Young children with dental pain and/or infection require treatment at any age—sometimes that means your child will need to go under general anesthesia or sedation. Of course, there are many reasons for this. Some dental procedures require your child to lie completely still, there may be a lot to fix, or the noise of the drill may be scary. The goal is always to provide the safest, most pain-free treatment.
In 2019, the American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD) updated the current guidelines for dentists and oral surgeons to follow when providing deep sedation or general anesthesia to children.
It requires that there are always at least 2 people in the room who are trained to provide advanced life support measures in case there are any problems. One of these people will be the dentist or oral surgeon performing the procedure and the other will be an independent observer. This independent observer must be “a physician anesthesiologist, a certified registered nurse anesthetist, a second oral surgeon, or a dentist anesthesiologist.”
The following information provides an overview of the various types of sedation and anesthesia. It’s important for parents to know their options. Talk with your child’s dentist or oral surgeon about the type of sedation or anesthesia he or she recommends (and regularly practices) for your child’s dental work before the appointment.
Types of Sedation and Anesthesia Used on Children:
Nitrous oxide: This is a mild sedative and the least invasive. It’s commonly known as ‘giggle gas’ or ‘laughing gas.’ Children breathe this with a little oxygen. They don’t usually go to sleep, but most will get more relaxed. Most will get a little silly and lightheaded, but a few don’t like the feeling.
Mild sedation: This medication (or a combination of medications) are commonly used on older children and adults. Your child would be calm and awake—and sometimes able to do what the dentist or surgeon asks him or her to do. After the procedure, your child may not even remember things about the dental visit. Dentists and oral surgeons can safely give these medications while they do the dental work, because your child remains awake.
Moderate sedation: Under moderate sedation children are sleepier, but they are usually able to do what the dentist or oral surgeon asks them to do. Older children and young adults do better with moderate sedation than younger or more fearful children. They breathe on their own and will usually wake up easily. Most children will not remember anything about the procedure. Dentists and oral surgeons can safely give these medications while they do the dental work.
Deep sedation: This involves intravenous (IV) medications to help your child sleep through the procedure. While your child may still move a little and sometimes make noises, he or she may not be able to breathe well on his or her own. There must always be at least one additional qualified professional (independent observer), such as an anesthesiologist (see Who’s Who list below) who can monitor your child’s heart rate, heart rhythm, blood pressure, and oxygen saturation (breathing) during the procedure and until he or she wakes up. This professional can also determine when your child is ready to go home.
General anesthesia: Under general anesthesia, your child will be completely asleep and pain free. Specially trained anesthesia professionals (physicians, dentists, or certified nurse anesthetists) will administer medications and monitor your child while a separate dentist or oral surgeon performs the dental procedure or surgery. Anesthesia can be given in a dental office that is specially equipped, an ambulatory surgical center (ASC), or a hospital.
Information obtained from Heathy Children.org Article by Rita Agarwal, MD, FAAP & James Tom, DDS, MS