Wondering if sedation is safe for kids? Not sure how to prepare your child for sedation? In this blog from Greenpoint Pediatric Dentistry, we’ll answer a few common FAQs about sedation dentistry with local North Georgia doctors, John Hansford, DMD and Jody Jones, MD. Let’s get started.
Is Sedation Safe for Kids?
Absolutely. This is a valid concern that can be greatly alleviated as we unpack the question. One of the questions inside of “Is sedation safe for kids” is “how young is too young for sedation?”.
Children who are only a few hours to a few months old receive safe anesthesia when surgery is needed. These are the types of surgeries with potentially higher risk profiles i.e. if a child needs surgery before they are 12 months old, then it is likely they are quite sick. This means their physiological status may increase their anesthesia risk and the corrective surgery may have its own associated risks.
Fortunately, by the time a child has teeth and enough time has passed for them to develop cavities (over 12 months old) they are much more robust and healthy, they likely have no serious systemic illnesses accompanying their dental infection, and the surgery (dentistry) has no systemic risks. So, in human terms, the average 4 year old is very young, but, in anesthesia terms, they are in the prime of health and in the low risk category. To this point, Drs. Hansford and Jones treat some of the sickest patients in the Tri-State area without issues or complications. Anesthesia can be conducted safely for these patients by a board certified anesthesiologist with an appropriate anesthesia plan. For relatively healthy children, we take the same care and consideration, but the patients have less medical issues to manage than the systemically ill child requiring anesthesia and surgery.
Another cluster of questions inside of “Is sedation safe for kids?” is “What medications are you using, how much, what do they do, how do you know?”. It’s a good time to be an anesthesiologist. The sedation methods used by modern anesthesiologists have been in use for decades. That means the effects, risks, proper dosages, and other information about each one are very well-known. The anesthetic agents used daily around the world such as Sevoflurane, Midazolam, and Propfol were all invented in the late 1960s to early 1970s, and by the 1980s became the premier anesthetics used. No company has been able to invent better or safer medications to replace these gold standard medications in 40 years. Consequently, they are well studied and well understood. As a rule, when something new comes out it gets used in the hospital residency program for years, then studies are analyzed, and the drug finally enters the private practice and enjoys regular use.
Another question inside of “Is sedation safe for kids?” whether or not it causes permanent changes, and if the anesthetics build up over time or multiple operations. The answer is no. This finding is well studied and documented. The anesthetics that patients breathe e.g. nitrous oxide or sevoflurane are exhaled unchanged once we turn them off, and the medications patients drink or get through an IV are metabolised and eliminated by the body within 12 hours. In regards to the long lasting effect of anesthesia, the most memorable study showing there is nothing to worry about is the Pediatric Anesthesia Neurodevelopment Assessment because the acronym is PANDA, and that is cute! Other studies such as GAS and MASK are memorable acronyms and supportive of the conclusion that pediatric anesthesia is exceedingly safe.
The biggest variable in patient safety for dental anesthesiology is the provider. The credentials, training, experience, and philosophy of the provider truly comprise the biggest question mark because the children are healthy, good candidates and the medications are virtually the same worldwide. At Greenpoint Pediatric Dentistry, we feel only anesthesiologists should provide anesthesia services, and the safety of the operating room can and should be faithfully transferred to the out-patient office setting.
Feel free to ask us what medications we use and why, and which we don’t use and why not at your consultation. After a combined 32 years in school learning about this, we don’t know much else to talk about. Please, don’t ask us about sports or the Grammys. Please do ask us about the fluid mosaic model of cell membranes!
Whether your child needs mild sedation with laughing gas or requires general anesthesia for major dental anxiety, our team will ensure they receive the proper treatment to keep them safe and comfortable while they get the dental care they need.
Does Sedation Help With Behavior Management?
Yes. If your child has difficulty tolerating dentistry, and you’ve been to several offices in Brooklyn, but have not been able to be treated, then sedation and general anesthesia can be a very useful way to manage their behavior.
