Mostrando entradas con la etiqueta Dental Anesthesia. Mostrar todas las entradas
Mostrando entradas con la etiqueta Dental Anesthesia. Mostrar todas las entradas


DENTAL ANESTHESIA : Guideline on use of local anesthesia for pediatric dental patients

Emergency Pediatric Dentistry

Local anesthesia is the temporary loss of sensation including pain in one part of the body produced by a topically-applied or injected agent without depressing the level of consciousness.

Local anesthetics act within the neural fibers to inhibit the ionic influx of sodium for neuron impulse.

This helps to prevent transmission of pain sensation during procedures which can serve to build trust and foster the relationship of the patient and dentist, allay fear and anxiety, and promote a positive dental attitude.

The technique of local anesthetic administration is an important consideration in pediatric patient behavior guidance.

Read Also: ORAL SURGERY : Surgical techniques for the treatment of ankyloglossia in children

Age-appropriate nonthreatening terminology, distraction, topical anesthetics, proper injection technique, and nitrous oxide/oxygen analgesia/anxiolysis can help the patient have a positive experience during administration of local anesthesia.




An alternative local anaesthesia technique to reduce pain in paediatric patients during needle insertion

Dental Anesthesia

One hundred thirty-four children between the ages of 3 to 12 who visited the department of Paediatric Dentistry, Chosun University Dental Hospital, for dental treatment requiring local anaesthesia were selected for this study, regardless of previous dental experience, and randomly divided into the following 2 groups: alternative and conventional.

Gender, race, and ethnic restrictions were not applied, and emergency cases were not selected for this study. Patients who needed a mandibular block were included in both groups.

Patients were excluded from the study if they had behavioural management problems.

This study protocol was approved by the Institutional Review Board (IRB) of Chosun University Dental Hospital, Gwangju, Korea.

The written informed consents were obtained from all patients prior to study and they were informed about the aim of the study. All parents were informed about the treatment and associated procedures.

Read Also: ORTHODONTIC : Dental disorders are linked to mouth breathing

Reframing techniques, i.e., those using euphemistic phrases, e.g., “injecting the cotton roll only, not on your teeth”, were used to describe the injection to all the children.

No sedative or other pharmacological supports, such as nitrous oxide, were used in this study. Positive reinforcements and reassurance were given to the subjects throughout the insertion process.


° European Journal of Paediatric Dentistry vol. 14/2-2013
° S.H. Lee, N.Y. Lee


Pregnancy and Local Anesthetics in Dentistry


Pregnancy induces significant anatomical and physiological changes in the mother.

Many pregnant women need dental treatment due to poor oral hygiene related to pregnancy.

However, most dentists are reluctant to provide, and most pregnant women are reluctant to receive, dental treatment during pregnancy.

Depending on the types of drugs and the stage of pregnancy, the effects of drugs on the mother, as well as the fetus, may vary.

Local anesthetics are the most widely used in dental treatment.

Read Also: Pulpotomy medicaments used in deciduous dentition

Youtube / American Dental Association (ADA)


DENTAL ANESTHESIA may interrupt development of wisdom teeth in children

Researchers from Tufts University School of Dental Medicine have discovered a statistical association between the injection of local dental anesthesia given to children ages two to six and evidence of missing lower wisdom teeth.

The results of this epidemiological study, published in the April issue of The Journal of the American Dental Association, suggest that injecting anesthesia into the gums of young children may interrupt the development of the lower wisdom tooth.

“It is intriguing to think that something as routine as local anesthesia could stop wisdom teeth from developing.

Read Also : ANESTHESIA : Local Anesthesia in Pediatric Dentistry

This is the first study in humans showing an association between a routinely administered, minimally invasive clinical procedure and arrested third molar growth,” said corresponding author, Anthony R. Silvestri, DMD, clinical professor in the department of prosthodontics and operative dentistry at Tufts University School of Dental Medicine.

Wisdom teeth are potentially vulnerable to injury because their development — unlike all other teeth — does not begin until well after birth.

Between 2 and 6 years of age, wisdom tooth (third molar) buds begin to develop in the back four corners of the mouth, and typically emerge in the late teens or early adulthood.

Not everyone develops wisdom teeth, but for those who do, the teeth often become impacted or problematic.



