Is your child’s dental phobia worrying you? Allay your fear by scheduling an appointment with our Pedodontist and render timely dental care to your child by availing our constantly upgraded sedation equipment with a wider safety margin blended with expertise team of dental specialists.
Kids often feel dreaded to go to a doctor or a dentist. The fear of injection and pain make them anxious during their visit to dentist. The results of delaying and maintaining distance from the dentist out of fear can affect child’s oral health. Careful management of such fear can be accomplished by using conscious sedation techniques
Sedation in dentistry means to reduce the anxiety or agitation of the patient and to control such behavior and make the patient quiet and cooperative to allow the dental procedures to be carried out successfully.
To define: Sedation dentistry is a conscious sedation where level of consciousness is minimally depressed that retains patient’s ability to maintain airway independently and respond to physical stimuli and verbal command.
What are the benefits of sedation dentistry
- It helps your child relax when he/she is seriously anxious.
- It makes your child feel comfortable during a bad gag reflex.
- It aids your child in tolerating pain.
- It makes your child cooperative during dental treatments when he/she lacks cooperation due to any medical or psychological conditions.
- It’s easy since your child is awake and don’t lose consciousness, and it wears off quickly so you can get back to your day.
What are the pre sedation assessments to be done
- taking patient’s full medical and dental history,
- recording the age, weight and the vitals of the patient,
- Select conscious sedation technique based on the treatment plan and the patient’s condition.
What are the different types of sedation techniques
- Inhalation sedation- It is used when minimal sedation is required. It is usually the technique of choice for conscious sedation of pediatric dental patients. Nitrous oxide gas is the first choice of inhalational sedation technique.
- Oral sedation- It involves taking a pill prior to treatment, the dosage as suggested by the practitioner. Most commonly used due to its ease of administration but the dosage levels cannot be adjusted reliably.
- Intravenous and Intramuscular sedation.
The choice of a particular technique, sedative agent and route of delivery should be made at a prior consultation appointment to determine the suitability of the patient to a specific technique.
Know more about Nitrous Oxide Sedation
Nitrous oxide also called laughing gas is the most commonly used sedation technique due to its ease of administration and higher safety compared to other techniques. It has minimal side effects and low risk involved. It involves administration of nitrous oxide gas and oxygen at required levels through inhalation equipment.
Advantages of Nitrous Oxide Sedation
- It is a good analgesic and weak anesthetic.
- It has quick onset of action and its peak clinical effects can be achieved in 3-5 minutes.
- It is easily reversible and 99% of gas is rapidly eliminated by lungs.
- It has short recovery time.
- It can be adjusted to required level according to patient’s condition.
- At concentration of 30-50% N20, patient feels relaxed, dissociated and is susceptible to suggestion. Moderate sedation is achieved at 50% concentration. At concentration greater than 60% patient feels giddiness, ataxia, and increased sleepiness. Not more than 50% concentration is required in dentistry.
What are the precautions to be followed
For the safe and effective use of inhalation sedation, it is necessary to have a complete understanding of the different stages of analgesia and anesthesia with N2O, the delivery machine and circuits. This requires training in its administration and the careful monitoring of the patient.
Knowledge and training in emergency responses is also essential. The equipment must have the capacity to deliver 100% oxygen, and never less than 30% of the oxygen. If the reservoir bag does not inflate, examine for a tear. Before commencing sedation with N2O, always carefully inspect the circuit and the apparatus for leaks. Pulse oximetry should be mandatory to constantly check the pulse of the patient.
What are the preoperative instructions to be followed by the patient?
Child should eat normally on the day of their appointment and must avoid alcoholic drinks. Child must take routine medication as normal unless advised not to by the treating dentist or sedationist. Child should be escorted by a responsible adult.
Technique of Nitrous oxide sedation
Dental chair is reclined and mask is placed in close proximity to the skin. Fit of the mask is checked. A wide range of fragrant nasal masks are available for patient’s comfort.
The procedure is started by administering 100% oxygen for 2-3 minutes at flow rate of 5-6L/minute. The reservoir bag is monitored as the patient breathes – it should move at the same rate as the patient’s breathing with each inspiration and expiration. Constant monitoring is critical and the use of pulse oximetry is advised.
Child‘s eyes, general responses and level of consciousness are monitored throughout the procedure. Nitrous oxide is titrated at 10% intervals upto 30% concentration and maintained at this level. Local anesthesia is administered slowly.
Once the procedure is complete, or near completion, the concentration of gas should be lowered, so that the patient is maintained on 100% oxygen.100% oxygen should be given for at least 3-5 minutes. This displaces nitrous oxide from the patient’s body and lessens the risk of post-procedural diffusion hypoxia which occurs with inadequate amounts of oxygen.
What are the sensations felt by the child
Child will feel
- Initial ‘heaviness’ or sinking into the chair.
- Tingling and numbness of the extremities.
- A warm sensation and a feeling of ‘lightness’ or floating off the chair with increasing depth of analgesia.
- Children are very open to suggestion. Their thoughts and behaviors can be guided by the dentist.
Patients must be individually assessed considering their medical condition and responsiveness. Child should not be allowed to leave home unless he is recovered completely from sedation. Give clear postoperative instructions to the parent. The child should rest for the remainder of the day. Physical activity should be avoided and the child should remain under continuous supervision. Written details of postoperative instructions should be provided to the parent.