Sedation dentistry for children: What parents should know and expect

Do understand the basic goals of sedation

Fear of the dentist presents a barrier to successful dental treatment. A high level of anxiety may not only interfere with your child’s comfort level during the procedure, but it may also jeopardize the overall safety and quality of the care that is delivered. Thus, sedation may be recommended.

According to guidelines outlined by the Academy of Pediatric Dentistry (2013): ” The goals of sedation in the pediatric patient for diagnostic and therapeutic procedures are: 1) to guard the patient's safety and welfare, 2) to minimize physical discomfort and pain, 3) to control anxiety, minimize psychological trauma, and maximize the potential for amnesia, 4) to control behavior and/or movement so as to allow the safe completion of the procedure, and 5) to return the patient to a state in which safe discharge from medical supervision, as determined by recognized criteria, is possible.”

Other patients that may benefit from sedation are very young children who don’t have the full capacity to understand or cope with routine dental treatment, patients with special needs, or children that have extensive cavities and dental needs.

Do know that there are various types of sedation

Dentists can use various techniques for providing anxiety and pain control in patients during dental treatment. While pediatric dentists routinely use psychological techniques, there are instances where the use of adjunctive medications is necessary. Different types of sedatives may be used. These medications can be administered in different ways, including orally (by drinking a small amount of liquid), intravenously (through an IV line), or intramuscularly (through a quick injection).

Sedation is a broad term and the effects fall along a continuous spectrum ranging from mild, moderate to deep sedation. In some cases, in-office sedation may be too limiting and your dentist may recommend general anesthesia in a facility outside of the dental office as a more appropriate method of treatment for your child. Your dentist will determine what level of sedation will be necessary in order to fully complete your child’s dental needs.

These decisions are usually based on many factors including your child’s overall health status, his anxiety level, the extent of his treatment, and whether your child needs to be completely asleep for the treatment or if he may only need a bit of medication to make him drowsy and more cooperative throughout the visit. Each level of sedation will have different requirements regarding how many people need to be in the room, what type of equipment is needed during the visit, and additional certifications or specialty training required for the doctors.

Do be prepared

Many parents don't realize the important role they play in helping their child feel more comfortable at the dentist. Parents’ fears and anxiety can be transferred to their child. Children tolerate dental treatment best when their parents fully understand what to expect and prepare them for the experience. Before the procedure your dentist should conduct a complete consultation outlining the overall goals of sedation, the reasons why your child may benefit from sedation, important instructions to follow during the days leading up to his appointment, and what to expect during and after your child’s treatment.

It is important to ask all questions you may have and address any doubts with the procedure. A very important part of being prepared is to know that changes may happen. Sometimes the treatment plan may need to be altered or your child may respond differently to the sedation and require an alternative plan to complete the treatment. Regardless, being aware that this is a possibility ahead of time is important.

You may also not be permitted to be in the treatment room during certain parts of the visit so it is crucial to be familiar and comfortable with all aspects of your child’s care. Trust and confidence in your dentist is vital. Your child will follow your lead in how he responds to the dentist and treatment.

Do give your dentist an accurate health history

In order to safely determine if sedation is right for your child, his overall health status will be heavily considered. Your dentist will ask about your child’s general health and do a review of systems, especially paying close attention to any respiratory-related problems such as asthma or sleep apnea. A thorough history of hospitalizations and surgeries will also be documented as well as details about any prescribed medications your child is currently taking.

Tell your dentist about all medications, including any herbal supplements or over-the-counter medications, and be sure to report any drug allergies or adverse reactions to medications that your child may have experienced. Your dentist may also require a visit to your child’s pediatrician the week before the sedation in order to get an accurate assessment of your child’s health and make sure nothing has changed before the day of his appointment. If there are any changes, such as a recent cold or other illness, it is best to notify your dentist immediately to see if it will be necessary to reschedule the sedation appointment.

Finally, your dentist will do a visual assessment of your child’s tonsils, listen to his breath sounds and evaluate baseline vital signs. All of this is necessary to determine whether sedation is right for your child and will aid in choosing the appropriate sedative medications. Being honest about your child’s health status will help to ensure the safety of your child and decrease the risk of unanticipated negative effects.

Do follow all of your dentist’s special instructions

It is essential to follow all of your dentist’s instructions before the visit. Typically your dentist will require a strict fasting protocol in the hours before the sedation. These guidelines are designed for the maximum safety of your child. Pay close attention to your dentist’s requirements for the consumption of food and liquids before the appointment. Some of the medications used for sedation may have the potential to change the way your child's airway reacts, especially during deeper sedation periods. Though adverse reactions are rare, it's still prudent for your child to have an empty stomach to eliminate any complications that may occur with vomiting or regurgitation.

