Sedation and Pediatric Dentistry

Sedation dentistry is the use of a mild sedative (calming drugs) to manage special needs or anxiety while your child receives dental care. Sedation also may be used when several procedures need to be done at the same time, when the safety of a child may be compromised, or if your child has a strong “gag” reflex. Your child’s dentist will give the sedation.

It is important to note that the sedation medication does not control pain or discomfort. Once your child has received sedation, the dentist will give him or her an injection (shot) or injections in the treatment area to keep it pain-free during and after the procedure. The sedation medicine may last up to 6 hours after the treatment is done.

Nitrous Oxide
Often called “laughing gas,” nitrous oxide is a very safe, mild sedative that will help your child remain relaxed during dental procedures. Your child’s dentist will give the sedation with the use of a “space mask,” which carries air (oxygen) mixed with the medication. Your child will be asked to breathe through the nose, not the mouth, and will sense a faint, sweet smell. The sedation will take effect in about 5 minutes. The mask will remain in place until the procedure is done. Your child will be awake during the entire procedure and may have a “happy” feeling. When the procedure is complete, the nitrous oxide will be turned off and your child will breathe in pure oxygen for about 5 minutes to clear out any remaining gas. You should limit your child to a very light meal before this procedure, such as toast or a bagel.

Oral Sedatives
If your child is nervous, oral sedation may be used. It is taken by mouth or through the nose. This type of medicine will make your child a little drowsy, and will keep him or her relaxed and calm during the procedure. The medicine usually begins to work within 20 minutes. Your dentist will have your child take the medicine once you arrive at the appointment. If your child is having sedation, he or she should have nothing to eat or drink after midnight the night before the appointment.

IV Sedation
Intravenous (IV) sedation requires a needle to be inserted into your child’s vein, usually in the arm or hand. The biggest advantage to IV sedation is that the dentist can give your child more medicine during a longer procedure to keep him or her relaxed. Home preparation is required for this type of sedation.

When sedation is needed, there are important rules for eating and drinking that must be followed in the hours before the procedure. One business day before your child’s procedure, you will receive a phone call from the Dental Clinic. Calls are not made on weekends or holidays. Please have a pen and paper ready to write down these important instructions. 
You will get specific eating and drinking instructions for your child based on your child’s age. Following are the usual instructions for eating and drinking. No matter what age your child is, you should follow the specific instructions given to you on the phone.

For infants under 12 months:

• Up to 6 hours before the scheduled arrival time, formula-fed babies may be given formula.
• Up to 4 hours before the scheduled arrival time, breastfed babies may nurse.

For all children:

• After midnight the night before the procedure, do not give any solid food or non-clear liquids. That includes milk, formula, juices with pulp, coffee, and chewing gum or candy.
• Up to 2 hours before the scheduled arrival time, give only clear liquids. Clear liquids include water, Pedialyte®, Koolaide®, and juices you can see through, such as apple or white grape juice. Milk is not a clear liquid.
• If your child takes daily medication, you may give it unless specifically told not to do so by your child’s doctor or the scheduling nurse.

Once your child has been registered for the procedure, a member of the dental staff will meet with you to take your child’s vital signs, weight, and medical history. As the parent or legal guardian, you will be asked to sign a consent form before the sedation is given.

• The dentist will meet with you and your child to review your child’s medical information and to explain the type of sedation your child will receive.
• Sedation medication may be given by mouth, through the nose, or directly into a vein through an intravenous (IV) line.
• The medicine will work in one of two ways — in a single dose that takes effect slowly and lasts throughout the procedure, or in a continuous dose throughout the procedure.
• You may stay with your child until he or she is very drowsy. 
• During the procedure your child’s heart rate, blood pressure, temperature, and blood oxygen level will be monitored closely.

As a parent, watching your child undergo sedation may be a very uncomfortable experience for you. Children can sense a parent’s concern — so for your presence to be helpful to your child, you must try to be as calm and encouraging as possible.

There are ways you can help your child, even if you feel uncomfortable.

• You can bring along a “comfort” item — such as a favorite toy, stuffed animal, or “blankie”— for your child to hold during the induction.
• You can touch your child to remind your child that you are there. Holding your child’s hand or caressing his or her hair and face will remind your child of your presence.
• You can whisper, talk, or sing to your child. The sound of your voice can provide reassurance.

• When the procedure is done, you will be called to the room to be with your child as the medication wears off.  The length of time it will take the medication to wear off will vary, as some children take longer than others to become alert.
• Children coming out of sedation react in different ways. Your child might cry, be fussy or confused, feel sick to his or her stomach, or vomit. These reactions are normal and will go away as the sedation medication wears off.
• When your child is discharged, he or she still might be groggy, dizzy, or nauseous, and should take it easy for the rest of the day.

• Your child’s nose, mouth, and throat may remain numb for 1 to 2 hours after the procedure.
• Your child’s gums and mouth may be sore for several days afterward, depending on the dental procedure.
• Use caution when your child eats and drinks for about 2 hours after the procedure, watching to make sure he or she does not bite the tongue or the inside of the mouth. 
• Your child should only eat soft foods for the first few hours after undergoing a dental procedure that requires sedation.
• Your child is not to return to school or day care that day. 
• Upon returning home, your child should take it easy for the rest of the day.
• Your dentist will tell you when you should schedule a follow-up visit.

If your child’s gums are sore, Tylenol® or Motrin® will help with any discomfort. If your child experiences any of the following for more than 24 hours, you should call your dentist:

• fever
• severe bleeding of the gums
• severe pain 
• vomiting

If your child has any of these symptoms, call the Dental Clinic at 412-692-5440 immediately. If you are calling during the evening or on a weekend, please call the hospital at 412-692-5325 and ask for the dental resident on call.

If your child has any special needs or health issues that you feel the dentist and anesthesiologist need to know about, please call Children’s Dental Clinic at 412-692-5440 before the procedure. If your child has developed a cold, stuffy nose, or other condition that makes it hard to breathe through the nose, you will need to call your dentist and your child’s procedure will have to be rescheduled. It is important to notify us in advance about any special needs your child might have.