Many children require a different approach to their dental treatment which varies from having the treatment done in the dental chair to having it done under general anaesthesia. Sometimes this includes the need for sedation (depending on their age, medical history or stages of development). Our specialist will determine the best way of delivering treatment in a friendly way appropriate to their age. Some of our patient will only require a caring approach and familiarization to the dental setting. The following are the options
1. Local anaesthesia on the dental chair
Local anaesthetic or “sleepy juice” or “numbing juice” is an aesthetic agent given to induce the absence of sensation in a specific area or teeth/tooth. Topical anaesthetic gel is placed on the surface of the soft tissues so placement of the anaesthetic is more comfortable.
We use a special device called ” The Wand TM” to administer the local anaesthesia. This technique is very comfortable and less fear provoking procedure for children.
Numbness of the mouth lasts for 1-1.5 hours, especially a lower lip can be an unusual experience for many children. Please remind your child not to bite or pinch the numb lip (or tongue). In the event that your child does bite the lip/tongue, an ulcer will develop and this should heal on its own in 7-10 days.
2. Nitrous oxide sedation/ Laughing gas
Nitrous Oxide-Oxygen sedation (laughing gas) helps your child to relax throughout the dental procedure. This has a mild pain -relieving effect as well. It has rapid onset and is reversible. Your child will feel like he is floating up the air or feel very light or may be starts laughing on inhaling this gas. It is well tolerated by children and has got excellent safety record. Your child will be fully conscious and responds to the question and commands. More information will be provided at the treatment planning visit, where your child will be assessed to see if they will benefit from treatment with “laughing gas” sedation.
Children easily perceive anxiety on others (especially from anxious parents/ siblings). Please assist us by reassuring your child pre- and post- operatively. Do not mention words such as needle, pain, injection, etc. The dentist will explain your child step by step on the day of appointment. Depending on the severity of this reaction, treatment may be abandoned.
3. Oral sedation
We use Midazolam as oral sedation in children. We treat children about 7 years old. The oral sedation is mixed with a sweet drink ( to avoid the bitter taste) and given to your child. It takes at least 20-30 minutes to work. During treatment your child’s pulse and oxygen saturation are monitored. Please let us know if your child has had any reactions to other sedatives drugs such as Phernagan, Histafine (Chlopheniramine) etc and inform us if parents have had any reactions to other drugs as well.
Oral Midazolam works well for most of children but sometimes there are side effects of oral sedatives. The “angry child syndrome” is a rare side effect that is self-limiting once the drug wears off. Depending on the severity of this reaction, treatment may be abandoned.
Certain foods may change your child’s reaction to sedation procedures. This food may ‘react’ with the sedative agent that is being administered, and delay/alter the desired effect. Fasting instructions will be given appropriately prior to the procedure.
Children easily understand anxiety on others (especially from anxious parents). Do not mention words such as needle, pain, injection, sharp etc. The specialist will explain your child step by step on the day of appointment. Please do not bring your other children to this appointment as your child will need full attention during the procedure.
4. General anaesthesia
General anaesthesia (GA) that is done for paediatric dental patients is to provide comprehensive and high quality dental care when conventional dental treatment is not an option. General anaesthesia means that your child is fully asleep. This is for children who are unable to cooperate, experience ineffective local anaesthesia, are extremely fearful, anxious, or uncommunicative, require significant surgical procedures, can benefit from GA protecting them from psychological trauma and/or reducing medical risks, and require immediate, comprehensive oral care.
The American Society of Anesthesiology (ASA) classifies patients according to their physical status as follows: (I) a normal healthy patient; (II) a patient with mild systemic disease; (III) a patient with severe systemic disease; (IV) a patient with severe systemic disease that is a constant threat to life; (V) a moribund patient who is not expected to survive without the operation; and (VI) a patient declared brain-dead whose organs are being removed for donor purposes .We carry out general anaesthesia for ASA I and II patients only. Due to the increased demands in safely monitoring for such a procedure, anaesthetic procedures are carried out in a hospital environment as a day-stay procedure.
Children with airway problems including sleep apnoea, loud snoring, large tonsils, adenoids, retruded (small mandibles) or children with obesity have an increased risk of side effects during conscious sedation. Children below 24 months of age also have a higher risk to sedation in a dentist chair. Consequently, some of these children are better treated under general anaesthesia.
Fasting is an important part of general anaesthesia. The dentist/ nurses will advise you regarding the fasting instructions. Not fasting may compromise and endanger the recovery of your child post-operatively.
Dental treatment involving fillings, tooth removal and other surgical procedures are often be carried out using injections (local anaesthesia) to numb the child’s mouth. It is also possible to add sedation (oral), which makes the child feel drowsy, and helps to relax children who are anxious or afraid.
Please be aware that your child will need close supervision after the procedure and a day’s rest after the sedation. Avoid outdoor activities (e.g. running around , sports or swimming) on this particular day.