You will also be given guidelines on how to dress your child for his dental visit and what to bring. Often times your child’s favorite blanket or stuffed animal will aid in giving him extra comfort upon arriving at the office. Your dentist may also give you suggestions as to whom you should bring with you. Commonly, it is best to leave other children at home so you can give your child your full attention before, during and after his procedure. It is also generally recommended to have two adults accompany your child so that one person can observe him at all times. This is especially important after the procedure.

When leaving the office, your dentist will make sure your child is responsive and stable enough to leave. There is a chance that your child may become re-sedated once he is at home, in a quiet environment, until the medications are completely metabolized. Because each child will metabolize the medication at different rates, constant home supervision will be necessary until your child has fully recovered from the effects of the sedatives. Your dentist will also discuss post-operative instructions with you, including advice on how to re-introduce diet and activities after the procedure. If choose to ignore your dentist’s orders you may be doing so at the risk of your child’s comfort and safety.

Do not think that every child will be a candidate for sedation

Sedation is quite effective for a healthy child who had unsuccessful dental treatment in the past due to anxiety or fear. It also is indicated for children who are unable to cooperate for treatment because they are either too young or have special needs. Furthermore, if your child has particularly extensive dental needs, then sedation may allow all the treatment to be safely completed in very few visits.

However, sedation may be contraindicated in certain cases. There are criteria that dentists must follow when choosing sedation as a treatment option for patients. Some children may have specific health conditions that make sedation in the dental office unsafe. These children may require advanced techniques in a hospital or a facility outside of the dental office. There are always risks associate with any sedation and it is important to weigh the risks versus the benefits. If your child is generally cooperative for most dental procedures or if he has minimal dental needs, then the benefits of sedation may not outweigh the risks. He may benefit from the use of more common behavior guidance techniques or nitrous oxide, which is safe and routinely used in the treatment of children.

Do not expect that every child will have the same reaction to sedation

Children may respond very differently to sedation. The effects can vary from one child to the next. Your child may become very relaxed by the medication and may even fall asleep during the procedure. However, it is also possible that the medications may not have a profound effect on your child and he may react negatively throughout the treatment. This can be attributed to an array of factors. If sedation is unsuccessful then your dentist will discuss various alternatives with you. She may want to try again but increase the dose of the medication or use a different sedative altogether. In some cases, other modalities may be recommended such as deeper sedation or general anesthesia.

A very important part of being prepared is to know that every child may respond differently and therefore you and your dentist should come up with a plan for your child’s treatment should he not respond as anticipated.

Do not rush into a decision

It is very normal to feel slightly uncomfortable when sedation is recommended for your child. While sedation is becoming much more common in the dental treatment of children, most parents don’t fully understand what it entails. This is why your dentist will always do a thorough consultation with you before booking the treatment appointment. This should outline the necessary information you will need to make an informed decision about proceeding. This is the time to ask all the questions you have and to explore all the areas that you are concerned about. It also may be helpful to have other family members accompany you to the consultation so that they also understand what to expect.

Don’t rush; there is nothing wrong with needing time after the consultation to process all of the information before making a decision. Don’t be afraid to do your research and even seek a second opinion before deciding. Your comfort level and trust is crucial and necessary in order to provide a successful outcome.

Do not be afraid to reschedule your child's appointment if he is sick

Your child must be healthy for his sedation visit. Any changes in health status, recent illness, fevers, or periods of coughing can place your child at an increased risk for complications during his procedure. Changes should be reported promptly so that your dentist may decide if it is necessary to reschedule the treatment. Even if his cold may not seem like a problem, it is not worth putting your child’s life at risk just to have his dental work completed. Furthermore, your child will have a more positive experience during and after treatment if he is rested, relaxed, healthy and comfortable.

Do not forget that there are always risks involved

There are always inherent risks involved with sedation and anesthesia. It is usually safe, though, when an experienced and qualified dentist administers the sedation. Most pediatric dentists have had additional years of training in sedation and emergency rescue techniques. These dentists will also adhere strictly to the sedation guidelines of the American Academy of Pediatric Dentistry, which includes consistent monitoring of your child's vital signs throughout the procedure using required equipment. In some cases an anesthesiologist may be involved to provide an additional level of safety.

Dentists who do sedation in their office regularly will make sure that they have the required equipment, supplies and medications necessary to safely treat a patient and minimize the risks associated with sedation. Likewise, all staff members involved in the sedation procedures should be trained properly in the duties and responsibilities they have during the sedation.

A key factor in safety is case selection. Your dentist will do assessments to make sure your child is a candidate for sedation. Some patients may be given alternative treatment recommendations if they have certain medical conditions that may make complications from sedation more likely. Therefore it is crucial for you to give the dentist an accurate and thorough report of your child's health history as well as follow all of the instructions given to you prior to the appointment. If you have any concerns about safety, speak with your dentist about all the measures taken to protect your child's health and well-being.