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About Pediatric Sedation
Anyone who has taken their child to the dentist for consecutive appointments knows the - ahem - drill. And if your child is like most kids (with an attention span no longer than a Sesame Street episode) then no amount of prizes from the prize basket will alleviate their unhappiness.
To put it plainly, going to the dentist can be even more taxing for kiddos than for us grownups. So what’s a parent to do?
There's a way to help: pediatric sedation dentistry.
"The phobia that many adults have today regarding dental treatment is often the result of poor dental experiences when they were children. Children today receiving invasive dental treatment can be treated as they would if they received invasive medical treatment – with safe orally administered sedation. Utilizing modern, safe sedative medications, a child can be conscious, yet sleepy, with no memory of their dental treatment. With proper case selection, utilization of monitoring equipment, and established emergency preventative and preparedness protocols, a properly trained dentist and team can safely perform oral conscious sedation on appropriate children in the dental practice. Children today can grow up without unpleasant memories of going to the dentist and enjoy a trusting, positive relationship with a dentist and team for the rest of their lives." —Roger Sanger, DDS, MS
Adult sedation dentistry has grown in popularity over the last fifteen years and was developed as a way to reduce or eliminate much of the fear or anxiety many adults experience upon visiting the dentist. Pediatric sedation is the unique study and implementation of sedation for children aged 5-12. It allows appropriately trained dentists to create safe and comfortable dental experiences for children who have avoided the dentist out of fear. A dentist who has been trained to implement pediatric sedation can effectively help a patient become as comfortable and relaxed as possible using well established and proven protocols with a variety of sedation medications administered orally and sublingually (under the tongue). This approach also prevents children from developing a fear of the dentist by creating great experiences.
Although children have the same fears and reservations towards the dentist as adults often do, pediatric sedation dentists must be trained specifically to treat children – not just adults. Children have a largely distinct set of needs. They have different airways than adults and, of course, different rates of metabolizing sedatives. Therefore, pediatric dentists must complete a unique curriculum in order to perform pediatric sedation.
As a parent, it's important to research pediatric sedation fully to know if it is the right choice for you and your child. Below are some common questions parents and children may have prior to considering pediatric sedation dentistry.
Sedative medication helps relax patients by slowing the action of the central nervous system. Your child will remain aware of their surroundings, but will be less responsive to external stimuli like the sound of the drill or the smell of the materials. Sedation will also produce an amnesic effect in your child – which means although they will be conscious during the appointment – it is likely they won’t remember the appointment the following day. This is beneficial to many children as the memories they have associated with the dentist may be unpleasant.
Sedatives will also help reduce your child's sense of pain. Today’s doctor draws upon a continually-expanding list of new sedatives to help lessen pain and dental anxiety. Doctors weigh a number of factors carefully to assess which drug will be the safest choice in a unique situation for your particular child.
Needless to say, every child should be individually and carefully evaluated for his/her suitability.
Sedating pediatric dental patients is usually recommended for otherwise healthy kids who require extensive dental treatments and/or are likely to be anxious in unfamiliar settings.
Sedation dentistry allows dentists to accomplish more during each office visit, reducing the number of total visits a child requires – which often means parents miss less work as well. As important, if not more important, sedation dentistry relieves children of much of their anxiety – meaning they won't develop a lifelong phobia of visiting the dentist.
Children with non-dental medical conditions frequently can be safely and effectively treated using sedation medications. It is crucial, however, to alert your dentist in advance to either health or mental conditions that might impact treatment, and to provide the dentist with a full list of all medications you're giving your child.
No child should ever be sedated by a dentist who has not received qualified, specialized, recent training in sedation techniques. In addition, the dentist and all dental assistants must be trained in airway support and other safety procedures for those very rare instances when a child has an unanticipated reaction to sedation.
While many adults find it difficult to visit the dentist and sit still for long procedures, for kids and toddlers the experience can be even more traumatic and create an aversion to seeking dental care that endures into adulthood.
Sedation, as properly dosed and applied to children, is not about minimizing pain. It is about eliminating anxiety and emotional discomfort. Moreover, often a child who is correctly sedated and closely monitored can complete more dental work in a single visit – which most parents and kids favor over having to return time and again for treatments.
Before agreeing to allow your child to be sedated during a dental visit, do ask your dentist what specific medication s/he plans to use. It’s a good idea to write it down, as well as the planned dose.
The recommended sedatives and doses for children are typically different that what sedation dentists use with adults. The state-of-the-art protocols in pediatric sedation, often formalized by state regulation and national guidelines issues by the American Dental Association, are intended to use medications that are as mild as possible and wear off quickly.
Today, the most commonly used oral sedative drug in pediatrics is Midazolam (Versed) which is not only a very safe sedative drug with a reversal drug should an emergency occur, but it is one of the most popular drugs that provide amnesia so that the child has no memory of the appointment.
