5 year old dental anesthesia: Kids’ Dental Anesthesia: What Parents Should Know

Kids’ Dental Anesthesia: What Parents Should Know

March 3, 2021 — A handful of tragic cases involving children who died during dental appointments have prompted a closer look at pediatric dentists’ growing use of anesthesia for kids having routine procedures like cavity fillings, root canals, and tooth extractions.

In Minnesota, a Twin Cities dentist paid a $2 million settlement to the family of a teen who died while having her wisdom teeth removed after he allegedly failed to properly monitor her after administering anesthesia.

In California, the death of a 4-year-old Oakland boy while under sedation during an oral procedure prompted the state’s dental association to draft sweeping new guidelines for dentists using anesthesia with children.

And in Hawaii, an Oahu dentist was charged with manslaughter after a 3-year-old girl had a heart attack during a root canal after being put under. The dentist was later acquitted, but the case prompted lawmakers to pass “Finley’s Law,” named after the patient, with new anesthesia guidelines for pediatric dental care.

Although cases like these are rare, the American Academy of Pediatric Dentistry (AAPD) recently issued new national guidelines for dentists who use general anesthesia to sedate young patients for procedures.

The guidelines, issued jointly by the AAPD and the American Academy of Pediatrics (AAP), call for certified anesthesiologists and trained emergency response specialists to be present in dentists’ offices whenever children are put under sedation.

In addition to the new national guidelines, state dental boards also have specific guidelines, says Kevin J. Donly, DDS, a professor and chair of the Department of Developmental Dentistry at the University of Texas Health San Antonio and a former officer for the AAPD.

“The guidelines go right down to safety equipment that must be available and all types of things for procedures — preoperative, things to do during the operation, and post-operative procedures,” he says

But some patient advocates argue more needs to be done to track and evaluate the risks. They note that no national regulations govern the use of anesthesia in children having dental procedures, and general guidelines vary state to state.

“It never has gotten sufficient attention,” says Debbie Hagan, who advocates for families of children who have been harmed in dental offices. “The only time you hear about it in the news is usually after there has been a devastating outcome; even then, it will be a local news report, with a reference to maybe one other incident.”

Some state dental boards are more proactive in protecting patients than others, Hagan says But as she has monitored the issue for the past 14 years, “I’ve seen state dental boards become less effective at anything to do with protecting public health and well-being and more about protecting dentists.”

How Safe Is Anesthesia for Kids?

Tooth decay — dental caries — is the most common childhood infectious disease, affecting 621 million children worldwide whose cavities are untreated. Without treatment, cavities can cause pain and infections that may lead to problems with eating, speaking, playing, and learning, according to the CDC.

In the process of treating cavities, dentists often give children moderate sedation or general anesthesia. Common medications include benzodiazepines, opioids, local anesthetics, and nitrous oxide — all of which can cause adverse side effects, such as allergic reactions, hypoxemia (low blood oxygen levels), respiratory depression, a blocked airway, and even death.

An estimated 100,000 to 250,000 pediatric dental sedations are done annually in the U.S., according to a paper published in the journal Pediatrics in November 2017.

That wide range reflects uncertainty about how widely pediatric anesthesia is used. It’s also not known how many children die after receiving general anesthesia in the dental chair because dentists are not required to report such cases.

“There is no mandated reporting of adverse events or deaths, so we don’t know how often these occur,” wrote the authors of the 2017 Pediatrics article, “Ethics Rounds: Death After Pediatric Dental Anesthesia: An Avoidable Tragedy?”

A 2013 study published in the journal Pediatric Anesthesia identified 44 deaths associated with dental anesthesia in patients under 21 between 1980 and 2011. But the study was based only on media reports because “systematic data collection on outcomes of pediatric dentistry was lacking … despite an increase in the number of pediatric dental sedations administered over the past two decades.”

Rita Agarwal, MD, a practicing pediatric anesthesiologist and professor of anesthesiology at Stanford University, says that lack of information makes it difficult to truly assess risks.

“This is one of the big problems,” says Agarwal, former chair on the American Academy of Pediatrics Section on Anesthesiology and Pain Medicine, who helped write the new AAPD guidelines for pediatric dentists. “There are no real reporting requirements, and each state is governed by their own dental boards, and [they] are different. The majority of information that we have is from media reports. There are few studies, and getting information from the dental boards is difficult.”

She sees the need for new federal requirements for dentists to report deaths and adverse events, which would help improve safety guidelines.

“There is a lot we do not know about what does and does not happen with office sedation [and general anesthesia] for dental work in children,” Agarwal says. “What we really need is a non-voluntary database that is fast, easy, accurate, and captures every sedation/anesthesia event.”

Another concern: Parents may not understand the kind of anesthesia that a particular procedure will involve.

“Many patients are booked as ‘conscious sedation’ or just ‘sedation,’ without the understanding and appreciation that young children often need deep levels of sedation or general anesthesia to lie still and cooperate with what can be a very scary experience,” she explains.

The new AAPD guidelines “probably do not go quite far enough,” Agarwal says, but they “are a lot better than they were.”

Dental Deaths ‘Very Rare’

Even so, deaths and complications are “very rare” in light of how many children receive general anesthesia, says dentist Donly of the University of Texas Health San Antonio.

“Thousands and thousands of general anesthesia procedures are done in children every year, and they come out well, he says. “Some are done in hospitals; some are done in dental offices or oral surgery offices. … And, so overall, it’s a safe procedure.”

In addition, deaths have often involved children who had conditions that may put them at risk for respiratory or cardiac failure.

That makes it critically important for dentists to know a patient’s medical history, Donly says. He often consults with a child’s pediatrician, cardiologist, or other specialist before he decides how to proceed with a patient who has a chronic condition.

“What if you have a kid who has severe heart defects, and you don’t want to put him under a lot of stress in an outpatient dental clinic?” he says.

“Then it might be best to have the work done under general anesthesia, even if they’re 10, 12 years old. Because we don’t want to put that child under any additional stress, because of that kid’s heart condition. ”

Children with severe autism or certain other conditions are more likely to be sedated in the dental chair — even for routine preventive care, says James Tom, DDS, a dentist anesthesiologist.

“Those children and adults with severe autism are common candidates for dentistry performed under general anesthesia,” explains Tom, past president of the American Society of Dentist Anesthesiologists. “[For] children with severe autism, providing regular dental hygiene [to prevent] severe dental decay often requires general anesthesia.”

It may also be a good option for children who require complicated dental work or are very young and won’t sit still in a dentist’s chair.

Tom says there are reasons why the new AAPD guidelines don’t clearly spell out when — and for which patients and procedures — general anesthesia is the best option.

“There are just too many factors to consider to simply write guidelines recommending what should be performed under general anesthesia and what should be performed under local anesthesia by itself or with nitrous oxide, oral sedation, or some other means,” he says.

“The need for general anesthesia is based on factors other than just the procedure itself — age, level of cooperation, development of the child, caretaker expectations, invasiveness of the procedure(s), etc.”

Questions for Parents to Ask

In light of the uncertainties, how should parents respond if a dentist recommends general anesthesia for a child?

First of all, parents should verify that a certified anesthesiologist and a second trained emergency response medical specialist — such as a nurse — will be present, along with the dentist and any other assisting staff, as the AAP guidelines recommend.

“I think the most important thing is for parents to really be aware of the difference in the personnel and to ask who will provide the sedation, who will help if something goes wrong,” says pediatric anesthesiologist and guideline writer Agarwal.

“If they are not happy, they can talk to their pediatrician about alternative options. There are many hospitals, surgical centers, clinics, and physicians that will provide anesthesia and sedation with a board-certified anesthesiologist or other qualified personnel. ”

Experts also suggest asking the following questions:

• Is general anesthesia really necessary in this case?
• What procedure are you going to do, and do you have to do it?
• What medicines are you going to use to sedate my child?
• Will there be a separate certified provider for general anesthesia in the room?
• How will my child be monitored by a second medical specialist during the procedure should something go wrong?
• How much training and experience have the personnel had in caring for kids my child’s age?

Donly says preventive medicine is the best way to head off the need for procedures that require sedation, with the AAPD recommending a child’s first dental appointment no later than their first birthday.

“The latest data I saw was that the most unmet health care need during this COVID-19 era has been dentistry,” he says. “So, parents need to get their kids in on a prevention basis — whether it’s a general dentist or a pediatric dentist — really early in life to prevent caries, so we really don’t have to face these issues. ”

Anesthesia or Sedation for Your Child’s Dental Work?

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​​​​​By: Rita Agarwal, MD, FAAP & James Tom, DDS, MS

Young children with dental pain and/or infection require treatment at any age—sometimes that means your child will need to go under general anesthesia or sedation. Of course, there are many reasons for this. Some dental procedures require your child to lie completely still, there may be a lot to fix, or the noise of the drill may be scary. The goal is always to provide the safest, most pain-free treatment.

How Safe is Anesthesia or Sedation in Dental Procedures for Children?

In 2019, the American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD) updated the current guidelines for dentists and oral surgeons to follow when providing deep sedation or general anesthesia to children.  

It requires that there are always at least 2 people in the room who are trained to provide advanced life support measures in case there are any problems. One of these people will be the dentist or oral surgeon performing the procedure and the other will be an independent observer. This independent observer must be “a physician anesthesiologist, a certified registered nurse anesthetist, a second oral surgeon, or a dentist anesthesiologist.”

The following information provides an overview of the various types of sedation and anesthesia. It’s important for parents to know their options. Talk with your child’s dentist or oral surgeon about the type of sedation or anesthesia he or she recommends (and regularly practices) for your child’s dental work before the appointment.  

Types of Sedation and Anesthesia Used on Children—Know Your Options:

• Nitrous oxide: This is a mild sedative and the least invasive. It’s commonly known as ‘giggle gas’ or ‘laughing gas.’ Children breathe this with a little oxygen. They don’t usually go to sleep, but most will get more relaxed. Most will get a little silly and lightheaded, but a few don’t like the feeling.  

• Mild sedation: This medication (or a combination of medications) are commonly used on older children and adults. Your child would be calm and awake—and sometimes able to do what the dentist or surgeon asks him or her to do. After the procedure, your child may not even remember things about the dental visit. Dentists and oral surgeons can safely give these medications while they do the dental work, because your child remains awake.

• Moderate sedation: Under moderate sedation children are sleepier, but they are usually able to do what the dentist or oral surgeon asks them to do. Older children and young adults do better with moderate sedation than younger or more fearful children. They breathe on their own and will usually wake up easily. Most children will not remember anything about the procedure. Dentists and oral surgeons can safely give these medications while they do the dental work.

• Deep sedation: This involves intravenous (IV) medications to help your child sleep through the procedure. While your child may still move a little and sometimes make noises, he or she may not be able to breathe well on his or her own. There must always be at least one additional qualified professional (independent observer), such as an anesthesiologist (see Who’s Who list below) who can monitor your child’s heart rate, heart rhythm, blood pressure, and oxygen saturation (breathing) during the procedure and until he or she wakes up. This professional can also determine when your child is ready to go home.

