Fear of the dentist prevents many children from receiving dental treatments essential for preventing tooth decay and gum disease. Fortunately, pediatric dentists offer three types of safe and effective dental sedation methods for easing a child’s anxiety about going to the dentists–IV sedation, oral sedation and nitrous oxide. Sedation dentistry for kids is also useful for special needs children and young patients who suffer a severe gag reflex in response to something making contact with the back of mouth or tongue. In addition, children sedated for dental procedures usually have no memory of the procedure, which may help alleviate a dental phobia as the child matures and grows less fearful of dentists and dental treatment. Pediatric dentists are trained to understand why many children react fearfully when visiting them and will try other methods for alleviating their fears before recommending dental sedation, such as on-the-spot counseling and distraction techniques.
Nitrous Oxide Sedation
Nitrous oxide (laughing gas) is given to children to inhale through a mask about 10 or 15 minutes prior to having dental work performed. Nitrous oxide calms fears by putting children (and adults) in a state of “conscious sedation” that allows them to remain awake but only slightly aware of what is going on around them. In fact, most children given nitrous oxide continue communicating and interacting with their pediatric dentist during the dental treatment. Quickly eliminated by the body, nitrous oxide also suppresses the gag reflex to facilitate treatments. Nitrous oxide sedation causes no lingering effects and wears off within 30 minutes of stopping the gas. However, while nitrous oxide relieves anxiety, it is not an analgesic. If a child is having a cavity filled, a tooth pulled or undergoing other intensive dental work, a pediatric dentist will need to administer local anesthesia to reduce discomfort.
The development of modern benzodiazepines has popularized the practice of oral dental sedation for kids. Commonly used by pediatric dentists to calm fearful patients, Versed (midazolam) is administered in liquid form 30 minutes before beginning treatment. Producing post-sedation amnesia, midazolam prevents children from remembering anything about the dental treatment. In some cases, pediatric dentists may add an antihistamine (hydroxyzine) to midazolam to enhance its calming affect and to suppress nausea. Midazolam may sometimes be used as a supplement with nitrous oxide as well.
IV dental sedation for kids does not put them fully to sleep but places them in a deeply relaxed, “twilight” state that induces memory loss upon coming out of the sedation. The reason why kids (and adults) claim they were asleep during the dental procedure is mainly because they cannot remember everything occurring during treatment. For children frightened of needles, pediatric dentists can give them oral anti-anxiety medication to be taken prior to coming to the dental office. A topical anesthetic is applied to minimize the pinching sensation upon inserting the IV needle. While a child is under IV sedation, a trained technician monitors their heart rhythm, blood oxygen level and blood pressure during and after the dental treatment.
Before a Child is Sedated for Dental Treatment
Parents need to restrict drinks and food the night and morning before treatment. Being sedated with nitrous oxide, oral medications or intravenous fluids can cause nausea and vomiting afterwards. In addition, dressing children in loose clothing allows dental technicians to attach monitoring equipment quickly and without making a fuss. Pediatric dentists require parents provide a complete medical history of the child and information about any over-the-counter medications, prescriptions and even herbal supplements currently being given to the child.