As a parent, it is crucial that you always inform your child’s dentist of any other medications s/he takes – even over-the-counter drugs – and any health or psychological conditions that affect your child. Often, if you ask the dentist ahead of your office visit about what sedation medication s/he is likely to use, you can research the drug yourself on the Internet and ask any questions you may have before treatment begins.
News coverage of such tragedies, as very rare as they are, is shocking and disturbing to all dentists. Serious injuries or fatalities should never occur as a result of an oral health procedure.
We are hesitant to draw upon media reports alone to develop a theory as to what went wrong in any individual instance. Often, due to lawsuits and privacy concerns, the specific details of high-profile cases are never made public.
What we do know is that healthy children and adults who are treated by dentists who follow all
recommended sedation safety protocols have been treated safely, successfully and in comfort many millions of times without incident.
Dr. Roger G. Sanger, a pediatric dental specialist and the Course Director for the pediatric sedation courses at DOCS Education, has personally treated more than 13,000 children with sedation and never had one emergency arise.
If your child has non-dental related medical conditions, especially those impairing his/her immune system or impacting breathing, your child may not be able to receive sedation dentistry in an outpatient (office) setting.
Children with certain behavior issues are also not good candidates for sedation dentistry.
This is why it is absolutely vital that you provide your dentist a full record of your child’s health (including mental) conditions and all medications (both prescription and non-prescription) that you administer to your child.
No. All medical procedures and medications carry with them some risk. This being said, medication or medications used should be the safest possible ones available today and used at a level to achieve only minimal sedation. Because your child remains conscious the entire time – and the medication used is mild– the risk is smaller than if your child were treated at the hospital under a general anesthesia. Oral sedative drugs should never be used at a high level to achieve deep sedation. Oral conscious sedation will never replace intravenous or inhalation deep sedation or general anesthesia. However, both of these come with a higher degree of risk.
Dentists vary in their preferences on this issue. Increasingly, dental practices feature open treatment rooms and many do permit – even encourage – a parent to remain with a child during routine procedures. If your dentist doesn’t permit this, ask why not.
However, when a child requires sedation and complex treatment, the typical standard of care is to request that parents wait in the outer office. This is really in the child’s best interest, because anxious parents can sometimes distract the dentist or a member of the dental team by asking frequent questions – when the dentist’s full focus should be on your child and monitoring the all of your child’s vital signs.
Like surgeons in a hospital setting, dentists – who conduct microsurgery – should not have to concern themselves with any matter other than the child’s safety, comfort and effective treatment. (Many dentists will designate a non-essential team member to regularly brief waiting parents about the progress of their child’s treatment. It is certainly your right to request such regular updates.)
No. The goal of sedation is to reduce your child’s anxiety and discomfort. Unlike a general anesthesia, such as might be administered in a hospital operating room, sedation dentistry is designed so that your child is still awake and can respond to the dentist. In addition to the sedation drugs given, the dentist will also give a local anesthesia drug that will “numb” the area of treatment.
Being conscious means your child may at times shed some tears, not so much from pain as from the unusual circumstance of being surrounded by strangers and having to sit still for longer than usual. Dentists consider whimpers or cries a good sign, indicating that your child’s airway is open.
An important characteristic of the most common sedation medications for kids is that they produce an amnesia-like effect. Your child is unlikely to remember any anxiety or discomfort whatsoever.
Yes, that is not uncommon. Which, of course, is why a parent should always escort the child and keep a close watch on her/him for up to seven hours following the procedure. Ask your dentist for specifics on how to help protect your child until the medication wears off.
The most common pediatric sedation medications do have a relatively short-lived effect and typically wear off completely by the next morning. There are no lingering side effects.
Most importantly, let the dentist (or a member of the dental team) know of any new medical conditions (even a cold or flu) or other health developments that could influence the use or dosage of sedation medication.
It is especially important to alert the dentist to the last time your child had any food – which can be dangerous if consumed too close to the procedure.
Be upbeat with your son or daughter, answering questions or concerns they might express with reassurance and plenty of love. If you do stay with your child during treatment, make certain not to ask negative questions – such as, “Is the dentist hurting you?” – that might give your child reason to be anxious.
Choosing the right dentist should be contingent on a variety of factors, as we’ve indicated above. Having confidence in your dentist’s knowledge, training and procedures is of paramount importance. DOCS Education offers continuing education courses to both pediatric dental specialists and general dentists who treat children.
When it comes to the issue of pediatric sedation, we believe what is most important is that your child’s dentist be properly trained, have sufficient experience, and be fully up-to-date on all related safety protocols. Both general dentists and pediatric specialists who meet these criteria will be capable of properly and safely administering sedation medication to your child.