Sedation Options in Kids Dentistry
Dental procedures are inherently difficult tasks, and can be especially hard for children. Fortunately, most kids are able to perform needed dental work under very conventional conditions. However, for some, sedation will be considered in order to complete treatment.
Baby teeth WILL fall out, and it is very important to see your dentist or a pediatric dental specialist regularly. They will keep track of cavities, severity, and discuss WHEN the teeth will fall out. For most kids the final baby teeth are not lost until 12-13 years old. With many teeth being lost and new ones showing up particularly between 6-8 years old, and again between 10-13 years old. A regular exam and yearly x-rays can help the dentist provide sound advice on treatment. Fixing teeth, even baby teeth is often very necessary, and can help prevent emergencies or toothaches, which can be severe even in young children.
If treatment is judged to be appropriate, whether for baby teeth, permanent teeth, or even in kids with surgical needs, then another MAJOR consideration can be the use of sedation alternatives to affect care in a reasonable manner.
Many factors are taken into account when planning dental treatment for kids, including the use of sedation, when needed: their age, ability to cooperate, medical and behavioral history, medical issues or limitations, and the extent of treatment needed are a few of the most important considerations.
Informally, there are several levels of management in dentistry. Some involve no sedation, while others are far from routine, sometimes requiring a hospital visit.
What are my options?
1. Conventional care: This is treatment performed without ANY sedation, and many dentists worldwide perform this type of care millions of times every day, for kids and adults. For children, many age-appropriate “behavior management” techniques can be used here. Like simple explanations to the child often referred to as “tell-show-do” distraction techniques, slowed or limited work, and sometimes light or “passive” restraint.
Rarely, but sometimes necessary, a restraint board called a papoose board, may be employed to deliver the patient through care. Typically, this is only employed in extreme emergency cases, when behavior cannot be controlled, or when a medical condition or age precludes the use of other alternatives.
2. Nitrous Oxide (Laughing Gas): Certainly, the most commonly-used method of sedation here at Chillicothe Pediatric Dentistry. Simple, safe, and effective for kids of all ages. A nosepiece is placed on the patient’s nose during treatment, and the gas is inhaled. The vast majority of kids are awake and aware, but are treated comfortably and easily via this option. Side effects are extremely rare. Occasionally, some light pre-operative meds can also be given to help the laughing gas be more effective. In our office, this type of sedation is free, but typically there is a fee of $30-$50.
3. General Anesthesia (GA): For pediatric dentists, this is the pinnacle of sedation treatment. Just like any outpatient hospital procedure, GA is an inhaled sedation agent, and is combined with IV access, and a breathing tube. The patient is totally unconscious, and loses many of their protective reflexes. GA is performed by a licensed anesthesiologist, or a nurse anesthetist in a very careful and controlled state. There is a longer recovery period for most people, but the controlled benefit of GA makes it the most appropriate for kids who are pre-cooperative, extremely anxious, or who by age or medical condition, would have a difficult time with other forms of care. Cost varies significantly, but is often covered by medical insurance.
Options not offered at our offices
4.Oral Conscious Sedation (OCS): After medical clearance and consents are performed, a child may be scheduled into the office for an OCS appointment. The child must be generally healthy, well on the day of treatment, and on an empty stomach. The pediatric dentist gives a mixture of oral medicine often, but not always containing narcotics. These can be ingested or squirted up the nose. The child is “awake” but disoriented, and vitals must be monitored. Often, the child is disoriented and agitated, which requires the dentist to put the child in a restraint board during treatment.
These appointments are kept relatively short for that reason, and this procedure may need to be performed several times to affect care. OCS is often appropriate for kids in the 3 to 10 year old range, but is not recommended for kids under 3 years old. Cost is usually out of pocket, and typically ranges from between $250-$500 for each appointment. Most pediatric dentists and a few general dentists have undergone extensive training to provide this type of sedation in-office, and are licensed by the state to perform these procedures.
5. Intravenous sedation (IV): A mixture of medicines, primarily narcotics is given via an IV. Most people have had this type of anesthesia to get their wisdom teeth out. This procedure requires medical clearance, reasonable health, again an empty stomach. It is more reliable than OCS, but can be riskier, so consents must be explained and reviewed. The patient is “out of it” in most cases, often appearing “asleep,” but maintains their protective reflexes. Individuals providing this care have training in IV procedures, and maintain state permits for such care. Cost is typically between $600-$1200 and may be covered by some medical insurances.
The information provided in this blog is only intended to be a general discussion of treatment, and of treatment options, for pediatric dental patients. A full dental exam by a licensed dentist and x-rays if attainable help the practitioner to make an individual assessment of the needs of each patient. Various recommendations can then be made, and alternatives explained. Most kids with significant dental needs will end up in a pediatric dental office, where the specialist can evaluate for care, schedule and perform treatment per the child’s needs and the parent’s wishes.
We have never employed active restraint during our care of kids at Chillicothe Pediatric Dentistry. Dr. Griffin and his staff, along with the parents’ help, are typically able to usher kids through care without having to restrain them. If uncooperative behavior does occur, then we are able to transition to another, more appropriate alternative.
In our office, the nitrous oxide is our preferred sedation option. It is often paired with a video playing above the chair. Most kids are able to watch their movie and relax while their work is performed. Parents are welcomed back, and encouraged to coach their kids when needed during care.
We do not provide OCS sedation at Chillicothe Pediatric Dentistry. In our opinion, more controlled and less stressful-options are available, some with considerably less risk. Further, we do not employ “papoose boards’ during care in our office, as these devices are often needed during OCS.
We do not perform this Intravenous sedation at Chillicothe Pediatric Dentistry, again primarily because other options typically cover the patients for whom this type of sedation would be appropriate.
General anesthesia has been performed by our dentists at Chillicothe Pediatric Dentistry for well over 20 years, mostly via outpatient care at Adena Regional Medical Center in Chillicothe. In the past few years, a second GA option has been developed, whereby a licensed anesthesiologist- through an ambulatory anesthesia group- performs this type of sedation in our office. It has proven safe and appropriate for kids of all ages and abilities.
Chillicothe Pediatric Dentistry has been a provider of dental specialty care for children, since 2006. Care via the office in Chillicothe has been carried out on hundreds of thousands of children since the late 70’s. For more information, visit our office by requesting an appointment.