Types of Sedation for Children at the Dentist
- July 2nd, 2019
- Dental Sedation
As a parent, you know the importance of ensuring that your children get the best dental care. But some children are not very cooperative when visiting the dental office, which makes performing even the simplest procedures quite difficult.
Dental anxiety is a common concern for many people, including children, who tend to feel worried about going to the dentist for routine care or treatment. Fortunately, there are several ways to help these individuals feel less nervous, including the administration of local anesthesia, sedation, or general anesthesia. The safe and effective use of these modalities is an integral part of general and pediatric dentistry.
Your child’s first dentist may recommend the use of pediatric sedation dentistry to help your little one get the care they need. It helps them relax enough, or even go to sleep, in order to receive proper treatments.
Choosing the Right Pediatric Solution
Your pediatric dentist will work with you and your child to develop the best type of sedation depending on your little one’s anxiety levels, medical history, and the type of procedure to be performed.
There are generally four levels of sedation:
This method does not involve the administration of any sedation medication. Instead, the highly skilled dentist is able to keep the child calm enough to receive treatment. The dentist may use tactics such as:
- Positive reinforcement
- Tell-show-do or voice control
- Non-verbal communication
- Protective stabilization
- Parental presence or absence in some cases
All pediatric dentists receive formal training in all these methods of handling children. Depending on the treatment, it may be necessary to administer local anesthesia (numbing) to prevent pain.
2. Conscious sedation
This is a mild form of sedation where the child feels different but is not asleep. Your child will be able to breathe normally and respond to verbal commands, as well as tactile stimulation.
Conscious sedation works up to 6 times better for children aged between 4 and 6 years, in terms of overall behaviour, compared to children aged 2-3 years. Research indicates 54 – 73% success rates. While pediatric dentists and dental anesthetists are formally trained to administer sedation to children, general dentists who choose to work with children can undergo training at a dental school to administer medications for conscious sedation.
This level of sedation is typically achieved using:
Laughing gas (nitrous oxide)
This is considered the mildest form of sedation. The nitrous oxide is mixed with oxygen and administered via a small breathing mask. This is a non-invasive approach, and the sedative effects stop as soon as the mask is removed and your child stops inhaling the gas. The drug quickly leaves the body and your child returns to normal. Laughing gas helps your child relax, and can respond to commands.
Oral sedation (pill or drink)
Drugs are typically used to deliver mild sedation, so your child stays awake and can respond normally to verbal instructions, but may feel drowsy and unable to speak coherently. Your child’s cardiovascular and respiratory functions and reflexes are not affected and they can breathe normally without requiring oxygen. Your child will still be a little sleepy after the procedure, and may not be able to recall all of the procedure.
Nitrous oxide and oral sedation combination
Both techniques may be used for lengthy procedures to ensure a continued state of sedation for the entire duration.
Depending on the type of treatment to be administered, local anesthesia may be required to numb the site and prevent pain during the procedure. However, the results of conscious sedation are unpredictable and may vary depending on the pre-existing level of anxiety, type and amount of dental treatment, and the patient’s age.
3. Deep sedation
This type of sedation implies that your child will be asleep during the procedure. It is typically achieved through incremental doses of a specific medication, which takes 3-5 minutes to take effect via intravenous injection. Deep sedation can be used to make restorative dental treatments comfortable for children.
The extent of sedation is very predictable and fairly easy to monitor throughout the procedure. Sometimes it’s difficult to place the IV when the child is awake so it may be necessary to sedate them first with an aesthetic vapour while you distract them with a game or film, prior to placing the IV. Sedation medicine flows steadily into the bloodstream via the IV to ensure your child stays unconscious during the procedure.
Though your child is in deep sleep, they may move a little and mumble in response to stimulation or pain. Recovery takes a bit longer after the procedure, and your child won’t have any recollection of the events that happened. In addition, normal breathing and heart function may be affected so a qualified person will be with your child for the entire duration to monitor these functions.
That said, only a dental anesthesiologist is qualified to administer deep sedation for children. As the patient will be asleep, there’s usually no need for local anesthesia, except for tooth extraction.
4. General anesthesia
This is the level of sedation used during surgical procedures. The patient will be unconscious and unable to breathe on their own, so additional breathing equipment must be used. This involves placing a breathing tube as well as other IV medications to keep the patient asleep.
As with deep sedation, the results of general anesthesia are predictable. As it involves the use of tubes for IV and breathing, the child needs to be first sedated with an anesthetic vapour — often while distracting them — in order to install the these. There’s no need to use local anesthesia except when extracting a tooth.
This level of sedation should only be provided by dental or medical anaesthesiologists.
Is my child a good candidate for sedation?
Depending on the length and type of procedure, your child’s dentist may recommend any of the sedation methods discussed above. Sedation helps to:
- Avoid unnecessary discomfort during painful procedures
- Make the experience smooth for anxious children without worsening the problem
- To aid in the treatment of children with special needs or behavioural disorders, where it’s difficult to explain the importance of dental care
Sedation is only administered by qualified professionals, using only the appropriate level of sedation to help your child stay calm and still for the duration of the procedure. Otherwise, it is a common and safe practice for children of all ages.