• General anesthesia: Under general anesthesia, your child will be completely asleep and pain free. Specially-trained anesthesia professionals (physicians, dentists, or certified nurse anesthetists) will administer medications and monitor your child while a separate dentist or oral surgeon performs the dental procedure or surgery. Anesthesia can be given in a dental office that is specially equipped, an ambulatory surgical center (ASC), or a hospital. 

Medication Administration During Children’s Dental Procedures—Know the Who’s Who:

After you discuss the options for sedation and anesthesia with your child’s dentist or oral surgeon, find out exactly who will be administering the medications and who will be watching your child during the dental procedure.

Here’s an overview of the various medical and dental professionals who may be involved in your child’s dental procedure. Knowledge is power—familiarize yourself with the list below.

Note: The new AAP and the AAPD new guidelines state that an anesthesia professional or a another dentist or oral surgeon who is licensed and trained in anesthesia be with your child while the dentist or oral surgeon concentrates on the procedure. This person will deliver and monitor deep sedation and general anesthesia while the dentist or oral surgeon is performing dental surgery on your child. Other personnel may also be present to assist with deep sedation and general anesthesia or the dental surgery.  

• Pediatric dentist: Has completed all the above training and licensure as a general dentist, as well as a pediatric dental residency (usually 2-3 years). Pediatric sedation training is included in the residency training. Pediatric dentists may be board certified by taking and passing a national exam.

• Oral and maxillofacial surgeon: Completes an oral maxillofacial residency after dental school (4-6 years). Most oral and maxillofacial surgeons have a dental license, and some also have a medical license. In addition, some are granted a general anesthesia permit by a State Dental Board. Oral and maxillofacial surgeons may be board certified by taking and passing a national exam.

• Anesthesiologist: A physician or dentist who completes a 3-5-year anesthesiology residency after medical or dental school and passes all required exams. Anesthesiologists can administer anesthesia for dental procedures and oral surgery, and they may have a permit from a State Dental Board to deliver anesthesia in a dental office. Physician and dentist anesthesiologists may have specialized training to treat children, and they may have board certification by taking and passing a national exam.

• Nurse anesthetist: A registered nurse who completes a 2-year program after nursing school and has additional clinical experience. In some states, nurse anesthetists can administer anesthesia in a dental office without the supervision of a dentist or physician.

• Dental hygienist: Completes a 2-year dental hygiene degree after high school—usually an Associate’s Degree. Some dental hygienists have additional education and training such as a Bachelor’s Degree. They are licensed by their state and can give local anesthesia (numbing shots) in the mouth.

• Dental assistant: No formal training is required. Training may be “on the job.” There are also 10-12-month certificate programs. Dental assistants may be registered by their state dental board. Dental assistants do not
  qualify as independent observers for deep sedation or general anesthesia. 

• Dental sedation assistant: Requirements vary from state to state, but the dental sedation assistant can obtain a certificate allowing him or her to help watch patients under anesthesia. Certificates can be obtained via an online education program or at an approved on-site educational program. Dental assistants, however, cannot administer sedation or rescue medications on their own in a dental office.

Additional Information & Resources:

• Anesthesia and Children: Information for Parents

• Guidelines for Monitoring and Management of Pediatric Patients Before, During and After Sedation for Diagnostic and Therapeutic Procedures (AAP Clinical Report) 

• What to Expect on a Typical Anesthetic Case (American Society of Dentist Anesthesiologists)

• Public Resources (American Society of Dentist Anesthesiologists)

• Questions to Ask Your Dentist about Anesthesia and Sedation for Your Child (PDF) (MouthHealthy. org)

• 9 Questions to Ask Your Dentist Before Your Kids Go Under Sedation (Today.com)

• Policy
  for Selecting Anesthesia Providers for the Delivery of Office-Based Deep
  Sedation/General Anesthesia (American Academy of Pediatric Dentistry) 

About Dr. Agarwal:

Rita Agarwal MD, FAAP is Clinical Professor of Anesthesiology at Stanford and a practicing pediatric anesthesiologist at Lucille Packard Children’s Hospital Stanford. She went to medical school at Baylor College of Medicine, where she also did her residency. Her fellowship in Pediatric Anesthesiology was completed at Denver’s Children Hospital. Dr. Agarwal spent over 20 years at the Children’s Hospital of Colorado where she was the pediatric Anesthesia Program Director, former Acute Pain Service Director. Within the American Academy of Pediatrics, she is Chair of the Section on Anesthesiology and Pain Medicine.

About Dr. Tom:

James Tom, DDS, MS is the past President of the American Society of Dentist Anesthesiologists and holds a full-time Associate Professor of Clinical Dentistry position at the Herman Ostrow School of Dentistry of USC. He completed his dental education at USC and his anesthesiology residency at The Ohio State University. Dr. Tom represented dentists and dentist anesthesiologists on the American Society of Anesthesiologists Task Force on revising the Practice Guidelines for Procedural Moderate Sedation and Analgesia. In addition, he maintains an Assistant Editor position with Anesthesia Progress: A Journal for Pain and Anxiety Control in Dentistry.

​ 

Last Updated

5/28/2019

Source

Section on Anesthesiology and Pain Medicine ＆ Section on Oral Health (Copyright © 2019 American Academy of Pediatrics)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Should you let your child undergo anaesthesia for a dental procedures?

Sedation is commonly used for dental procedures in kids—even for fillings. Here’s what you need to know before the dentist puts your child under.

Sheila Banerjee vividly remembers the time her four-year-old, Jai, needed general anaesthesia for two fillings. “We had the appointment scheduled and Jai ate one leaf of spinach from our backyard that morning,” recalls the Toronto-based mom. After a lengthy drive to the dentist’s office, they were sent home and the procedure was postponed: The anaesthesiologist had decided that because Jai had eaten in the eight hours prior (which is known to be associated with a risk of vomiting and choking during anaesthesia) the procedure would have to be rescheduled.

Thankfully, the procedure happened two weeks later, and everything went smoothly. “Overall, it was a positive experience,” says Banerjee.

The real reason why cavities form
Using general anaesthesia to treat dental issues in kids is common in Canada, and Jai’s procedure was just one of the 19,000 day surgeries involving anaesthesia performed on children under six to fill cavities, do root canals and extract teeth every year. Dentists use anaesthesia in situations where kids require a lot of dental work and the doctors don’t want to traumatize them with hours of drilling in the dental chair. Brett Saltzman, Toronto-based paediatric dentist at Forest Hill Children’s Dentistry, says these are low-risk, in-office procedures, but, as Jai’s cancelled appointment demonstrates, they aren’t without risks. That means that parents need to be informed and weigh their options carefully when dental anaesthesia is recommended for their child.

Why use sedation during kids’ dental procedures? 

Often, general dental anaesthesia is used in cases when a child has numerous teeth with decay, says Diya Chadha, a paediatric dentist at Smile Town Dentistry in Burnaby, BC, who adds that it isn’t unusual to see eight to 10 teeth with cavities. Other times, it’s decay that has progressed to the nerve of the tooth—requiring a baby root canal—in which the nerve is removed, the hole is filled and a crown is placed on the tooth.

For kids with special needs, such as ADHD or autism, general anaesthesia or sedation can also make a procedure that would be very frightening more manageable, says Chadha. “You want to build on that positive experience, ensuring the child doesn’t associate the dentist with pain and anxiety,” she says. “And it allows the provider to do better dentistry.”

What are the risks of dental anaesthesia?

While general anaesthesia is considered safe, there still is risk involved. In Canada, the chance of a healthy person dying as a result of anaesthesia is between one in 200,000 and one in 400,000, according to the Canadian Anesthesiologists’ Society. Pre-existing medical conditions, such as asthma or diabetes, can raise the risk of complications, and in rare cases, patients may have allergic reactions to the drugs. Side effects of anaesthesia include nausea, vomiting and dizziness.

These risks have been highlighted by a few well-publicized cases. In 2016, a four-year-old Edmonton girl, Amber Athwal, suffered brain damage after she went into cardiac arrest while under general anaesthesia following a procedure to remove a tooth. Athwal had eaten breakfast that morning—something her father says he disclosed to the dentist—which may have played a part.

New standards have been put in place and dentists in Alberta can no longer both administer anaesthesia and perform a dental procedure on a patient. But the rules for dentists vary across provinces. In Ontario, for example, a dentist must have at least two trained assistants when administering anaesthesia.

While a situation like Athwal’s is rare, parents should still be vigilant. To ensure your child is a good candidate for general anaesthesia, make sure you report any health issues to your paediatric dentist. Jasdev Bhalla, a board-certified specialist in dental anaesthesiology who works at MM Family and Sleep Dentistry in Hamilton, Ont., says a child’s suitability for the procedure has to be assessed very carefully. Asthma, heart issues and sleep apnea could all affect sedation.

Tell your child’s dentist if your child has had adverse reactions to sedation in the past. You can also ask whether laughing gas or conscious sedation—which relaxes the patient but keeps them conscious—could work as an alternative, in addition to local freezing.

Once your child is deemed a good candidate for general sedation, you should ensure that the person administering general anaesthesic is a licensed dental anaesthesiologist or a dentist who has received authorization from their province’s dental authority to administer general anaesthesic. (Different provinces have different rules around this so check this on your province’s dental college website.) To receive this certification, a dentist has to complete emergency resuscitation and CPR courses, as well as specific anaesthesia training. The dental facility also has to have a permit from the college allowing anaesthesia to take place, and must have a certificate indicating it has been inspected by the college. You can ask your dentist to see these documents.

“You’re trusting someone to look after your child when they’re sedated,” says Bhalla. “It’s a good idea to determine how many procedures they have performed.”

How to prepare your child for dental anaesthesia 

Before a child goes under, a paediatric dentist or anaesthesiologist is legally obligated to present all the details of the procedure, as well as the reasons for the general anaesthesia, says Saltzman. This is called informed consent, and the parent or caregiver must sign off before any anaesthesia can be performed.

In Banerjee’s case, she and Jai had a lengthy consultation with the dentist. “We were advised that, because of Jai’s age, doing the dental work without general anaesthesia would not be feasible,” says Banerjee. “It would be too scary.” But a child’s temperament should also play a role in the decision.

Bhalla suggests parents learn as much as possible about who will be doing their child’s sedation, where it will be happening and what emergency procedures are in place. Because many times parents will meet the anaesthiosiologist for the first time minutes before a procedure, he says parents should call the dentist/dental anaesthesiologist in advance of any surgery to find out the steps he or she will be taking to ensure the safety of the procedure. Will a monitor be attached to the child after the sedation to monitor vital signs? Will an assistant be in the recovery room with the child at all times? Is there a defibrillator—a device used to restart the heart during cardiac arrest—on site? And is there a wall and/or portable suction and supplementary oxygen in recovery? In Amber Athwal’s case, her monitor was turned off and failed to alert the dentist and his assistants that she was in cardiac arrest and deprived of oxygen. The assistant on duty also left the recovery room, and the staff had not received adequate resuscitation training.

