There are times when a child must undergo dental treatment to treat active dental decay. Depending on the size and location of the cavity, our doctors may recommend to have the treatment completed with various sedation options. Some cavities are considered small, and thus may not require the use of local anesthesia (numbing agent). However, if the cavity is in a location that is difficult to reach or if the cavity has become large enough to make the removal of the lesion uncomfortable without numbing the area, we may recommend different types of sedation to help ensure your child is comfortable and has a pleasant experience. Keeping a patient calm and relaxed is our top priority when we provide dental care. We do not use any physical restraints to complete any dental procedures (unless certain emergencies require), as we believe that by doing so, it will only create a further phobia for the child towards the dentist. Rather, if a child is unable to remain calm for elective dental treatment, we have options to decrease the anxiety of the patient, or to have an anesthesiologist present for placing your child comfortably asleep in order to complete all treatment.
The use of nitrous oxide, or commonly known as “laughing gas”, is widely used by many pediatric dentists to help a patient remain calm during the dental procedure. It is a very light sedative which can relax a patient who is willing to work with the doctor, but needs something to give them that increased confidence to do so. The laughing gas does not work, however, with those children whose dental anxiety far outweighs the sedative effects of the laughing gas. Many parents have the misnomer that as long as they are breathing the nitrous oxide in, that their child can calm down no matter the level of anxiety. If this is the case, the child will become more agitated and will not allow for comfortable completion of dental treatment.
Like the laughing gas, oral sedation can possibly calm an anxious child, making it more comfortable to receive the dental treatment. This usually consists of the patient arriving approximately 45 minutes to 1 hour prior to their dental appointment, at which time the dentist would provide a liquid oral sedative to the patient, and wait for the medication to take effect. Unfortunately, because it is a liquid which is consumed, it is hard to predict how the patient will respond, and there are times when a child has a paroxysmal, or opposite effect, to the medication and becomes further upset or anxious. With this reason, Dr. Yeung and Dr. Kang do not routinely provide this service, as it has a high level of uncertainty, and the patient is still awake, and usually aware of his/her surroundings.
Intravenous sedation, or as people call “sleep dentistry” is commonly used for those children who have a high level of dental anxiety, or for those who are very young to comprehend what we are trying to accomplish comfortably, or due to the amount of dental work needed. In order to provide this type of sedation, we bring in an anesthesiologist who can properly administer the medication through an intravenous line, which will place your child into a very comfortable sleep. During this time, the anesthesiologist will monitor your child’s vital signs, such as blood pressure, level of oxygen in the body, heart rate, as well as ECG (electrocardiogram) readings. This is the sole responsibility of the anesthesiologist, while the sole responsibility of our pediatric dentists will be to complete all dental treatment needed. The obvious advantage of this type of sedation is that your child will be unaware of what we are doing, they will have no memory of the visit, and most importantly, all of the dental treatment can be completed in one visit. With the other sedation options (nitrous oxide and oral sedation), multiple dental visits maybe required depending upon the amount and location of the dental caries present.
With these sedation options, we now have the opportunity to present them to you, and we will be able to discuss our recommendations and answer any questions you have about these different modalities. Our main goals are to protect both the physical and oral health of your child, as well as the emotional component your child perceives towards the dentist into their adulthood.
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Dr. Kang on Doc McStuffins