Sedation dentistry refers to the use of sedation during dental treatment. Conscious sedation is most commonly used during extensive procedures, for patients with dental phobia or for patients who find it difficult to sit still. The patient may fall asleep, but there is not a loss in consciousness at any point in time. There are different types of sedation, including nitrous oxide ("laughing gas"), IV sedation, oral sedatives and general anesthesia.
Sedation can range from the use of nitrous oxide to calm a patient to general anesthetics used to put patients to sleep. Patients with dental phobia, low pain tolerance, major dental treatment, physical handicaps or strong gag reflexes may require sedation. Procedures like fillings, crowns, bridges, root canals, extractions, cosmetic procedures and periodontal treatments often require sedation. The sedation treatments available in increasing strength are as follows: laughing gas, versed/extra management, Demerol/hydroxyzine, and outpatient general anesthesia.
Sedation is endorsed by the American Dental Association and is an effective way to make many patients comfortable during their dental visit. Before using a sedative or anesthetic, it is important to tell your pediatric dentist about any medications or medical treatments your child is receiving. Before administering any sedative or anesthetic, your pediatric dentist will talk to you about the process of sedation and pre- and post-sedation instructions.
Conscious Sedation
Conscious Sedation is recommended for apprehensive children, very young children, and children with special needs. It is used to calm your child and to reduce the anxiety or discomfort associated with dental treatments. Your child may be quite drowsy, and may even fall asleep, but they will not become unconscious.
There are a variety of different medications, which can be used for conscious sedation. The doctor will prescribe the medication best suited for your child’s overall health and dental treatment recommendations. We will be happy to answer any questions you might have concerning the specific drugs we plan to give to your child.
Laughing Gas (Nitrous Oxide)
- Administered as a mixture of oxygen and nitrogen that has a calming effect on scared or anxious patients of all ages.
- Is fast acting and has mild effects.
- Patients generally stay awake and can still talk to the pediatric dentist.
- Effects of laughing gas wear off almost immediately after a 10 minute oxygen flush.
Versed/Extra Management
- Used for patients between the ages of 1 and 3 years of age with minimal dental work needed.
- Is fast acting and induces a drowsy state with impairment to motor skills.
- Memory of the procedure is not remembered by the patient.
- For extremely apprehensive patients a papoose board may be used to restrict movement to prevent injury to the patient and staff.
Demerol/Hydroxyzine
- Used for patients greater than 3.5 years of age with moderate dental work needed.
- Is slow acting and makes the patient feel calm/relaxed and may make patient fall asleep.
- Memory of the procedure is remembered by the patient.
Outpatient General Anesthesia
- Recommended for apprehensive children, very young children, and special needs children would not work well with lighter sedation.
- Renders the patient completely asleep similar to when tonsils are removed or ear tubes are repaired.
- Performed at Driscoll Children’s Hospital.
Appointment Instructions
Preoperative Instructions
Eating/Drinking
To avoid nausea, vomiting, and complications during treatment with sedation, do NOT allow any food or drink (nothing) immediately before the appointment. Carefully follow the schedule below:
**Please have patient NPO before appointment**
- Clear fluids may be given up to 2 hours before appointment
- Breast milk may be given up to 4 hours before appointment
- Formula may be given up to 6 hours before appointment
- Solids may be given up to 8 hours before appointment
Changes in Health – Any change in the patient’s health, especially the development of a fever, cough, congestion, or illness within 3 days of treatment is very important. Please call our office so that we can discuss the particular problem.
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Medications:
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Give your child only those medications which he/she takes routinely, such as hyperactivity or seizure medications or heart antibiotics, and those prescribed by the dentist. Do NOT give your child any other medicines, before or after treatment, without checking with the dentist or your physician.
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Arriving:
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For your child’s safety and comfort, do NOT allow the following:
- Nail/Toe polish
- Hairbows or Ponytails
- Tights
- Bulky clothing—such as sweaters
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ONE OR TWO RESPONSIBLE ADULTS must accompany the patient to the dental office and must remain until treatment is completed. Plan to arrive early for your appointment. Do NOT be late or your child’s visit may be rescheduled.
Post-operative Instructions
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Activities:
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Allow the child to rest—do NOT plan or permit activities for the child after treatment. Your child’s coordination will be inadequate for physical activities. Closely supervise any activity for the remainder of the day, usually they want to nap. Please have them sleep on their side, never on their stomach. A parent or adult needs to be in the same room observing them.
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Getting Home:
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The child should be watched to avoid biting the numb tongue, cheeks, or lips. The patient must be observed by a responsible adult throughout the day. The majority of our patients tend to sleep for several hours after treatment, which is a normal response to sedation.
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Food/Drink:
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The first drink should be plain water. Clear juices or Gatorade can be given next. Drinking small amounts are often better than taking a large amount at once. A soft diet is recommended for the next 24 hours.
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Temperature:
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The child’s temperature may be elevated to about 101°F for the first 4 hours after treatment. Tylenol and fluids given every 3-4 hours will help this condition.
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CALL IF:
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1) Vomiting persists after 24 hrs
2) Temperature remains above 101°F beyond 24 hrs
3) There is any difficulty breathing
4) You have any problems related to your child’s dental treatment
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