Once you’ve signed off, find out what instructions you need to follow before your child’s procedure. Fasting for eight hours before a procedure is key to preventing vomiting and food from being inhaled into the lungs, leading to choking.

And prep for post-op cuddles. Many kids can wake up confused or upset after anaesthesia—which isn’t unusual. They may take a few hours to return to normal. Banerjee says that, after waking up from the dental anaesthesia, Jai was groggy and teary. Luckily, the episode was short-lived and lasted only 20 minutes, she says.

Ultimately, if your provider is well-trained, and equipped for emergencies—and you follow their directions carefully—all should go well. “Most parents say, ‘We are so glad we did that,’” says Chadha.

Banerjee is glad she chose anaesthesia for Jai.  “After I did the research,” she says, “it didn’t seem alarming.”

Read more:
How to prepare for your kid’s first hospital visit
How to prepare for your child’s first dental visit

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FILED UNDER: dental health dentist Kids teeth sedation

Will Your Child Require General Anesthesia for Dental Work?

ALPHARETTA, GA – If your child needs to undergo extensive dental work, your dentist might recommend placing your child under general anesthesia. This can help your child sit longer, ensuring a smooth procedure for both of them. But there are several things you should know before agreeing to it.

Who can benefit from sedation methods in pediatric dentistry?

Typically, a dentist will recommend general anesthesia due to the young age of a patient, high anxiety, or the amount of treatment required. Treatment performed under general anesthesia allows for a pain-free and atraumatic dental visit and can allow your dentist to perform all the required treatment in just one session.

For some children, it is just impossible to stay still in a chair for what can feel like an eternity when they aren’t doing anything but looking at the ceiling, coupled with the natural reactions of a child feeling their teeth and mouth being pulled or a sensible gag reflex and you’ve got yourself a very bumpy dental intervention. To make the procedure go as smooth as possible, your dentist may recommend sedation.

Which treatments require sedation?

If your child needs extensive dental work, such as crowns, caps, a root canal, or multiple fillings, it’s not uncommon for your dentist to recommend placing your child under general anesthesia to ensure the procedures are quickly and effectively done.

How to prepare your child for sedation

The first thing you need to do to prepare yourself and your child for sedation is to be properly informed. Talk to your dentist before the day of the sedation so that you can understand what’s the process they are going to perform, why it is necessary to sedate the child, who will the staff consists off, and what equipment they will have on-site.

As for the preparations, the child must avoid eating at least 8 hours before the scheduled procedure. This includes all foods and drinks that are not clear liquids. If they have any type of prescription not related to the process, be sure to talk to the dentist about it a few days before the appointment.

Should general anesthesia be performed in hospitals or at an out-patient facility under the watch of an anesthesiologist?

Dentists can perform general anesthesia in a dental office if they have the correct setup. While some offices can offer general anesthesia, some may not. They will perform the required procedures in a hospital or outpatient facility.

Is there any risk associated with general anesthesia, and what are the side effects?

As with any medication, certain risks apply, but this procedure is generally safe. Most side effects are temporary, and some children may experience a sore throat, confusion, lethargy, headache, and nausea that should completely go away in a few hours to a few days. Although some serious complications are possible, it’s very rare.

What are the disadvantages of general anesthesia?

Although the advantages of general anesthesia far outweigh the disadvantages, the biggest concern is the assistance of respiratory and cardiovascular function. Another disadvantage of general anesthesia is that the patient may require hospitalization or an out-patient facility for surgery where an anesthesiologist will administer and monitor the anesthesia while the pediatric dentist can perform extensive dental work in one visit.

Are any tests required before having elective general anesthesia?

In most cases, there will not be any tests required. However, if a child has a significant medical condition, your dentist may require lab tests or additional evaluations by the child’s physician.

Can you explain the differences between general anesthesia and the types of sedation?

• Minimal sedation is a drug-induced state that allows patients to respond normally to verbal commands. It will relieve apprehension without causing impairment to major functions of the body.
• Conscious, or moderate, sedation is a drug-induced depression of consciousness that allows a patient to purposefully respond to verbal commands. The purpose is to help the patient relax and avoid pain. The medicine wears off rather quickly, so specialists use it for shorter, less complex treatments.
• Deep sedation is a depression of consciousness during which the patient cannot be aroused. The patient will respond purposefully following repeated or painful stimuli and may require assistance in maintaining a patent airway.
• General anesthesia is the drug-induced loss of consciousness during which patients are not able to be aroused, even by painful stimuli. Patients typically require assistance in maintaining a patent airway, and they could have their cardiovascular function impaired.

Is deep sedation the same as general anesthesia?

No. Deep sedation, or deep anesthetic, will generally not require assisted breathing or cardiovascular assistance, as with it’s the case with general anesthesia.

If you have any further questions, please be sure to ask a qualified Pediatric Dentist in Roswell like Dr. Nanna at Polkadot Pediatric in Alpharetta.

© 2018 Polkadot Pediatric Dentistry. Authorization to post is granted, with the stipulation that Polkadot Pediatric Dentistry, an Alpharetta, Johns Creek, and Roswell dentist, is credited as sole source. Linking to other sites from this document is strictly prohibited, with the exception of herein imbedded links.

Practice now under new scrutiny

Araceli Avila never dreamed that her daughter’s life might be at risk during a visit to the dentist. But on June 12, Daleyza Hernandez Avila, 3, died during a dental procedure. The dentist sedated Daleyza to keep the toddler from wriggling while she was getting crowns and having a tooth pulled. The little girl never woke up.

Now, Araceli wants to warn other parents about the dangers that she wasn’t aware of. “I’m looking for justice so what happened doesn’t happen to other mothers,” she told Sacramento NBC affiliate KCRA. “So they don’t have to feel the same pain I feel after losing my daughter.”

After several recent tragic cases, there are demands for different practices from the influential American Academy of Pediatrics, according to a report by NBC News national correspondent Kate Snow, which first aired on “Sunday Night with Megyn Kelly.”

We apologize, this video has expired.

Dr. Wendy Sue Swanson of Seattle Children’s Hospital and a spokesperson from the influential pediatricians group is sounding the alarm about sedating children for oral surgery.

“If we can prevent one more child from an adverse event or a death, we’ve got to try,” Swanson told NBC News.

It’s unclear how many children — or adults, in general — have died in the U.S. during dental procedures. The state boards that oversee dental practice in America usually don’t make that kind of information public.

But earlier this month, a Texas high school student died about a week after undergoing anesthesia to have his wisdom teeth removed. And last summer, two children lost their lives after undergoing extensive dental procedures.

According to a Dallas Morning News investigation in 2015, a dental patient dies nearly every other day in the United States. That’s more than 1,000 people over the course of five-and-a-half years.

The numbers on deaths are only estimates and with millions of dental procedures performed each year on children ages 2-17, such tragedies are very rare.

But one thing is certain, “there are too many of them,” said Dr. Michael Mashni, a dentist with anesthesia training who practices in California.

Without data on deaths from all the state boards it’s impossible to determine where the problems are and how to fix them, Mashni said.

“There’s really no legitimate oversight,” said Dr. Jay Friedman, a California-based dental consultant and author. “And there are very few sanctions. You have to do something really bad before anything gets done about it.”

In Friedman’s experience, many young children are being over-treated by their dentists. And children are more likely to be over-treated if they are under full sedation, he said.

Children can choke more easily

The danger isn’t from local anesthesia such as Novocain or numbing gels. General anesthesia —when the patient is unconscious — can be risky in young children and some dentists may not recognize the danger quickly enough, said Dr. Karen Sibert, an associate clinical professor of anesthesiology at the University of California, Los Angeles.

“Children have small airways and they choke more easily than adults,” Sibert said. “It doesn’t take much to obstruct a small child’s airway. Their vocal cords can close. They can choke on a little bit of blood.”

In a hospital or an ambulatory surgery center, there are medical support systems to help a child in distress. In an office setting,”by the time anyone gets there, the child is in such deep trouble, it’s too late,” said Sibert.

Parents whose sedated children died during dental procedures often say they were unaware that death was a possibility. And while there may have been a consent form including that danger, many don’t absorb the information in the dentist’s office, Friedman said.

Given the risks associated with sedation, “the dentist should have a frank discussion with the parents on the risks and benefits of anesthesia for treating the underlying disease,” said Dr. Jim Nickman, president of the American Academy of Pediatric Dentistry. “We advise members to use extreme caution when they’re looking at sedating a child less than 3. For those under the age of 2, I would recommend anesthesia be done in a hospital setting.”

Before child undergoes any serious dental procedure:

Ask lots of questions

Parents should ask questions until they have no more, and they should always feel they have all the information they need to give consent for an elective procedure, said pediatrician Swanson.

Experts suggested these questions:

1. What procedure are you going to do and do you have to do it?

2. How much training have you had? Get up and walk out if somebody says, “Oh, I took a weekend course and I just started doing this, but it’s going to be OK,” said Dr. Roger Byrne, an oral surgeon in Houston.

3. Are you going to sedate my child? If so, what medicines are you going to use? Be sure the doctor doesn’t understate the anesthesia being given. Answers like “it’s only a few pills” or “it’s just something that relaxes you” are red flags, said Dr. Louis K. Rafetto, past president of the American Association of Oral and Maxillofacial Surgeons.

4. Will there be a separate provider for general anesthesia in the room? “I would insist on a separate qualified anesthesia professional looking after my child,” Sibert advised.

5. How much experience does this person have caring for kids my child’s age?

6. How will my child be monitored during the procedure? Be sure there will be vigilant monitoring. Ask if the office has EKG, blood pressure, pulse oximetry and end tidal carbon dioxide monitors, Rafetto said.

7. Who is going to be in the room if something goes wrong? The staff should be prepared to recognize and respond to crisis situations. It also is appropriate to ask about the office’s safety record, he added.

8. Are you going to use a Papoose Board — a temporary restraint?

9. What kind of recovery setup do you have?

Get a second opinion

Instinct matters, so if you feel unsettled, consult another doctor, Swanson said.

“Get a second opinion if it’s not a crisis — and very little dental work is a crisis,” Sibert added. “Parents can also simply ask, ‘Can this wait a year or two?’”

Consider the setting

Parents should have a healthy respect for deep sedation and general anesthesia in an outpatient setting, where there’s very little help available if something goes wrong, Sibert said. They should ask if it would be better to take the child to an ambulatory surgery center, where an anesthesiologist would be present.

If the procedure is being done in an outpatient clinic without a pediatric anesthesiologist, make sure it’s low risk, Swanson noted. Sibert would have no problem with her grandsons having a procedure in a dentist’s office if all it would require is “local anesthesia, nitrous, and cartoons.”

After the procedure

Kids can come out of sedation a little slower than adults and need prolonged observation, Swanson said. Before you go home, make sure your child is no longer sedated — he’s not falling asleep and not slowing his breathing, Swanson noted.

