Anesthesia and Sedation for Pediatric Dentistry
In some cases, a child’s dentist may recommend anesthesia for some dental treatments. Anesthesia may be recommended if the child is too anxious for a procedure to be performed safely otherwise, or it may be used when the procedure is particularly complicated or can be expected to last a long time. Anesthesia should only be used as needed, so if a dentist recommends anesthesia for your child’s treatment, it is advisable to take their recommendation. You will receive special instructions for before and after the procedure, and you should also plan to spend the whole day at the hospital so that there’s time for the anesthesia to safely wear off before the child goes home. A pediatric anesthesiologist will administer the medication and participate in monitoring the patient throughout the procedure. General anesthesia puts the patient to sleep, relaxing their reflexes and helping the patient undergo a painless procedure that they have no memory of.
If your child is having a dental procedure that requires general anesthesia, it is very important for them to follow all the rules regarding eating and drinking during a specified period preceding the procedure. The parameters of these rules depend on the patient’s age, and your child’s oral surgery team will clearly explain the rules to you and to your child. Generally, infants should avoid ingesting anything for 4 to 6 hours before the procedure. Children up to age 12 are usually instructed to avoid solid foods or non-clear liquids beginning at midnight the night before the procedure and are allowed to drink clear liquids the morning of the procedure, up to 2 hours before the scheduled time. When the child takes medication in the mornings, discuss this with the child’s doctor or the nurse who plans the surgical treatment; in some cases, it may be recommended that the child forgo their daily medication on the day of the procedure, but it is usually okay to take it.
On the day of the procedure, an anesthesiologist associate will measure the child’s weight and vital signs and confirm their medical history, discussing the choice of anesthesia medication your child will receive and explaining this to the child. The parent or legal guardian must sign a consent form before general anesthesia can be administered. Sometimes, the doctor may give the child a more mild form of sedative medication to relax the patient before administering the general anesthesia. It is usually okay for the parent or guardian to remain with the child while the anesthesia is administered, though they cannot be present during surgery. First, the pediatric anesthesiologist will use a face mask to direct nitrous oxide gas into the child’s mouth and nose, helping them relax and fall asleep. Once they have fallen asleep, the anesthesiologist will start intravenous sedation, through a needle that is placed in the arm or hand, that will keep the patient sleeping for the duration of the procedure. The child’s heart rate, blood pressure, and vital functions will be closely observed throughout the procedure by members of the surgical and anesthesiological teams.
It’s completely understandable for parents to be nervous or uncomfortable when their child is preparing to have surgery. If possible, however, it’s very helpful to the child for the parents to be calm and to reassure the child as much as possible. Encourage your child to bring a favorite stuffed animal or toy, or, if they have a blankie or other comfort item, have them hold this special object until they are fully sedated and asleep. You may also want to hold their hand while they are initially administered anesthesia, or stroke their hair in a comforting way, or you may want to speak or sing soothingly to them as they fall asleep. Any of these methods can be effective in calming a patient before the anesthesia takes effect; one it has taken effect, the patient will remain asleep and in no pain, and they will remember nothing about the procedure. Of course, sometimes, children remain frightened of the operating room despite the presence of soothing people or objects. This is normal, and you shouldn’t feel bad if your child is upset; trust that they are under the qualified, excellent care of a team of professionals who care greatly about their patient.
Following the surgical procedure, the patient will go to the recovery room, where they will be monitored by nurses as the anesthesia wears off. It is normal for the child to experience a sore throat for a couple of days following general anesthesia, and their gums and other oral tissues may be core for several days. For the first hour or so after the procedure, the child may feel some numbness in their face or throat, and they should use extreme caution if eating shortly following the procedure, limiting their diet to soft foods for several hours. Sometimes, people may feel dizzy or nauseated following general anesthesia, though this discomfort is typically short-lived. On the day of the procedure, your child should not plan to go to school or daycare, and they may not feel up to resuming normal activities on the following day, too. If they are tired or don’t feel like they have enough energy on the day after anesthesia, that’s normal; let them sleep and relax, and monitor them throughout the day. Your dentist will give you instructions for scheduling a follow-up visit, which is an important part of the procedure and associated aftercare. For general sensitivity, over-the-counter pain relieving medication can provide relief. If the patient has a fever, excessive pain, excessive vomiting or dizziness, or severe bleeding from the gums, call your dentist as soon as you can. If any of these symptoms are especially severe, you may want to call your local hospital to see if there’s a dental resident available.