Home care of children crucial after ORAL SEDATION

Sedation often helps children who need dental treatment by keeping them safe and calm during the procedure.

Oral sedatives are commonly used, but their effects can be unpredictable.

The level of consciousness while the patient is sedated can vary depending on the drug and the patient, so the dental practitioner must be aware of each patient’s sedation level at all times.

The effects can also vary once the patient is discharged, so the caregiver must watch the child closely.

A study reported in the current issue of the journal Anesthesia Progress investigated the adverse effects of oral sedation that occurred once young patients left the dental office.

Read Also : DENTAL ANESTHESIA : Children's Dental Injection Technique

The authors used the observations of dental practitioners and the children’s caregivers to find the most common lingering effects of oral sedatives and the best ways to care for patients who had been sedated.

For this study, 51 children who needed dental treatment were given some form of oral sedation. More than 75% of the study’s subjects were given a drug combination that included morphine.

Perio-Implant Advisory Editors


SEDATION : The dentist wants to sedate my toddler. Is that safe?

You mentioned that you had some concerns about your 2 year old little boy's teeth, you took him to the dentist, and they mentioned some sort of sedation in the future to clean off the tartar and check for any cavities or other problems that might need to be addressed.

And you're wondering if that's a normal thing.

If a child can go to the dentist and have their teeth cleaned without sedation, then that's best, but some kids just totally freak out, and it's not even possible to look in their mouths without a little bit of sedation.

So a lot of dentists will recommend some gas, and that doesn't put the child to sleep, it just helps them feel okay with whatever is happening, it just makes them more relaxed with it.

Every once in a while, deeper sedations are used in a dentist's office, but I do recommend talking with your dentist about their intentions, and ask them the questions that you have.

Read Also : ORAL SURGERY : Surgical management of macroglossia in children: two case reports

Generally speaking, there are a few things you want to consider if your child is going to receive sedation in a dentist's office.

Number 1, you want to make sure that the person who is administering it is well-trained, they're certified, they know about pediatric dosage, there's going to be monitoring during and after the procedure, they've spent some time talking with you about your child's health history, and that your child doesn't have any risk factors that might increase the chances of having complications during sedation.

It's also a good idea for this person to check out your child's airway and make sure there aren't any obstructions, like tonsils or something like that.

And it's also good for enough personnel to be available in case an emergent situation arose. It wouldn't be a bad idea to ask the dentist about what their procedures and protocols are if something happens.

Youtube / IntermountainMoms


Safe and Stress-Free Pediatric Sedation Dentistry: An Important Guide for Parents

If you’re a parent and have concerns about sedation dentistry for your child, it’s completely understandable.

After all, there have been questions raised in the past several years about the safety of sedation and anesthesia in pediatric dentistry — including reports in the media regarding complications and even deaths in some rare cases.

With that said, there are some important factors to keep in mind as a parent:

· When administered by a qualified, experienced, and highly trained oral & maxillofacial surgeon or anesthesiologist in an accredited ambulatory surgical facility, sedation dentistry can be safely administered to pediatric patients.

· If your child has anxiety about going to the dentist or has special needs, sedation dentistry is a proven, effective, and safe procedure to help ensure that your child receives the dental treatment he or she needs to provide good oral health for years to come.

Without dental sedation, a child may become fearful and may likely resist going to the dentist or sit still in the chair as he or she grows older, increasing anxiety and fear about having any procedure done, even a routine cleaning, and even into adulthood.

Read Also : SEDATION : The dentist wants to sedate my toddler. Is that safe?

An anxious and fidgety child will make the dentist’s task very difficult, resulting in less than ideal conditions and care for everyone.

What are the sedation/anesthesia options for my child?

Depending on the procedure, including the length of time it will take, along with your child’s unique needs, there are several options for dental sedation and anesthesia. They include:

1. Local Anesthesia
The simplest option, local anesthesia, involves injecting numbing medication around the area that will be treated. The local anesthetic will block the nerves in that area which transmit pain, and the patient will feel numbness in the area. Local anesthesia is almost always administered in addition to any other anesthesia treatment to minimize the amount of anesthetic required to make patients comfortable.