If your child is in the backseat for the car ride home, make sure there’s someone who can be there beside him to watch him and make sure his airway doesn’t get closed off or he doesn’t slow his breathing while you’re driving home, Swanson said.

“There are events where children have had sedation, get in a car seat or a car, their respiratory rate goes down and they’re just quiet and someone may not know,” she noted.

Two adults accompanying a child are ideal for this situation.

Bottom line

For those uncomfortable with the idea of general anesthesia, “there are other options that can work, for example having the parent hold the child in a blanket to keep him still — like you’d do in the emergency room if the child required stitches,” Nickman said.

Ultimately Friedman isn’t convinced that the benefits of sedation outweigh the risks.

“In my opinion, there’s no excuse to give any of these kids general anesthesia,” he said.

NBC News national correspondent Kate Snow contributed to this report.

Should Kids Be Sedated for Dental Work?

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Ehren Foster, 8, under sedation medication during a dental procedure Tuesday at the University of Pittsburgh’s pediatric dental center, where residents are taught sedation and monitored.Credit…Jeff Swensen for The New York Times

• Aug. 24, 2017

In dental offices nationwide, children who need cavities filled or teeth pulled are sometimes sedated. Ideally, it makes them less anxious and more cooperative.

They may swallow a liquid sedative or inhale laughing gas and once it kicks in, they will be conscious but calmer, so the dentist can do extensive work.

But in rare cases, children fall into a much deeper level of sedation than intended. If they aren’t rescued quickly, they may stop breathing or even die. It is critical for the dental staff to keep track of the patient’s vital signs and quickly recognize an obstructed airway or a problem with the heart or breathing.

In recent years, a few reports of sedated children dying at dental offices have come to light, alarming lawmakers, parents and the dental profession. In 2013, University of Washington researchers found 44 cases over three decades in which dental patients died after sedation or general anesthesia. Most were 2 to 5 years old.

More recently, in 2016, Daisy Lynn Torres, 14 months old, underwent general anesthesia at an Austin dental office to fix two cavities, and died after her heart and breathing stopped. Her parents sued after dental experts found no evidence of cavities on her X-rays. In June, Daleyza Hernandez-Avila, 3, went to a surgical center in Stockton, Calif., to have her teeth fixed and never woke up.

For sedation to be safe, certain protocols are critical and many factors must be carefully weighed, according to the 2016 guidelines jointly written by the American Academy of Pediatric Dentistry and the American Academy of Pediatrics.

From left, Erica Regan, a dental assistant, and Dr. Allison Gerlach working to install a crown on one of Ehren’s teeth while Dr. Deborah Studen-Pavlovich and Dr. Corbin Salthouse monitor Ehren’s vital signs.Credit…Jeff Swensen for The New York Times

Sedation is a continuum from minimal to moderate to deep to general anesthesia, and “it is common for children to pass from the intended level of sedation to a deeper, unintended level of sedation,” the guidelines note. So parents should ask the dentist what level they’re aiming for and what emergency measures will be taken should, for example, moderate sedation become deep and a child can no longer breathe on his or her own.

“The risk is small but there’s always a risk when you sedate a child, primarily of airway obstruction, where the child — for whatever reason — becomes oversedated,” said Dr. Joseph P. Cravero, a senior associate in perioperative anesthesia at Boston Children’s Hospital.

A dentist’s office generally has fewer hands on deck than a hospital if trouble strikes. “If you are working in a hospital, you press a button, an alarm goes off and everyone comes to help with that kid,” Dr. Cravero said. But in an office, “you end up having to call 911 for help” and the dentist must begin resuscitation during the wait.

The Pediatric Sedation Research Consortium — which collects data mostly from hospitals, not dental offices — has found a low but persistent rate of life-threatening events associated with sedation, such as airway blockage, a drop in blood oxygen levels or a spasm of the vocal cords that makes breathing hard.

Unfortunately, it’s not known how many children are sedated in dental offices nor the actual frequency of problems. “What you have in dentistry are reports of disasters, and that’s all we have to go by,” said Dr. Cravero, a co-founder of the consortium.

Some children are particularly vulnerable during sedation because of their youth, anatomy or other factors. Enlarged tonsils may increase the chance of airway obstruction, for example.

Ehren did not love the taste of the oral sedative he took before the procedure.Credit…Jeff Swensen for The New York Times

Children younger than 6 may have a greater risk of adverse events, a 2009 study suggested, based on nearly 50,000 sedation/anesthesia procedures at 37 locations, mostly hospitals. The authors concluded that the safety of sedation depends on a practitioner’s ability to manage less serious events. No deaths were recorded, but airway obstruction happened roughly 2,800 times.

“Kids under 6 have a smaller airway that can easily be blocked,” said Dr. Jeremy Horst, a pediatric dentist at the University of California, San Francisco. “The size difference is so enormous” between a 4-year-old and a 12-year-old. Very young children “don’t have as much of an oxygen reserve in their blood as older children or adults so their body can’t compensate for short lapses in oxygen,” he said.

Overweight and obese children merit special consideration, too, said Dr. Deborah Studen-Pavlovich, the director of the pediatric residency program at the University of Pittsburgh School of Dental Medicine. A sedative “doesn’t get metabolized as quickly as the drug is stored in fat cells so they have a longer recovery time,” she said.

It’s unclear why but a 2009 study found that sedated children with developmental disabilities have three times the risk of having a decrease in blood oxygen levels that can lead to life-threatening complications.

“Sedation is above and beyond routine dentistry,” so the first thing parents should ask is whether it’s necessary, said Dr. Paul Casamassimo, the chief policy officer for the American Academy of Pediatric Dentistry’s research center.

Sedation may be needed, for example, if a 3-year-old requires root canals for badly decayed molars or has a throbbing abscess, said Dr. Casamassimo, who sedates children at Nationwide Children’s Hospital in Columbus. But less advanced cavities may be treated by brushing a liquid called silver diamine fluoride on decayed parts to stop the infection. (The substance may darken decayed areas, but baby teeth fall out.)

Dr. Studen-Pavlovich, who directs the pediatric residency program at the University of Pittsburgh School of Dental Medicine, emphasizes the importance of hands-on sedation training for dentists: “Classroom training is not enough,” she said.Credit…Jeff Swensen for The New York Times

“It’s not appropriate for sedation to be a first-line treatment” for all cavities, Dr. Horst said. Less risky and less invasive options, such as placing a temporary filling to buy time until a child will sit for a proper one, should be discussed.

The quality of dentists’ sedation training matters, because a dentist needs to be able to choose the right candidates and the appropriate drug and know how to rescue an oversedated child. Pediatric dentists train for an added two or three years to learn sedation.

By contrast, a general dentist may have taken a weekend course in moderate sedation. “Classroom training is not enough,” Dr. Studen-Pavlovich said.

Moderate sedation, also known as “conscious” sedation, requires more vigilance than minimal sedation, such as laughing gas, because children could slip from moderate to deep sedation, which means they can’t necessarily maintain their own airway. For moderate sedation, dentists should have rescue drugs on hand and monitor oxygen levels and heart rate. In addition, the American Society of Anesthesiologists recommends “a qualified individual” other than the dentist monitor the patient, because it “reduces risk of adverse events,” said Dr. Jeffrey S. Plagenhoef, the society’s president.

Both deep sedation or general anesthesia using an IV should be administered only by qualified anesthesia providers, according to the anesthesiologists’ society.

Pediatric dentists also learn how to manage kids by talking to them. “Anyone can work on a patient who is knocked out,” said Dr. Jeanette MacLean, a pediatric dentist in Glendale, Ariz., adding, “Behavior management is a dying art form.”

Money plays a role, too. Dr. Peter Hartmann, a general dentist in Santa Barbara, Calif., worries “that sedation and anesthesia are overused as profit-making tools.”

The bottom line is parents should be told the risks, benefits and alternatives, Dr. MacLean said. “If not, get a second opinion.”

Anesthesia for children – GALA DENT

We, dentists, especially CHILDREN’S, are responsible for the health of the child here and now, and we must think about his future health. It depends on us what attitude a person will have towards a dentist, and towards all doctors in general. It is the responsibility of the parents to help the child learn how to properly treat their health and seek help in a timely manner.

Pain is the factor that forms fear. If a child was deceived at least once: they said that treating teeth did not hurt, but at the reception he experienced pain, trust in the dentist and parents in this matter will end forever. Therefore, it is IMPOSSIBLE to treat children’s teeth WITHOUT anesthesia. If an adult responds even more or less normally to discomfort during treatment, then for a child such a situation is scary and incomprehensible.

Does the child have a toothache?

This is a real question parents often ask. Yes, children’s teeth hurt, and sometimes more so than adults. Also, it’s much scarier for a child. Therefore, any treatment with minimal preparation, and even brushing teeth in the dentist’s office, should be carried out with the use of anesthetics.

Modern anesthesia techniques and types of drugs help the pediatric dentist to effectively treat children without pain and stress, and at the same time in a completely safe way. How to do it? This article is about this.

What is the difference between pediatric and adult anesthesia?

Features of pediatric anesthesia are determined by the characteristics of the child’s body.

For example, a child’s body needs 2 times more oxygen than an adult. Also, the children’s body is characterized by a rapid change in physiological conditions and an increased ability to adapt. At the same time, children are more sensitive to changes in environmental temperature, have increased emotionality, it is difficult for them to stay in one position for a long time. There is a high probability in children and allergic reactions, and the smaller the child, the more careful you need to choose the drug.

Therefore, when performing pediatric anesthesia, the following rules must be observed:

Accurately select the anesthetic drug and its dose. There is some difficulty in anaesthetizing children under 4 years of age, because most local anesthetics are used from the age of 4. For a child prone to allergies, it is better to conduct special allergy tests in order to know exactly which drug is safe for him.

The child should be administered the anesthetic in the most gentle way possible. Children are often afraid of tools, and even more so of syringes. Before the injection, the injection site should be treated with a tasty anesthetic gel that “freezes” the gums. A large selection of such drugs is available today.

Due to the increased susceptibility to ambient temperature, the child may be cold during treatment in a cool room, or vice versa – hot if the room is poorly ventilated and too small. This factor must be taken into account.

Do not neglect the method of premedication before visiting the dentist. Taking a sedative medication will help your child relax and be less afraid.

A very important component is the doctor’s personality. A good pediatric dentist finds an approach to parents and to the child and turns fear into interest. Advice to parents: help him with this to the best of your ability.

What types of anesthesia are used in pediatric dentistry?

Application anesthesia gel with anesthetic.

This is the most “not scary” method of pain relief for a child, but also the weakest. It is enough to perform professional hygiene, remove a loose tooth or “freeze” the injection site. But its use should not be underestimated.

Classic injectable local anesthesia.

Mainly used from about 4 years of age, but has few contraindications. The main thing is to find out if the child has an allergy to the proposed drug. The dentist chooses the type of anesthetic substance based on the child’s age, condition, and even mood. Articaine preparations are widely used for anesthesia of dental treatment in children – its action is 5 times stronger than novocaine familiar to us, it is non-toxic and does not provoke allergic reactions.

