The use of sedation in Paediatric dentistry is a common way of delivering dental care in a compassionate and appropriate manner for young children.
There are many reasons why these services are provided and the use of oral sedatives, medications and/or the use of nitrous oxide sedation (happy gas) are the two most common forms of sedation in paediatric dentistry.
However, there are other parts of sedation which include conscious sedation, deep sedation as well as general anaesthesia.
You may find below some videos kindly provided by the American Academy of Pediatrics Dentistry that shows some important information regarding sedation in young patients.
Administration of Oral Agent in Knee to Knee Procedure
Angry Child Response to Midazolam
Evaluation of Child Before Discharge
Patient Physical Examination Including Airway Prior to Sedation
Nitrous Oxide Sedation
Instructions for patients undergoing nitrous oxide sedation for dental treatment
Nitrous Oxide Sedation (happy gas or laughing gas) is an ideal technique for children who readily accept a nasal mask and can breathe through the nose:
- If a mask is provided to your child for familiarization, please ensure that you bring this one back on the day of treatment.
- If your child is either congested, has a cold/flu or cannot breathe adequately through the nose, please advice our surgery as we may need to postpone your appointment.
Conscious sedation techniques such as oral sedation or Nitrous sedation mean that your child remains awake throughout the dental treatment and this procedure is carried out in the dental surgery. However, his/her perception is altered to facilitate unpleasant, invasive or painful dental procedures. “Memory” of the dental experience may vary depending on the technique and dose of the drugs used.
Nitrous Oxide sedation, relative analgesia (RA), happy or laughing gas, is a form of conscious sedation where your child remains awake throughout the dental treatment. This technique is often used in young children who are able to tolerate a nasal hood (mask). The aim of this technique is to decrease anxiety and provide a state of relaxation.
Protocol to follow when bringing the patient
- Please ensure that you do not bring any other siblings to the sedation appointment as your child will require your full attention.
- Children easily perceive anxiety on others (especially from anxious parents). Please assist us by reassuring your child pre and post-operatively. Do not mention words such as needle, pain, injection, etc. The dentist will explain your child step by step on the day of appointment.
- Our reception should provide you with a treatment plan and proposed cost for this appointment. Although this fee is accurate in most cases, this is only an estimate and this is dictated by the length of the appointment or the demands of treatment. Changes may apply on the day.
- Ensure that your mobile phone is set to silent or switched off as noises distract patients under sedation.
- Your child may have a light breakfast or meal before the appointment. All nitrous oxide sedation appointments are carried out in the mornings as children are more receptive, which makes them more compliant.
- Parents/Guardians are allowed in the room during treatment. However, we ask you to remain quiet and not to participate in the procedure. The voice of a parent is very familiar to a child and therefore children divert their attention away from instructions by the dentist. From time to time the dentist may invite you to ‘help’ but if this is not done, please assist us by adopting a passive role during the appointment.
- If your child is not complying with treatment you may be asked to take a seat in the reception area. This approach often helps children regain compliance. Although every effort is made to provide treatment under relative analgesia (RA), this technique is not successful 100% of the time. Your child may require a different approach should he/she be unable to cooperate throughout the appointment.
- If your child has received local anesthesia (dental injections), please note that the mouth will remain numb for approximately 2-3 hours. Our nursing staff will provide post-operative instructions and explain your child the effect of numbness. Numbness is more pronounced with lower teeth. Please ensure that your child does not bite or pinch the lip while the soft tissue is anaesthetised. Drinking a cold drink through a straw can have a soothing effect on a numb mouth.
- Side effects of nitrous oxide may include, nausea, feeling unwell, not being able to cope with the nasal mask (claustrophobic), tingling of the hands/limbs and in some rare cases vomiting (hence the need to only have a light meal).
- Should you have any questions about the procedure or when you get home please do not hesitate to contact the surgery (9715 3711). Our staff should call you the day after to check on the recovery of your child.
DOWNLOAD NITROUS OXIDE BROCHURE
Oral Sedation
Treatment and sedation
If your child has been assessed as needing sedation to cope with treatment, your dentist will administer your child with an oral sedative called Midazolam. This short term acting medication will be mixed with Panadol syrup to make it more palatable for your child.
The medication will sedate your child in approximately 20-30 minutes. Your child may fall asleep before, during and after the dental treatment, but will be awakened easily. This sedative effect will last approximately 2 to 3 hours in total.
What to do to prepare for sedation:
- Please ensure that your child is healthy on the day of the appointment and that you have informed your child’s dentist of any medical condition that your child may suffer from.
- Conditions that may interfere with sedation are respiratory difficulties such as sleep apnea, asthma, night-time snoring and tonsillitis. If you are unsure if about any condition your child might suffer from, please ask your child’s dentist before the day of the sedation procedure.
- Inform your child’s dentist if your child is taking any medications.
- Your child should have nothing to eat for 6 hours prior to their appointment, especially milk products and nothing to drink for 4 hours prior the appointment time. Unfortunately, this may mean no breakfast!
- Please be prepared to spend approximately two hours at the surgery on the day of sedation. Your child will require your full attention, so please arrange for alternative care for any other children.
- Private transport should be arranged to take your child home after their appointment, as it may be difficult to manage your child on a bus or train. If you are the driver, please arrange for a second adult to look after your child while you concentrate on driving home.
- Please keep a close eye on your child after the procedure, as the sedation may make them prone to falling or tripping easily for the rest of the day.
A rare side effect of the medication is known as the ‘Angry Child Syndrome’. In the event that this occurs, the dental procedure may have to be postponed or abandoned until an alternative course of treatment can be arranged.
If you have any questions or require further advice please do not hesitate to contact the surgery.
Intravenous (IV) Sedation
Treatment and Sedation
If your child has been assessed and recommended IV sedation to cope with treatment, an appointment will be arranged with our Paediatric Dentist. This may be because of the amount of treatment, the nature of the procedure or because of dental anxiety related to treatment. A paediatric specialist Anaesthetist will administer the sedative medication straight into the blood stream via a cannula (needle) which is most commonly placed on the back of the hand .The medication will sedate your child almost instantly and the level of sedation will be determined by the anaesthetist, appropriate to the treatment duration and procedure being carried out. Your child may feel sleepy during and after the appointment, but responsive and will be awakened easily and will be discharged once alert and able to walk unassisted. There may or may not be a recollection or memory of all the details of the appointment.
This method of sedation is also referred to as “sleep dentistry” and “twilight sedation” as your child is not completely asleep. This sedative effect will last approximately 2 to 3 hours in total.
What to do to prepare for sedation:
- Please ensure that your child is healthy on the day of the appointment and that you have informed your child’s dentist of any medical condition that your child may suffer from.
- Conditions that may interfere with sedation are respiratory difficulties such as sleep apnea, asthma, night-time snoring and tonsillitis. If you are unsure if about any condition your child might suffer from, please ask your child’s dentist before the day of the sedation procedure.
- Inform your child’s dentist if your child is taking any medications.
- Your child should have nothing to eat for 6 hours prior to their appointment, especially milk products and nothing to drink for 4 hours prior the appointment time. Unfortunately, this may mean no breakfast!
- Please be prepared to spend approximately two hours at the surgery on the day of sedation. Your child will require your full attention, so please arrange for alternative care for any other children.
- Private transport should be arranged to take your child home after their appointment, as it may be difficult to manage your child on a bus or train. If you are the driver, please arrange for a second adult to look after your child while you concentrate on driving home.
- Please keep a close eye on your child after the procedure, as the sedation may make them prone to falling or tripping easily for the rest of the day.