In addition, our dental team is trained in behavior management techniques for kids. Even if you don’t choose sedation for your little one, we know how to help them stay calm and relaxed in the dentist’s chair. Our practice philosophies include “give the minimum effective dose” and “let the anxiety determine the level of anesthesia”
Using the minimum effective dose and correlating anxiety to anesthesia need, in this situation, can best be explained by an example of a patient experience at GPD:
A patient presents with cavities. Step one is to use behavior management techniques such as tell-show-do, verbal distraction, singing, and movies above the dental chair to see if the patient can tolerate dentistry under local anesthesia only.
If parents feel the child is fairly anxious, then all the step one therapies can be provided along with nitrous oxide, or laughing gas, for a mild sedation.
If patients aren’t tolerating dentistry at this point, then the procedure is aborted, and we begin discussing how we want to get all the dentistry completed in one appointment without memory of the day of surgery, i.e. moderate sedation or general anesthesia
How Do I Prepare My Child to Be Sedated?
This depends on the type of sedation treatment your child is receiving at Greenpoint Pediatric Dentistry. For laughing gas, you don’t need to do anything special, though we recommend that your child avoids eating for 1-2 hours before the procedure to reduce the risk of nausea.
The three main components of preparing for sedation or general anesthesia are:
Wear a black T-shirt you don’t care about so you can drool on it on the way home.
Bring a change of clothes and a pull-up because 1 or 2 kids every few months will wet themselves once they receive the medications.
Don’t eat for the recommended time.
Bring a blanket.
How Should I Care for My Child After Sedation?
If your child is sedated with laughing gas, they will be back to normal within a few minutes of their treatment. They may even be able to go back to school after their procedure.
For moderate sedation and general anesthesia, the after-effects will last a lot longer, often up to 6-8 hours. Your child will be drowsy, confused, and foggy. Most importantly, they will be safe in terms of their cardiovascular and pulmonary state, but they will be a fall risk. Therefore, go straight home after your sedation or general anesthetic by car (not the G train back to Long Island City or the B43 bus to Bed-Stuy). It will be safe for patients to sleep in their bed or on the couch, eat and drink once they are aware enough to ask for food and drinks, and position themselves in any comfortable posture, but you’ll need to assist them when moving e.g. walking to the bathroom.
One of the features of our anesthetic planning that we are proud of is our customized recovery phasing. We recover our patient in two phases: Phase 1 Recovery: The anesthesiologist recovers patients individually for 15 to 30 minutes after the surgery is complete. Then the parents are brought back to the operatory for phase two. Phase 2 Recovery: parents sit with patients. Patients have different metabolisms and recovery timelines, therefore, this phase of recovery is customized for each patient. If patients are a little more awake, then they go home earlier, and if they are a little more asleep, then they stay under the doctor’s care a little longer. With this approach, parents don’t have to worry about managing patients or being any kind of anesthesiologist once they leave the office. This is part of our Low Volume/High Vigilance practice philosophy. By the time twelve hours have passed since the procedure, all the drugs will be out of the body. The next day, your child may go to school or go about their normal routine if they feel up to it. If you want the day off because you just went through a long, trying day, you’ll automatically have a school and work excuse sent to you in the “your visit to Greenpoint Pediatric Dentistry” email that you receive when you visit the office. We’ve already signed it, and we will back you up if work or school calls us to confirm. (If you take a month off, then you’re on your own.)
Contact Greenpoint Pediatric Dentistry for Sedation In Georgia
Whether you’re in Winder, Morgan, Athens, Watkinsville, or Winterville, the team at Greenpoint Pediatric Dentistry is here for you. We offer caring, gentle sedation dentistry. Even if your child is very scared or anxious about their appointment, Dr. John and Dr. Jones can help. Contact us online or give us a call at (929) 324-1140 to get the help you need right away.