General anesthesia is treatment under general anesthesia.

It is often possible to meet the desire of parents to treat their child’s teeth under anesthesia. It’s easier for parents and a doctor, but for a child?

Two strict rules for the use of anesthesia in pediatric dentistry:

• Anesthesia is NOT USED unless there are very good reasons.
• Treatment under anesthesia is possible ONLY in rooms specially equipped for this, where there is a full set of equipment for resuscitation, and there is an anesthesiologist and resuscitator on staff. Or such equipment can be deployed by a mobile anesthesia team.

Indications for dental treatment of a child under anesthesia:

• Age up to 4 years.
• Developmental features: autism, Down syndrome, cerebral palsy or epilepsy.
• Large volume of dental intervention.
• Allergy to local anesthetics.

Extreme overwhelming fear of treatment, in case other methods have been tried and have not worked.

4. Sedation

   Sedation is not pain relief in the classical sense. This is a relatively new method in which a small patient breathes a mixture of nitrous oxide – “laughing” gas, and oxygen. This method has a good relaxing effect, the child calms down, plunging into a superficial sleep, but can answer questions and remains conscious. Sedation goes well with local injection anesthesia.

What is premedication and when is it needed?

Premedication is the use of special sedatives in advance of a visit to the dentist. It is also effective in children, so we draw the attention of parents to this method of relieving attacks of fear.

Pain has 4 factors:

• sensory sensitivity is the physical cause of pain,
• psycho-emotional state of the patient,
• autonomic component due to overload of the autonomic nervous system,
• motor component.

That is, the more a child is afraid, rushes about and is in a state of stress (mobilization of the autonomic nervous system), the more painful it is for him. If you see that persuasion, stories and other tricks do not work on the child, then it is better to use medication than to cause irreparable harm to the child’s psyche.

It is best to discuss with your pediatrician which sedatives are appropriate in this situation.
From safe home remedies, you should try a decoction of valerian roots or motherwort. You need to drink it 1-3 days before going to the dentist in accordance with the doctor’s instructions, according to the age of the child.

How anesthesia is done for children in the GALA DENT clinic

Small patients of the GALA DENT clinic in Prosvet have access to application and local injection anesthesia. The choice of anesthetic is made by a pediatrician based on the results of anamnesis in a conversation with parents. If necessary, we refer the patient to an allergy test. A big request to parents: please fill out the child’s “Health Sheet” very carefully before admission.

We always give an injection of an anesthetic to a child with local application anesthesia, so that he does not even feel the injection itself.

And a little advice from our practice, in order to minimize the stress of a child from a visit to the dentist for treatment, come with him for the first time to a preventive appointment, where he will not be treated for teeth, to get acquainted with the clinic and the doctor.

Still have questions?

Book your child for a consultation with our specialists and enjoy all the benefits of treatment at the GALA DENT clinic.

FAQ

How to treat teeth if a child has an allergy?

Answer:
Allergic reactions are much more common in children than in adults. Any new substance can cause an allergy. Therefore, before the first anesthesia, it is better to take tests and find out which substances will be safe for the child. How to do this – the doctor will tell you. It is worth remembering the drug that is suitable for the child and, if possible, use it in the future.

Is anesthesia possible for children under 4 years of age?

Answer:
Yes. At this age, anesthesia is often used for major dental interventions. At the same time, it is necessary to evaluate what is more dangerous: the consequences of anesthesia or not treated. For children under 3 years of age, conservative treatment, prophylaxis and professional hygiene under topical anesthesia are recommended, if necessary.

After 3 years, local injection anesthesia can be used to a limited extent with an accurate calculation of the dose of anesthetic according to body weight. There are no direct contraindications to this, but the effect of painkillers at an early age has not yet been fully studied.

Why does the child injure the mucosa after anesthesia?

Answer:
A child feels the action of an anesthetic in the same way as an adult – part of his gums and tongue become numb. Having experienced such a sensation for the first time, the child may not calculate the movement of the jaw to injure himself. The dentist will definitely warn parents and the baby that you need to be careful. It is advisable not to give the child food for 2-3 hours after treatment, and it is better to drink water through a straw.

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The cost of children’s anesthesia clinic “Gala Dent”

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Additional services

The most important of the

• 9000, the same as and the same as and the same an adult feels a toothache, so it is necessary to treat children’s teeth with anesthesia.

• The child’s body has a number of physiological features that must be taken into account when performing anesthesia. One of the main ones is the tendency to allergic reactions.

• The dose of anesthetic for a child is always calculated according to age, body weight and depth of intervention.

• For pain relief in pediatric dentistry, application, local injection anesthesia, sedation and, in some cases, anesthesia are used. The latter is not used “at will”, but only according to indications.

• The effect of local anesthetics on very young children up to 3-4 years of age has been little studied and is therefore undesirable. The alternative is conservative treatment or treatment under anesthesia.

• Premedication – taking sedatives before dental appointments for excitable and emotional children has a very good effect and is approved by dentists and pediatricians.

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Dentistry for children under general anesthesia

Online consultation ANNEX

Author: Linkova Tatyana Viktorovna anesthesiologist, doctor of the highest category, K. M.N.

ABOUT ANESTHESIA

If a decision is made to treat a child’s teeth under anesthesia, the most important thing is getting to know the anesthesiologist.
The full name of the specialty is “anesthesiologist-resuscitator”. This is a specialist who performs general anesthesia (narcosis) during interventions that a child can endure for various reasons while awake, and sedation methods are ineffective.
There are both similarities and differences between anesthesia and sedation.

Both anesthesia and sedation are medicinal effects on the central nervous system. But during sedation, the consciousness and interaction of the patient with the doctor is necessarily preserved. In small and/or non-contact children, this method does not allow achieving the desired level of calmness, adequate reactions to what is happening and prolonged immobility, which are necessary for the quality work of the dentist.

Anesthesia is a state of deep sleep when the patient is not aware of the situation, does not move, does not swallow, does not cough and does not feel pain during the action of a general anesthetic. At this time, the anesthesiologist is responsible for the life and health of the patient.

In outpatient pediatric dental practice, general anesthesia based on the modern inhalation anesthetic sevoflurane (Sevoran, Sevoflurane Baxter, Sevofluran Vial, Sojourn and a number of other trade names) is most preferable. Sevoflurane allows painless, quick and gentle induction of anesthesia, maintains the state of general anesthesia for the required time, provides a quick (within a few minutes) awakening of the child after the end of treatment and after 40-60 minutes to let him go home from the clinic. Such anesthesia is well controlled and has a very high degree of safety.

GETTING STARTED. HOW TO PREPARE FOR TREATMENT UNDER ANESTHESIA.

Outpatient dental treatment under anesthesia is possible only if the child is healthy: at the time of treatment, he does not have acute digestive disorders, allergic reactions, respiratory diseases, exacerbations and decompensation of chronic diseases. For preparation you need:

1. Electrocardiogram (ECG) with orthotest, get a film and a description. Validity of the ECG 6 months. Sometimes, when describing an ECG, experts recommend doing an echocardiogram (ultrasound of the heart) and / or visiting a cardiologist.
   !! Echocardiography is a useful, sometimes necessary, element of the pre-anesthesia examination of a child, but it DOES NOT REPLACE an ECG.
2. Complete blood count with leukocyte count, platelets, clotting time and bleeding time. Validity of the analysis is 2 weeks.
3. Pediatrician’s consultation. For a patient with a concomitant disease, a consultation with a specialized specialist is necessary on the eve of treatment.
   Both the pediatrician and specialized specialists give conclusions about the current status of the patient according to their profile. If necessary, recommendations for correction of the condition.

The anesthesiologist makes the final decision on the possibility of performing dental treatment for a child under anesthesia on an outpatient basis.

The results of the examination can be sent to the anesthesiologist by mail or messenger. The patient with parents can visit the clinic in advance on one of the anesthetist’s attendance days for an on-site examination and consultation. It is also possible to discuss the test results and most of the questions that arise over the phone.

Hungry and water pauses.

One of the main rules for patient safety is a completely empty stomach before anesthesia. This is a vital requirement, it must be unconditionally fulfilled. Since the treatment is outpatient, and the little patient comes from home, compliance with this requirement is entirely up to the parents (legal representatives).

Before anesthesia:

• intake of solid and any milk (including liquid milk and fermented milk products) – 6 hours ahead , no later than;
• breast milk 4 hours before anesthesia – only for children up to a year . Children older than a year can even breast milk no later than 6 hours before anesthesia;
• 2 hours before anesthesia you can give a little (2 ml/kg) plain water (boiled or mineral water without gas). Before this time, water can be given to the child if desired.

COMING TO THE CLINIC.

Upon arrival at the clinic, it is very important to get in the right mood, behave constructively and benevolently. The emotional background of the child depends very much on the mood of the parents, and this, in turn, is important for a more comfortable course of the period of induction of anesthesia and the awakening of a small patient. The clinic staff will do their best to ensure that this day goes smoothly and calmly for your family.

Clothing.
You can come to the clinic in any clothes.
While the treatment is in progress, the child sleeps in a dental chair covered with disposable underwear, covered with a light blanket. And at this time, simple cotton underwear is most convenient (a T-shirt or T-shirt with a wide neck and short sleeves, panties or diapers, tights / pants without tight elastic bands and belts). Sometimes, given the duration of treatment, it may be necessary to change underwear.

INTRODUCTION AND INSPECTION.

Before starting anesthesia, the anesthesiologist examines the child, re-asks some questions to the parents regarding the patient’s growth, development, health status, allergic and hereditary predispositions in the family, drug tolerance, food and fluid intake times.

In anesthesiology practice, the patient’s age and body weight are very important parameters that allow the anesthesiologist to make all the calculations necessary in the work. It is good if you can weigh the child at home in advance. If necessary, weighing will be done in the clinic before treatment.

If there is any doubt about health and fasting, outpatient general anesthesia may be delayed for safety reasons. If there are no contraindications to planned dental treatment under anesthesia, the doctor gives parents the necessary information about anesthesia, talks about how and what will happen, answers questions; after which the legal representatives of the child (or the patient over 15 years of age) sign an informed voluntary consent for anesthesia. The procedure can be started.

INTRODUCTION ANESTHESIA, MONITORING, VENOUS ACCESS, AIRWAY PROTECTION.

General anesthesia is performed by an anesthetic team consisting of an anesthesiologist-resuscitator and a nurse anesthetist, who are with the patient during the entire period of anesthesia.

General anesthesia with sevoflurane (“Sevoran”) usually does not require premedication – a preparatory intramuscular injection before the onset of anesthesia. Therefore, sevoflurane has deservedly been the anesthetic of choice for painless, yet fast and comfortable induction of anesthesia in children for decades.

