Posted on March 4, 2015
Let’s discuss pediatric dental sedation.
I recently read an interview with the president of the American Academy of Pediatric Dentistry. Dr. Moody had some interesting insights and opinions on sedating children for dental treatment in the office versus taking a child to the hospital.
Sedation by dentists is becoming increasingly common due to a host of factors. For children, this is a serious undertaking because you are usually talking about children under six years who have small bodies, small airways and small margins of error if something should go wrong. And you need to compare apples to apples. In Colorado, a pediatric dentist can be certified in minimal sedation or moderate sedation. The difference is huge in that minimal sedation usually involves one or two drugs and the child is awake and in control of his or her reflexes, breathing, gag, swallowing. In moderate sedation the child is usually asleep or nearly asleep with central nervous system suppression of breathing and heart rate likely. When you discuss sedation for children, which is it? Also, is the dentist certified and trained with assistant monitoring and emergency protocols in place?
Pediatric dentists are usually trained in residency programs on sedation and hospital dentistry, but preferences between dentists often dictate what they will suggest to parents. An experienced dentist may be able to accomplish a large amount of work or a technically difficult procedure using just nitrous oxide and behavioral coaching. Another dentist may draw the line at a type of procedure (repairing front teeth) or an age. For example, few 3 year olds can tolerate wearing a nasal nitrous oxide mask and having their mouth open for more than a few minutes, but 4 year olds commonly can. In my office, doing sedation or taking a child to the hospital is a money losing proposition. I do sedations and hospital cases when I have to for the best interests of my patients, but my first choice is to try in the office. I know of other pediatric dentists who prefer to do sedations and the more work they find the better. If in doubt, always get a second opinion!
If you are scheduled for a sedation in the office, here are some guidelines parents can follow.
1) Only do a sedation on a healthy child. Children with colds, large tonsils or asthma are not good candidates for sedation.
2) Ask about emergency procedures. Generally a pediatric dentist should be PALS and BLS certified and have a state license to practice sedations. If they don’t, ask for a referral!
3) How many sedations are planned? Each sedation will be more difficult on a child. Dr. Moody of the AAPD suggests more than two sedations is a good time to go to the hospital instead.
4) How urgent is the treatment? I have seen children scheduled for sedation for one or two small cavities on the front teeth. Is this treatment likely to avoid future pain? Not likely. Time buying techniques and urgency of treatment should be discussed by your dentist for you to have informed consent.
5) Lastly, did the dentist try? Pediatric dentists are trained and hopefully enjoy treating children. Did your dentist interact with the child to gage her tolerance or was it one look at the cavities and one look at the schedule to determine your treatment. It is crazy what some parents will allow to happen for huge sums of money when the long term outcome looks unsatisfactory.
After all, pediatric dentistry should be about the child first. And we treat children not teeth!
I love what I do and I love helping you raise healthy and happy children in Fort Collins. For questions on sedation or any other kid dentistry topic, email me at firstname.lastname@example.org.