2. Nitrous Oxide
In young patients who are anxious about dental procedures, the local anesthetic can be supplemented with nitrous oxide, also known as ‘laughing gas.” While nitrous oxide works well to reduce anxiety in cooperative patients, it does not work as well in patients who are dental phobic, or who cannot sit still for any sort of dental procedure.

Patients will also often remember most of the procedure as they are usually fully aware of their surroundings. Therefore, nitrous oxide is best used primarily to reduce anxiety as it does not have any sedative or anesthetic effect.

3. Oral Sedation
With oral sedation, children are given syrup to drink or a pill to swallow, which have a sedative effect to relax patients for the procedure. The problems with oral sedation are the following:

· The medication often takes 30 minutes or more to work, so it has to be given ahead of time and before the scheduled appointment time.

· The medication lasts a long time, anywhere from 2 hours to 6 hours, so patients may go home without fully being awaken, and therefore may be inappropriately cared for at home by parents or caretakers unfamiliar with how to care for a sedated patient.

· The dose cannot be titrated, which means that if the dose is underestimated, the patient will not be sedated appropriately for the procedure. Since the medication is given orally, it is very difficult to give a second dose orally to a partially sedated patient.

Additionally, if the procedure lasts longer than expected, then the medication will wear off before the treatment is completed. On the other hand, if too much medication is administered, the patient may be over sedated during the procedure.

4. IV Sedation
With IV sedation, an oral & maxillofacial surgeon or pediatric anesthesiologist will administer carefully measured doses of anti-anxiety drugs and anesthetics intended to help put your child at ease for the treatment.

Because the doses are determined on a patient-by-patient basis and administered through an IV line, this can be a safe option for children who are apprehensive about having dental surgery because the doses can be titrated as needed to achieve the level of sedation desired.

IV sedation is also beneficial because your child will have little or no recollection of the procedure after the fact, meaning that there are no bad memories to exacerbate fears that may make your child resistant to future appointments and treatments.

With IV sedation, the amount of medications needed to keep your child relaxed and at ease will be monitored and adjusted continuously until your child is resting comfortably for the procedure.

Short acting medications are used, so your child usually wakes up pretty quickly once the procedure is finished. And in case of any complication, most of the drugs administered can be reversed right away.

5. General Anesthesia
General anesthesia is sometimes necessary for children who are unable, either because of age or maturity level, to cooperate during dental treatment.

It should be noted that there are inherent risks where general anesthesia is used, and although they represent a small percentage of patients, it is always recommended that all patients be evaluated at an initial consultation appointment to ensure the best outcome for your child. The evaluation may include a thorough medical examination and blood work.

General Anesthesia is most helpful for:
· Infants
· Children who require major treatment
· An extremely anxious child
· Children who are medically compromised or have special needs and/or who have a condition which limits cooperation or the ability to follow instructions

With General Anesthesia, your child will be given medicine to put him or her into a deep. This is usually performed by an oral & maxillofacial surgeon or a pediatric anesthesiologist, who will administer the medications through an IV line, although inhaled anesthetics may also be used.

A breathing tube may be inserted during the procedure to safeguard your child’s airway throughout the procedure.

Important Questions to Ask Your Child’s Dentist about Anesthesia and Sedation
Again, it’s completely understandable to have concerns regarding sedation dentistry for your child. As a parent myself, I would feel the same way if I were not so familiar with the methods, requirements, and outcomes in sedation dentistry.

With that in mind, I urge parents to ask their child’s dentist a series of in-depth questions in order to feel confident in the dentist, their staff, the facility, and the sedation procedure that is being recommended.

Following is a list of questions you should consider asking your dentist, which should address any concerns you may have about your child’s proposed procedure.

If your child’s dentist does not take the time to answer every question thoroughly and to your complete satisfaction, I would recommend seeking another provider.

Prior to the Procedure:
Will the sedation be performed by an oral & maxillofacial surgeon, dental anesthesiologist, or medical anesthesiologist? The American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD) both recommend that an anesthesia professional be with your child while the dentist concentrates on the procedure.

Oral & maxillofacial surgeons have been providing office-based anesthesia for over 90 years. The American Association of Oral & Maxillofacial Surgeons (AAOMS) supports the Anesthesia Team Model, in which oral & maxillofacial surgeons, along with trained assistants, carry out administration of the anesthetic, perform airway monitoring, and the surgical procedure.