A small child can be placed on mum’s or dad’s lap in a normal chair; older children, if there are no objections, can immediately sit in the dental chair. The anesthesiologist puts the mask of the anesthesia machine on the patient’s face, and the patient calmly inhales the mixture of oxygen and sevoflurane. The first stage of general anesthesia – in fact, falling asleep – occurs approximately 10-20 seconds after the start of inhalation of the anesthetic. The child is placed in a dental chair in a horizontal position, the anesthetist nurse attaches monitoring sensors and covers the patient with a light blanket. At this time, only consciousness is absent, and sensitivity to stimuli and pain is preserved. Therefore, the supply of anesthetic through the face mask continues. In the process of deepening anesthesia, a short-term, not longer than a minute, period of snoring, increased respiration and heart rate, involuntary movements of the limbs is possible – the second stage of general anesthesia, it is called the stage of excitation; during anesthesia with sevoflurane, it is not always noted, it is weakly expressed and quickly passes into the third phase we need – the surgical stage of anesthesia: the child is relaxed, vital signs are close to rest, there are no pain sensitivity, movements, gag and cough reflexes; decreased salivation; and now the dentist can perform any unpleasant and painful manipulations.

It is necessary to take into account several very important points, associated with the general principles of anesthesia in children and with the specifics of general anesthesia in the treatment of teeth. This is a situation where the area of ​​work of the dentist – the oral cavity – is also the area of ​​interest and responsibility of the anesthesiologist.

1. The face mask, with which anesthesia was started, does not allow the dentist to work in the oral cavity, since for the hermetic supply of anesthetic and oxygen-air mixture to the patient, it must tightly cover the nose and mouth.
2. During anesthesia at the level of insensitivity to stimuli (hands and instruments of the dentist) and pain impulses (teeth preparation, work in the control chamber and channels), the muscles of the tongue, pharynx and floor of the mouth are relaxed in the patient. In addition, when working with the lower teeth, the dentist may move the tongue and lower jaw in order to gain access to the problem tooth. All this can interfere with the normal breathing of the child and the maintenance of anesthesia and, accordingly, make it impossible to treat the teeth.
3. Oxygen-air mixture with sevoflurane from the anesthesia machine must enter the respiratory tract and lungs of the patient during inspiration, and return to the breathing circuit of the anesthesia machine during exhalation. This system must be sealed to maintain the required level of anesthesia, adequate control of the child’s breathing parameters and the absence of leakage of the gas mixture with anesthetic into the patient’s oral cavity and the operating room atmosphere.
4. Cofferdam, which isolates the tooth from saliva during the work of the dentist, does not protect against the flow of liquids (cooling water from the drill, etchants and antiseptics for treating cavities and canals) into the throat. During general anesthesia, such leaks in an insensitive patient with an unprotected airway can be invisible to the doctor and dangerous to the child.
5. Before and during anesthesia, the child does not eat or drink for some time. Children are very sensitive to fluid and glucose deficiency. Also, during dental treatment, in addition to sevoflurane, it is necessary to use drugs for the prevention of pain, nausea and vomiting and to be able to introduce emergency aid in case of an emergency.

Therefore, to date, the safest scheme of anesthesia in the treatment of teeth under general anesthesia in children is general inhalation anesthesia with venous access and airway protection, with the ability to control and support breathing.

After the child falls asleep under a face mask, a thin short venous catheter is inserted into a vein in the hand or in the elbow bend, drip administration of balanced water-salt solutions with glucose (infusion therapy) is established, the child’s airways are protected by a laryngeal mask or (depending on the volume and time of treatment) with an endotracheal tube. Anesthesia-respiratory and monitoring equipment continuously monitors the concentration of oxygen, sevoflurane and carbon dioxide in the gas mixture inhaled and exhaled by the patient, airway patency, airway pressure, expiratory volume and minute respiratory volume, respiratory rate and heart rate, blood pressure, capillary saturation blood oxygen, body temperature. Additionally, the glucose level is monitored (by a glucometer). All anesthetic consumables: face and laryngeal masks, airways, breathing circuits, virus-bacterial filters, endotracheal tubes, catheters, stickers, etc. – Sterile disposable.

Despite the rather long description, the time from the beginning of induction of anesthesia (the application of a mask to the patient’s face) to the transition to the maintenance period of anesthesia (from the beginning to the end of the dentist’s work) takes, as a rule, no more than 15-20 minutes. But this is a very important time, ensuring the safety and comfort of the patient and the calm, high-quality work of the dentist for the entire period of treatment.

After preparation, the dentist examines the little patient and proceeds to work according to the treatment plan.

If the treatment plan has not been determined in advance, the doctor draws up a treatment plan after examining the sleeping child immediately after induction of anesthesia and agrees on the amount of treatment with the parents.

ANESTHESIA MAINTENANCE, INFUSION THERAPY, ACCOMPANYING THERAPY.

In the period of maintenance of anesthesia during the work of the dentist, sevoflurane (“Sevoran”) in a low (supporting) concentration, mixed with oxygen and air, continuously, with breathing, enters the patient’s lungs through the respiratory circuit of the anesthesia machine. The child is sleeping; all the necessary vital parameters of his condition, listed just above, are continuously monitored by the anesthesia team. A protocol and a map of the course of anesthesia are being conducted. A water-salt solution is slowly introduced intravenously by drip to compensate for the pre-anesthesia deficit and the current physiological need for fluid. According to glucometry, if necessary, glucose is added to infusion therapy. According to indications, drugs can be administered intravenously to prevent allergic reactions, nausea and vomiting; agents for preemptive analgesia. This is necessary because with the end of the action of sevoflurane and any other inhalation anesthetics, pain sensitivity is very quickly restored; with a large amount of treatment, pain and / or nausea during the awakening period without additional preventive measures can cause a child to feel unwell.

RARE NEED FOR LOCAL ANESTHESIA.

Nowadays it is difficult to imagine dental treatment without local anesthesia. This is an obligatory component of dental care for an awake patient or for treatment with sedation in children of different age categories and in adults. However, under anesthesia in most cases it is possible to treat milk teeth without the addition of local anesthetics. This is important, since almost all local anesthetics according to the instructions have age restrictions in children under 4 years of age. The ability to avoid local anesthetics reduces the risk of allergic reactions and systemic toxicity.

The addition of a local anesthetic during dental treatment under anesthesia may be necessary in case of tooth extraction or endodontic treatment of permanent teeth (tooth extraction and pulp extirpation are very painful manipulations, and excessive deepening of general inhalation anesthesia is undesirable).

If a local anesthetic is used in addition to general anesthesia, the child may wake up with a feeling of a “cotton” mouth, a “rubber” cheek. These sensations can cause anxiety, discomfort, a desire to bite the cheeks from the inside, which can lead to trauma to the mucous membrane.

END OF TREATMENT AND AWAKE PERIOD.

As soon as the dental team finishes its work, the supply of sevoflurane (Sevoran) to the patient is stopped, the period of recovery from anesthesia begins. After 5-7 minutes, the laryngeal mask or endotracheal tube is removed, the venous catheter is removed. All these actions are performed when the child is no longer in a state of anesthesia, but simply dozing and is not yet aware of what is happening. The anesthesiologist observes the patient for a few more minutes in the operating room, makes sure that the awakening period runs smoothly and transfers him to the awakening ward.

Awakening Chamber.
The wake-up room is a room where the child, laid on a comfortable sofa, finally wakes up in the presence of his parents. As a rule, weak sweet tea or water awaits him, small gifts “for courage” from the clinic.

An anesthesiologist observes the child in the ward for 40-60 minutes, assesses the condition and well-being and gives recommendations for the near future.

The family can then leave the clinic.

PROBLEM OF AGITATION, WELL-FEELING AFTER TREATMENT, RECOMMENDATIONS, FEEDBACK.

Sometimes after inhalation anesthesia in children aged 1-8 years, immediately after waking up, a state of psychomotor agitation may be observed – agitation. The reasons may be the increased emotionality of the child, the initially excited state before anesthesia, the effects of the anesthetic on the central nervous system, pain and discomfort in the mouth after treatment, the residual effect of local anesthetics, hunger and thirst. In the text above, in general, measures for the prevention of post-anesthesia agitation are mentioned: a benevolent attitude of parents, falling asleep in the presence of parents, balanced anesthesia with proactive analgesia, replenishment of the need for fluid and glucose, smooth calm awakening in the presence of parents in a calm environment, early prescribing fluids (breastfed babies can be breastfed as soon as they wake up), distraction with toys, parental comfort and support.

In most cases these measures work and children wake up calm; drinking tea, chatting, playing and asking to go home. But sometimes parents have to wait and endure this unpleasant period of up to 20-40 minutes, which looks like an unmotivated tantrum.

Sometimes crying and whims are not agitation – perhaps the child has a low pain threshold, or the treatment was voluminous and traumatic, for example, with severe tooth decay, a large number of pulpitis and periodontitis. Then Nurofen or Paracetamol will have to be given a little earlier, you may need to take painkillers again.

Discoordination of movements is possible for 2-3 hours immediately after waking up. Even if the child feels well and wants to actively play, run, etc., he must be carefully looked after at this time in order to avoid bruises and injuries.

Sometimes a slight sore throat may occur after treatment. In such cases, we recommend a warm drink, as in case of a cold. If, after a long and large-scale dental treatment, the baby is lethargic and capricious, then it is best to have a quiet pastime at home with cartoons, toys and books.

If parents are concerned about something, they can always contact the anesthetist and dentist by phone or messenger.

FREQUENT QUESTIONS: TO TREAT UNDER ANESTHESIA OR NOT TO TREAT AT ALL, LONG-TERM CONSEQUENCES.

According to foreign medical publications, literature reviews and anesthesia forums, as well as more than 16 years of experience with sevoflurane (Sevoran) in Russia, general anesthesia lasting 2-4 hours in children over 2 years of age does not have a clinically significant effect on further development and cognitive functions.

According to most dentists and paediatricians, dental care is necessary at any age. Multiple complicated caries in children can lead to such serious problems as eating disorders, psychological problems of schoolchildren and adolescents; damage to the rudiments of permanent teeth with the need for further long-term orthodontic, surgical and orthopedic treatment.

Carious microflora (mainly the Streptococci family) can be very aggressive and, being a focus of chronic infection, provoke frequent infectious diseases up to purulent-septic complications, support infectious-allergic processes.

Retention treatment is still practiced in many clinics, but this threatens the child with the development of neuroses and stomatophobia; trauma with dental instruments with resistance; the quality of dental treatment in this case can be depressingly low.

In any case, the doctor’s task is to inform about the possibilities of modern pediatric outpatient dentistry and anesthesiology and about the risks associated with both the implementation of medical intervention and the refusal of it.

The choice of treatment is always up to the parents.

The only advice: if there is no other way to sanitize your child’s oral cavity, except for general anesthesia (narcosis), and you decide to do this, then you should choose a clinic that can provide patients with a license to provide medical care to children in the profile “Anesthesiology and resuscitation” and a full anesthesia team: an anesthesiologist-resuscitator and a nurse anesthetist. This will mean that the clinic has highly qualified personnel, high-quality equipment, medicines, consumables, etc. , that is, all the necessary patient safety standards are met.

