Kids Dental Sedation

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Just Kids Dentistry – One amazing Pediatric Facility.

Having a practice that is limited to just children is unique and unprecedented.
We do not:

  • call someone in to our facility
  • travel to other general dental offices to provide pediatric dentistry or dental anaesthesia services
  • provide medical sedation or anaesthesia services for adult procedures in hospitals or surgical suites

This is our pediatric dental space where everything is specifically designed for children. From the 1500 sq. foot play area (not a kids corner… actually we have a grown up corner) to the pediatric benchs for check ups and cleanings, to the equipment designed for small mouths. Our doctors and staff understand pediatric dentistry and pediatric sedation/anaesthesia. Your child receives the appropriate care under the appropriate conditions. That’s because we do *Just Kids Dentistry*.

 

We do NOT charge a facility fee
We do NOT charge an administrative fee
We do NOT charge a pre medication fee

While anxiety, fear and pain can be modified by behaviour management techniques, in many cases medications are required. Usually these children are younger and although procedures are not particularly uncomfortable, they require the child to lie still. Sedation and anaesthesia allow a child to cope better with dental treatment. This can lead to better clinical outcomes and help prevent injury from uncontrolled or undesirable movement.

There are four ways to manage behavior so that children can undergo medical/dental treatment:

  • Awake

    Awake is self explanatory and can involve any of the following; tell-show-do, voice control, non-verbal communication, positive reinforcement, distraction, parental presence or absence, protective stabilization. Some general dentists are naturally gifted in dealing with children. Pediatric dentists are formally trained in the above techniques.

    • What you see

      Movement and vocalization expected

    • Training

      Pediatric Dentist
      General Dentist

    • Method

      • Tell-show-do/voice control
      • Non-verbal communication
      • Positive reinforcement
      • Distraction
      • Parental presence/absence protective
      • Stabilization
    • Appointment, Freezing, Predictability

      • Multiple appointments if several areas need treatment
      • Requires local anaesthesia (freezing)
      • Unpredictable; depends on age, pre-existing level of anxiety, type and amount of dental treatment
  • Conscious Sedation

    Conscious sedation is not asleep. It makes you feel different. Conscious sedation is commonly achieved with laughing gas, drinks or a combination of both. Conscious sedation can be unpredictable and results can vary from child to child.

    Older children (4–6 years of age) show six times more success for overall behavior than younger ones (2–3 years of age).

    An overall success rates of 54–73% have been reported.* General dentists can take training after dental school to administer medications that achieve conscious sedation. Pediatric dentists and dental anaesthetists receive this training during specialty training.

    • What you see

      Movement and vocalization expected

    • Training

      Pediatric Dentist
      General Dentist

    • Method

      • Nitrous oxide (laughing gas) inhalation
      • Oral sedation (drink or pill)
      • Nitrous oxide plus oral sedation
    • Appointment, Freezing, Predictability

      • Multiple appointments if several areas need treatment
      • Requires local anaesthesia (freezing)
      • Can be unpredictable; depends on age, type and amount of dental treatment, pre-existing level of anxiety
      • Some children may become agitated or distressed
  • Deep Sedation

    Deep sedation is asleep. Deep sedation is commonly achieved with incremental doses of a medication (the medication is effective for 3–5 minutes) through an intra venous (IV). Deep sedation is what adults experience to allow for colonoscopy procedures to be successful and comfortable. This same technique and medications can be used to treat children for restorative dental procedures. Deep sedation is extremely predictable. Placing an IV in an awake child can be challenging, therefore, children are initially sedated with an anaesthetic vapor while they watch a movie prior to IV placement.

    A dentist anaesthesiologist is the only dentist that has this level of training.

    • What you see

      Some movement
      No vocalization

    • Training

      Dentist
      Anaesthesiologist

    • Method

      Intra venous (IV) sedation

    • Appointment, Freezing, Predictability

      • Usually one treatment appointment
      • No local anaesthesia (freezing) unless tooth is removed
      • Predictable; treatment will be completed
  • General Anaesthesia

    General anaesthesia is commonly used for operations in hospitals. General anaesthesia involves placing an endotracheal (breathing) tube and using anaesthetic vapors and other intra venous (IV) medications to keep a patient asleep. General anaesthesia is extremely predictable. As with deep sedation, children are initially sedated with an anaesthetic vapor while watching a movie prior to IV placement.

    Dentist anaesthesiologists and medical anaesthesiologists have this level of training.

    Anaesthesia and Children: The Data

    The Animal Data

    The initial research that sparked the concern about anaesthesia and children was related to fetal alcohol syndrome. Further study into rodents and non-human primates showed that prolonged and multiple exposures to sedation and anaesthesia drugs caused apoptosis in developing brains. Apoptosis is a programmed cell death that occurs when cells are injured.

    There were three major concerns that arose from the animal research:

    1. What drugs or medications cause the programmed death of brain cells to occur?
    2. Would this also occur in humans?
    3. If it did occur in humans, would it cause any long-term side effects?

    Animal research has shown that nearly all drugs that provide depression of the brain causing sedation or anaesthesia cause apoptosis of neural cells.

    The major concern is that this includes all the medications capable of producing general anaesthesia and sedation, including laughing gas that is commonly used at dental appointments.

    The Human Data

    There are several major studies that have looked into the effects of sedation and anaesthesia on children.

    General Anaesthesia vs Spinal Anaesthesia (GAS Study)

    The GAS study is an international randomized double-blinded clinical study. It compared infants having hernia repair under general anaesthesia vs those infants having hernia repair under spinal anaesthesia. Spinal anaesthesia is the use of a local anaesthetic in the spine to block feeling, much like a dentist uses local anaesthesia to “freeze” the nerve or block feeling to the mouth. In this study, researchers assessed cognitive development at 2 years of age. The study found that the cognitive development of children having general anaesthesia was the same as those that had only spinal anaesthesia.

    Pediatric Anaesthesia & NeuroDevelopment Assessment (PANDA Study)

    The PANDA study looked at sibling pairs, one of which had general anaesthesia before the age of 36 months and one that did not. The researchers followed and tested each of the sibling pairs learning and cognitive abilities. The PANDA study found no difference in the brain development between young children having anaesthesia and those that did not. The use of sibling matched pairs helps to eliminate interfering factors with cognitive scores such as genetics, parenting, and environmental factors.

    The Mayo Anaesthesia Safety in Kids (MASK Study)

    The MASK study is the most recent and highly anticipated clinical study. The results were released on April 19, 2018. Nine hundred and ninety-seven children completed the IQ and cognitive testing. They divided the children into groups of those not exposed to anaesthesia, exposed a single time, and exposed multiple times. The MASK study found that there was no difference in IQ and cognitive testing scores between any of the three groups.

    • What you see

      No movement
      No vocalization

    • Training

      Dentist Anaesthesiologist
      Physician Anaesthesiologist

    • Method

      Anaesthetic vapour inhalation through an
      endotracheal tube

    • Appointment, Freezing, Predictability

      • One treatment appointment
      • No local anaesthesia (freezing) unless tooth is removed
      • Predictable; treatment will be completed

*Effectiveness of premedication agents administered prior to nitrous oxide/oxygen. Baygin O, Bodur H, Isik B Eur J Anaesthesiol. 2010 Apr; 27(4):341-6.
*Outcomes of moderate sedation in paediatric dental patients B Ozen, SF Malamed, S Cetiner, N Ozalp, L Ozer, C Altun Australian Dental Journal 2012; 57: 144–150