Furthermore, the AAOMS “Parameters of Care for Anesthesia and Outpatient Facilities” are reviewed and concurred with by the American Society of Anesthesiologists.

Therefore, while oral & maxillofacial surgeons are unique in that they have extensive anesthesia training and routinely administer anesthesia and perform surgery safely, you should discuss all these options with your dentist and choose the treatment plan you are most comfortable with.

· Confirm that the procedure will be done in a facility accredited for ambulatory surgery.
The American Association for Accreditation of Ambulatory Surgical Facilities, Inc. (AAAASF) provides accreditation for medical and dental offices. It sets the standard of care required in an outpatient setting to provide anesthesia services safely. No office should offer anesthesia services without being accredited as an ambulatory surgical facility.

It would be like a hospital operating without an accredited operating room. If the facility is not accredited by the AAAASF or another reputable accreditation agency, you may want to seek another provider or request that the procedure be performed in a hospital.

· Ask the dentist if he or she has hospital privileges, and ask if you can have your child’s procedure performed in a hospital. This should always be presented to you as an option.
· Who will provide the pre-operative evaluation? A thorough review of your child’s past medical history, surgical history, medications, allergies, and previous illnesses or hospitalizations should be reviewed on every patient prior to surgery.
· What is the recommended time that your child should be without food or drink prior to the procedure?
· Will any sedation medication be given to your child at home prior to coming to the office? If so, how should he or she be monitored before arriving into the procedure room?
· What training and experience does the sedation/anesthesia provider have in providing the level of sedation or anesthesia that is planned for the procedure? Does this training and experience meet all of the standards of the ADA Guidelines for the Use of Sedation and General Anesthesia by Dentists?
· Does the staff assisting in the procedure have current training in emergency resuscitation procedures, such as Basic Life Support and other advanced resuscitation courses as recommended by the ADA Guidelines? Is this training regularly renewed?
· Does the state dental board require a special sedation/anesthesia permit or license that allows for the sedation/anesthesia provider to administer this specific level of sedation or anesthesia in the dental office?

During the Procedure:
· In addition to the use of local anesthesia, what level of sedation/anesthesia will be given to your child? Is it minimal sedation (relaxed and awake), moderate sedation (sleepy but awake), deep sedation (barely awake) or general anesthesia (unconscious)?
· How will your child be monitored before, during, and after the procedure until released to go home?
· Are the appropriate emergency medications and equipment immediately available if needed – and does the office have a written emergency response plan for managing medical emergencies?

After the Procedure:
· Will the sedation/anesthesia provider give you instructions and emergency contact information if there are any concerns or complications after returning home?
What we do at Park Smiles NYC Pediatrics
As an oral & maxillofacial surgeon in a pediatric dental practice, and as Medical Director of our AAAASF-accredited ambulatory surgical facility, I take every precaution possible to maximize the safety and well-being of all our patients.

And as a parent, I empathize with your concerns of having anesthesia administered to your child. Following are just some of the safety measures we have in place at Park Smiles NYC Pediatrics:
· We offer all types of anesthesia from local anesthesia, to nitrous oxide, IV sedation, and general anesthesia, with the anesthesia plan being tailored to the specific needs of each patient during an initial consultation.
· All anesthesia services are provided in our accredited AAAASF operating room by a board-certified oral and maxillofacial surgeon or by a board-certified anesthesiologist. The choice is always left to the patient/parent.
· All procedures can be performed in our AAAASF-accredited ambulatory surgical facility or at the hospital. Again, the choice is yours.
· All our staff is highly trained to assist our dental surgeons in sedation dentistry cases. All staff is also trained in basic life support skills.
· Our state-of-the-art facility is fully equipped for all types of dental procedures — from general dentistry and pediatric dentistry to complex oral and maxillofacial surgery procedures.

It’s important not to let a fear of sedation dentistry prevent you from seeking the proper dental care for your child.

By asking the right questions, carefully choosing your provider, and ensuring that your child will be treated in an accredited ambulatory surgical facility, you can feel peace-of-mind knowing that your child is receiving safe and stress-free dental care to help him or her achieve a healthy smile for years to come!