Anesthesia for tooth extraction

Anesthesia during tooth extraction helps to eliminate pain, normalize the psychological state of the patient. The variability of techniques makes it possible to choose the optimal type of anesthesia, taking into account the age, duration and trauma of treatment, the physical and mental state of the patient. When removing teeth, superficial, infiltration and conduction anesthesia is used, according to indications – general anesthesia.

Anesthesia in dentistry: types and mode of action

Anesthesia is a decrease in sensitivity or a complete cessation of pain perception by disrupting the transmission of a sensitive nerve impulse at different levels.

Anesthesia methods for tooth extraction:

• superficial (other names – terminal, application) – blockade of nerve ending receptors;

• infiltration – shutdown of receptors and small nerves;

• conduction (regional) – blockade of nerve trunks and plexuses,

• intraligamentary (intraligamentous) – anesthesia of the periodontal cavity and intraosseous space;

• sedation with nitrous oxide – inhalation anesthesia with laughing gas, in small concentrations retains consciousness, but causes relaxation;

• mask anesthesia – a gaseous anesthetic enters the body through the respiratory tract when the mixture is inhaled;

• Propofol sedation is an intravenous injection of an anesthetic that temporarily disables consciousness.

Extraction of teeth under general anesthesia in Moscow is the most expensive type of anesthesia. The cost depends on the anesthetic and the duration of its action.

Application anesthesia

An anesthetic is applied to the surface of the gums surrounding the tooth. Use sprays and gels in the composition with lidocaine. This technique slightly reduces pain sensitivity. Anesthesia comes in 3–5 minutes and lasts 10–15 minutes. They are used more often in pediatric dentistry for the removal of milk teeth, anesthesia of the needle injection site.

Infiltration anesthesia

This is the injection of an anesthetic into the soft tissues of the gums. Lidocaine and ultracaine are most often used. The most common type of anesthesia for the removal of frontal teeth. Reduces pain sensitivity for an average of an hour. Not an effective method for removing chewing teeth.

Conduction anesthesia

The anesthetic is injected with a syringe into the area of ​​​​the branches of the trigeminal nerve, which provide sensitivity to the gums and teeth. The drug acts a few minutes after the injection, numbness persists for another two hours. Used for complex surgical interventions on the gums and molars.

Intraligamentary anesthesia

This is pain relief by injecting an anesthetic between the tooth and gum. With this method of administration, a significantly smaller amount of the drug is consumed, which is especially important for patients with diseases of the cardiovascular system.

Nitrous oxide sedation

Violation of consciousness is superficial. Nitrous oxide is administered intranasally (spray into the nasal cavity). After the cessation of administration, the effect of the drug ends, the condition and reactions stabilize.

The technique allows you to reduce the level of fear and anxiety. More often performed in patients with high anxiety, during traumatic and prolonged dental procedures.

Mask anesthesia

The anesthetic is given through an inhalation mask. The drug and its dosage are determined individually, taking into account the age and condition of the patient. The dose is regulated using a special evaporator. Consciousness is restored a few minutes after the cessation of the supply of anesthetic drug, the general condition returns to normal within two hours.

Propofol sedation

Propofol is a short-acting sleeping pill given intravenously. The patient instantly plunges into a drug-induced sleep, similar to physiological. The drug is non-toxic, quickly excreted from the body, can be used for patients with diseases of the heart, liver, kidneys. Children are allowed from the age of three.

Such anesthesia is justified with a large amount of treatment, dental phobia, diseases of the central nervous system, which are accompanied by an intellectual disorder.

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Anesthesia in dentistry: side effects

Subject to aseptic and antiseptic measures, injection techniques, the risk of side effects is minimal. Among the possible complications, allergic reactions to the administration of anesthetic drugs are the most common.

The main cause of allergies is individual intolerance to the components of the composition.

A hypersensitivity reaction occurs due to a medical error – the wrong choice of the drug and its dosage, trauma to the vessels, violation of the manipulation technique. Similar complications also occur due to inadequate patient response – sudden movements increase the risk of breaking the injection needle, traumatizing soft tissues.

Damage to the facial nerve leads to neuritis – a decrease or complete absence of facial movements, the appearance of facial asymmetry. Injury to the blood vessels, muscle fibers of the infratemporal fossa provokes trismus – a prolonged spasm of the masticatory muscles.

Other negative effects of anesthesia in dentistry:

• hematoma,

• sepsis,

• abscess and phlegmon of soft tissues,

• angioedema,

• anaphylactic shock,

• short-term loss of consciousness.

Complications of anesthesia in children include self-harm of soft tissues – biting the lips and tongue in the area of ​​loss of sensitivity.

The prognosis for most complications is favorable. To eliminate the consequences, it is important to provide medical assistance in a timely manner. Death is possible with the development of angioedema, anaphylactic shock, sepsis. Such severe complications are extremely rare.

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Responsibility of staff and trust of patients – that’s what distinguishes our dental clinic. In our clinic, the patient finds “his” dentist and trusts the health of the whole family, children and recommends to friends.

Over 23 years of successful work, we have formed a team of dentists who have a special attitude to work – this is both high professional competence and the desire to help a person, provide him with effective treatment, honestly, comfortably and at a reasonable cost.

All of our doctors are not just graduates with extensive experience. Each dentist in our clinic constantly improves his qualifications, mastering new dental technologies and materials.

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Extraction of baby teeth

Removing a baby tooth is a last resort. However, sometimes, when other methods are ineffective, doctors have to resort to it. Extraction of teeth in children has its own characteristics and differs from a similar procedure in adults.

At the age of 5-6, milk teeth begin to fall out, giving way to permanent ones. But sometimes you have to resort to the removal of a milk tooth in the dentist’s chair. Here are the main indications for the removal of milk teeth:

• Launched caries. If the tooth is so damaged that it cannot be restored, the doctor decides to remove it.
• Cyst at the base of a milk tooth.
• The milk tooth staggers, but does not fall out, injuring the gum tissue and causing inflammation.
• The milk tooth does not fall out for too long, preventing the normal growth of the permanent tooth.
• Serious tooth injury – chipped or cracked, root fracture.
• Indications of the orthodontist.
• Phlegmon, periodontitis, sinusitis or fistula on the gums.
• Supernumerary, that is, an extra tooth – this is rare, but it happens.

Permanent teeth in children are rarely removed. This usually leads to neglected caries with complications and serious inflammatory processes. In addition, there are the following indications:

• An impacted tooth that cannot develop is a potential source of inflammation.
• Severe periodontal disease (with strong tooth mobility).
• Serious injury to a permanent tooth.

Contraindications to the procedure

There are a number of relative contraindications to the extraction of teeth in children. Among them: tachycardia, angina pectoris, endocarditis, myocarditis, various diseases of the central nervous system, mental illness during an exacerbation, blood diseases, gingivitis, stomatitis. You can not remove teeth with pneumonia, whooping cough, influenza, acute respiratory infections, scarlet fever. If, in addition to problems with the tooth, there are diseases of the oral mucosa, such as candidiasis, they must first be cured. In urgent cases, removal can be carried out in a hospital.

Procedure for removing teeth in children

Sometimes, if the tooth is healthy, but staggers and does not want to fall out in any way, parents use “folk” methods – for example, they give the child a carrot or a hard green apple to gnaw. This method often works, but only if we are talking about a perfectly healthy milk tooth. If there are any problems, you need to go to the doctor, who will decide whether the tooth needs to be saved or whether it is more expedient to remove it.

The procedure for removing a tooth in children has some differences from the “adult” operation. First of all, the dentist uses special children’s forceps of a smaller size – they do not injure the gums. In addition, the doctor fixes the forceps loosely, since the teeth of children are much more fragile than the teeth of adults and excessive pressure can simply split the tooth. The pediatrician always remembers that under the milk tooth there is a rudiment of a permanent one, and all manipulations are carried out with caution. It takes practice and special skills. That is why you should contact a pediatric dentist.

Types of anesthesia for tooth extraction in children

Pain during tooth extraction is the main fear for both children and their parents, who, of course, worry about their child and want the procedure for removing teeth in children to be as easy as possible.

Today, effective and safe methods of anesthesia are used in pediatric dentistry. The choice of type of anesthesia depends on the problem.

If a milk tooth is to be removed, the root of which has already resolved, the doctor uses application anesthesia – applies a special anesthetic gel to the gum. But this method is used only for the simplest removal of milk teeth – in cases where the tooth is healthy and does not hurt, it simply does not fall out on time.

Most often in pediatric dentistry, infiltration anesthesia is used, in which an anesthetic drug is injected into the gums on both sides. For injections, special, very thin needles are used – often a small patient does not even feel an injection, since application anesthesia is preliminarily performed.

General anesthesia for tooth extraction in children is rarely used and only in extreme cases. Indications for general anesthesia are serious mental illness, acute purulent inflammatory processes, allergies to drugs for local anesthesia.

All anesthetics used for dental extractions in children are safe and generally well tolerated by young patients. However, the doctor is obliged to ask the parents before starting the procedure if the child is allergic to any medications, whether anesthesia was used before and how it went, whether the child has chronic diseases.

After a child’s tooth extraction

The procedure itself is very fast. But within a few days after tooth extraction, parents should carefully monitor the condition of the baby.

Usually, there are no complications after the removal of milk teeth – of course, if the entire manipulation is carried out correctly and the doctor is experienced. Sometimes parents notice inflammation of the hole or bleeding from it – this is a reason for a second visit to the doctor. A blood clot in the hole is a completely normal phenomenon. Moreover, it is necessary – this clot is a natural barrier for bacteria, it protects the wound from infection. Under no circumstances should you try to extract it! That is why doctors do not recommend actively rinsing your mouth with antiseptic and soothing solutions in the first 2 days after tooth extraction. Rinse may dislodge or even wash away this clot.

Pediatric dentists advise limiting the child in sweets, soda, very hot dishes in the first days after surgery. You should also avoid sunbathing, outdoor games, hot baths – in a word, everything that can cause an increase in body temperature.

When brushing your teeth, you should use a brush with soft bristles and avoid injuring the gums at the site of extraction.

After three days, if necessary, you can rinse your mouth with antiseptic solutions and herbal decoctions that relieve inflammation, for example, a solution of furacilin, a decoction of chamomile, calendula or sage. The liquid should not be too hot or too cold. It is generally dangerous to heat the area of ​​the extracted tooth, so hot rinses and even more so compresses are excluded – they can cause serious harm.

Moderate swelling, bruising, dryness of the corners of the mouth and discomfort are not pathologies. Pain after tooth extraction in children, especially in the first few hours, is a normal reaction to intervention. After the effect of anesthesia weakens (after about 1.5-2 hours), you can begin to give painkillers prescribed by your doctor, one dose every 6 hours. Severe and prolonged pain, fever, inflammation, heavy bleeding, numbness that lasts longer than a day are signs that something has gone wrong. In such cases, a second visit to the dentist is necessary.

