and [blockage of] air movement.” With oral conscious sedation, the child can go into a deeper state of sedation than expected and could stop breathing if too much sedation is given or the child is sensitive to the normal dose or has a respiratory problem. Children younger than 3 should only be sedated in a hospital or surgical center.
Dr. Bauman says he does all procedures under general anesthesia at Children’s Ambulatory Surgical Center in Fair Lawn. “This is safest because the child’s airway is protected, he or she’s monitored, we have emergency medications on hand and personnel are pediatric-trained,” he says.
Always have a pediatrician check your child prior to sedation and anesthesia to make sure she’s healthy and free of respiratory symptoms—including a dry cough—for at least two weeks. Preexisting conditions like autism, seizure disorders, respiratory or cardiac issues and birth history must be discussed.
What can I do to keep my kid safe?
Sedation should only be used as a last resort. If the tooth isn’t abscessed, silver diamine fluoride can be applied to the cavity twice a year to keep it from getting larger. It’ll turn the cavity black, but that’ll be remedied when the baby tooth falls out or when your child is older, more cooperative and can have the tooth restored.
Also, make sure a properly-trained dentist, anesthesiologist (for deep sedation IV/anesthesia) and qualified assistant are present. They should explain how they handle complications and emergencies.
Here’s what you should ask:
Who monitors my child’s vital signs during and after the procedure?
The AAPD requires monitoring of end tidal CO2, blood oxygen, heart rate and blood pressure while under sedation or anesthesia. A dentist cannot do the procedure and also monitor the vital signs, Dr. Bauman says.
Is there an airway emergency cart?
It should have devices that can help open the airway through the nose or the mouth, plus devices that can maintain an open airway.
What is your post-operative monitoring policy?
Because the child is still under the effects of sedation, postoperative monitoring of vital signs should continue for 30 to 60 minutes. Before discharge, your child should be alert and able to drink, hold her head up and not vomit. Two adults should take the child home—one to drive, the other to make sure the child doesn’t fall into a deep sleep.
If you’re not comfortable with the answers to any of these questions, trust your gut and get a second opinion before putting him under.
New Orleans native Karen B. Gibbs is a freelance writer specializing in health and lifestyle.