Extraction of a tooth can often be avoided, provided that the parents bring the child to the doctor’s appointment earlier – before the caries has destroyed the tooth. In order not to resort to this unpleasant procedure, the child should be taken to the reception regularly, at least 3-4 times a year. This will not only help to maintain the health of the teeth, but also teach the child to the obligatory visit to the dentist, will nullify the fear of him. And a calm attitude towards dentists is a guarantee that there will be no problems with teeth in adulthood.

How to pull out a milk tooth – extraction of milk teeth in children

The change of teeth in children begins at the age of 5-6. There is usually no need to specifically remove milk teeth, because they fall out naturally. But in cases where the tooth staggers for a long time, does not fall out and causes discomfort to the child, the process can be accelerated. There are two ways to provide such assistance – contact a dentist or remove a milk tooth yourself at home.

Is it necessary to hurry with the removal?

The process of losing a baby tooth is quite long. Gradually, the ligaments that hold the dental unit in the socket become thinner, the process of resorption of the roots begins. The permanent tooth pushes out the milk tooth, and the process of falling out usually proceeds without pain. As a rule, from the beginning of loosening to natural fallout takes up to 5 days. Is it necessary to remove a milk tooth if the process is delayed?

Dentists do not recommend helping the natural process for several reasons:

• milk tooth with physiological mobility closes the entrance to the soft tissues and prevents the ingress of pathogenic bacteria;

• milk teeth maintain the correct conditions for the formation of a permanent bite;

• if the removal is accompanied by discomfort, the baby will experience fear and anxiety before manipulation in the future.

If the tooth has not fallen out, the tissues may not be completely ready yet, and it is better to give it some more time. A permanent one appears almost immediately after the milk falls out, an open hole is already ready for it. If the baby tooth is removed too early, the gum will grow back, and the permanent tooth will have to overcome a more difficult obstacle. In addition, the roots of the first grow directly above the germ of the permanent tooth. If they have not completely resolved, attempts to remove them can damage the germ. All this is fraught with malocclusion, the shape of permanent teeth and their position relative to each other.

There are several indications for seeking medical help: the child complains of pain, severe discomfort, inability to eat normally.

When can I remove myself?

Extraction of a tooth without the intervention of a doctor is possible only when it is highly mobile. In this case, it will be removed from the gums without pain, and a lot of effort will not be required. Some toddlers do it themselves when they can’t wait to let go of the discomfort and get back to their favorite solid foods.

When is it not allowed?

There are more contraindications to self-removal attempts. These include the following features:

• the tooth is slightly mobile – the process of falling out has just begun;

• the child is in pain;

• there is bleeding of the gums, swelling or redness;

• touching the tooth causes discomfort;

• the child experiences intense fear and refuses to be manipulated.

It is not worth interfering if the child is unwell – he has ARVI, a high temperature has risen, there are signs of stomatitis, and other inflammatory diseases of the oral cavity.

We delete correctly

If the situation is not critical, and there are no painful symptoms, you can do without going to the doctor. But you should not rush to remove it, it is better to help the tooth fall out on its own. Here are some tips to speed up the process:

• Tooth loosening with tongue or finger: Have the child gently rock the loose tooth with their tongue in different directions. A curious baby is likely to touch the tooth with his fingers, so talk to him in advance about the need to thoroughly wash his hands. Remind the child that it is not worth making a lot of effort, you can only gently loosen the tooth.

• Teeth cleaning with special enthusiasm: you can act on the crown of a baby tooth with force, brushing it more thoroughly and for longer. You need to try to press the brush on the basal part.

• Eating solid foods: offer your child apples, carrots, or crackers. Very often, babies get rid of milk teeth during meals, and this is completely painless.

If a tooth is loose but does not fall out despite exposure, self-extraction can be performed. The positive attitude of the child is very important – tell him about what you will do, you can come up with a fairy tale together about a boy or girl who were afraid to pull out a tooth in vain, or discuss gifts from the tooth fairy.

Requires nylon floss, dental floss, cup of antiseptic solution for removal. It is better to remove a tooth in a well-lit room. Before manipulation, invite the child to brush his teeth and rinse his mouth with a solution. You can pull out a tooth with a thread: tie it around the crown part and pull sharply up if the tooth is lower, and vice versa down if the tooth is upper.

Removal by hand is acceptable with a sterile bandage: wrap it around your fingers, grab the tooth around and gently twist it in different directions. Pull down or up in the opposite direction. Close the wound with sterile cotton.

Aftercare

Extraction of a baby tooth in children is usually quick and painless. But sometimes after the manipulation there is a slight bleeding and swelling of the gums. With severe swelling, redness, unstoppable bleeding, it is important to contact your dentist as soon as possible. If there are no such symptoms, you can handle the treatment yourself.

Treat the well with an antiseptic, chlorhexidine sprays may be used. If blood is observed, apply a piece of sterile cotton wool with hydrogen peroxide. Within two hours after removal, it is better not to eat or drink.

On the evening of removal and the next morning, you can rinse your mouth with mild saline or mouthwash.

Talk to your child about not touching the hole with your fingers or picking with your tongue. The first few days it is better not to eat hot and cold food and solid foods. Give your child warm meals, grated soups, drinks at room temperature.

Baby tooth extraction is best done by an experienced pediatric dentist. By the time the bite is changed, the child has probably already visited the dentist several times, and therefore will not experience severe anxiety. The doctor has antiseptic solutions and sterile materials in his arsenal, so removal in a dental office is always safer, and the risk of infection of the hole tends to zero.

Remember that in most cases anesthesia is not required during the extraction of a milk tooth during the period of physiological change, since the procedure does not cause pain. But if the child is calmer, you can apply an application anesthetic – an anesthetic gel. This will help to quickly deal with the problem and get rid of discomfort.

You can visit a pediatric dentist at STOMA clinics. You can make an appointment by phone or through a special form on the website.

Local anesthesia in dentistry | Clinic Vasilenko

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Anesthesia is the most important task of modern dentistry, aimed at providing comfortable conditions for the patient in the dentist’s chair during any medical or diagnostic procedures.
Local anesthesia – the most common and commonly used type of anesthesia, in which pain sensations are blocked in a certain area (where the intervention is performed), while the patient remains fully conscious. Local anesthesia in dentistry has always been used, but only in recent years, truly effective and safe anesthetics have been used in dental treatment.
Local anesthetics , used today, allow for a comfortable treatment without pain and discomfort. Since local anesthesia also helps the patient to get rid of the fear of the dentist, the quality of the work of the dentist and the dental services provided by him has reached a completely different level.
In the clinic of Dr. Vasilenko in St. Petersburg under local anesthesia the following procedures are carried out:
We guarantee comfortable, painless and safe dental treatment even in the most difficult cases!

You can make an appointment with a dentist at the clinic of Dr. Vasilenko on Kondratievsky by calling our contact number or by filling out a special form on the website.

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Types of local anesthesia – dentistry Vasilenko

APPLICATION ANESTHESIA

Application anesthesia consists in applying to the gums of special drugs in the form of a gel, spray or paste, which anesthetize the oral mucosa. Such a “freezing”, although it does not require the use of a syringe, is effective for a very short time (no more than 15-20 minutes). For this reason application anesthesia is used only in uncomplicated cases and for manipulations that do not require a long-term anesthetic effect.
In dentistry, this type of anesthesia is most often used in the treatment of children – in order to preliminarily anesthetize the injection site (before injection anesthesia).

INFILTRATION ANESTHESIA

Infiltration anesthesia can be direct or indirect.
In the first case, an anesthetic is injected directly into the area next to the tooth requiring treatment using a syringe with a needle. Anesthesia occurs exactly at the injection site.
In the second case, the analgesic effect extends to a larger area.
Infiltration Anesthesia is one of the most popular pain relief techniques, also known as “freeze”.
The average effect of the anesthetic is one hour.

ROD ANESTHESIA

Tether anesthesia provides blockage of the nerve that controls the site of the planned intervention. Conduction local anesthesia is indicated for complex dental procedures that take a significant amount of time (up to 1.5 hours or more).
This type of anesthesia allows you to “freeze” a large area around the tooth .
The anesthetic is used in a smaller volume than in infiltration anesthesia, but in a higher concentration. It is worth noting that conduction anesthesia requires special qualifications and skills from the dentist – in order to avoid injury to blood vessels or nerves.

Also, the conduction technique is associated with a high risk of intravascular injection of anesthetic!

Local anesthesia of the teeth – local anesthesia

Local anesthesia , used in modern dentistry, makes it possible not to experience pain and discomfort during therapeutic and surgical treatment. However, there are cases when local anesthesia of the teeth does not give the desired effect and pain relief does not occur.

This may be due to:

• Drinking alcohol before a visit to the dentist.
  Ethyl alcohol, getting into the patient’s blood, will block the action of the anesthetic;
• If the patient has taken an overdose of pain medication before visiting the dentist, this can also interfere with the “normal” action of the anesthetic;
• In rare cases, the patient may experience individual resistance to a particular local anesthetic;

An experienced dentist will definitely find out why anesthesia does not work!
In some cases, treatment under local anesthesia may be rescheduled for another day.

Preparations for local anesthesia – dentistry Vasilenko

Local anesthetics are divided into 3 main groups according to their duration of action:

• 0209 The most common drug in this group is Novocain , which was widely used during the Soviet Union. Today, Novocain is not used in dentistry due to the very low effectiveness of pain relief. It was replaced by new modern preparations based on articaine .

  A little later, Lidocaine appeared, which was more effective than Novocain, but still much weaker than articaine anesthetics.
  In modern dentistry, Lidocaine is used for topical anesthesia.

• INTERMEDIATE-ACTING ANESTHETICS
  a) Ultracaine is an articaine-type anesthetic with an excellent analgesic effect. Traditionally produced in the form of ampoules with a solution for injection, but for dentistry anesthetic Ultracain is produced in the form of special cartridges – karpul .
  For carpool anesthesia, a special carpool syringe is also used, in the side part of which there is a recess for the carpule. Carpool anesthesia allows you to accurately dose the anesthetic, is sterile and painless for the patient.
  In modern dentistry, Ultracaine can be used for patients from 4 years of age.
  b) Ubistezin is a German local anesthetic drug with a fast and long-lasting effect. Due to the fact that anesthetic Ubistezin practically does not contain synthetic adrenaline, its use is primarily indicated for pediatric dentistry.
  c) Septanest – anesthetic with adrenaline based on articaine. It is 2 times more effective than Lidocaine, but has a number of contraindications.
  d) Scandonest is an anesthetic drug without adrenaline. It is indicated for all patients with individual adrenaline intolerance, including children and elderly patients.
• LONG-ACTING ANESTHETICS
  Bupivacaine is often used in dentistry for the extraction of wisdom teeth and in maxillofacial surgery. The analgesic effect can reach 3-4 hours. This anesthetic is also able to reduce pain after the operation ( long analgesic effect provides good postoperative pain relief).