Sedation and Hospital Dentistry

Making kids and parents feel at ease

Most kids are calm, comfortable and confident when they come to Must Love Kids® Pediatric Dentistry. Our advanced specialized training and experienced staff excel at making kids and parents feel at ease with the help of sedation and hospital dentistry.

For children with severe dental anxiety and/or special health care needs – including Autism, Downs Syndrome, Cerebral Palsy and ADHD as well as additional complex medical conditions – one of the many benefits we offer is treatment with Nitrous Oxide/Oxygen Inhalation, in-office general anesthesia as part of our sedation and hospital dentistry services.

Nitrous Oxide/Oxygen Inhalation

Nitrous Oxide/Oxygen can be used when required by our well-trained team. This is a safe and effective technique used to reduce anxiety, produce analgesia and enhance effective communication in a mildly anxious child who is otherwise cooperative. With this technique, a fitted mask sits over a child’s nose and they can watch a TV show which further helps with distraction. Since the child experiences the feeling of relaxation and giddiness, Nitrous Oxide/Oxygen is also called laughing gas.

General Anesthesia and Hospital Dentistry

Behavior guidance techniques and/or use of nitrous oxide allows most children to receive treatment in the pediatric dental office with minimal discomfort and without fear. However, some children require general anesthesia or deep sedation to receive comprehensive dental care in a safe and humane fashion similar to a placing of “Ear Tubes” for a young child. Depending on the child’s needs, this can be done in a hospital (Emanuel Legacy Hospital) or the dental office. General anesthesia is a controlled state of unconsciousness that eliminates awareness, movement and discomfort during a dental procedure.

The criterion considered for dental treatment under general anesthesia or deep sedation are:

  • Young age needing dental treatment, unable to tolerate or cooperate for examination, x-rays, prophy (cleaning)
  • Extensive dental treatment in a young child (e.g. crowns, root-canals, extractions)
  • Patient with developmental disability or psychological impairment who might not tolerate dental treatment
  • Extremely uncooperative, fearful, unmanageable anxious behavior
  • Ineffective nitrous oxide sedation, behavior guidance, and positive reinforcement/encouragement
  • Needs oral surgery or other dental treatment that would be difficult for the child to tolerate while awake

As part of a decision tree, the following alternatives are also considered:

  • No treatment (might not be an option if your child had dental disease and/or has pain already)
  • Medical management of caries with Silver Diamine Fluoride (limited to initial or start of caries/cavities only)
  • Non-pharmacological management of behavior (without sedation, using positive reinforcement , tell-show-do, but has limitations in very anxious or very young children)
  • Use of nitrous oxide and hard tissue laser or dental drills (has limitations in a very anxious child)
  • A second opinion from another pediatric dentist
  • When needed, the in-office anesthesia service is provided by an independently contracted, board certified anesthesiologist, who manages the pre, intra and post procedure anesthesia. The anesthesiologist can be contacted directly to answer any questions you might have about anesthesia for your child. Some children need anesthesia services in a hospital setting, your child’s dentist and primary physician will help determine the appropriate place for anesthesia.

The goals of in-office and hospital based sedation/anesthesia are:

  • Maintain and monitor the patient’s safety and well being
  • Minimize physical discomfort and pain
  • Minimize anxiety/psychological trauma
  • Control behavior and/or movement so as to allow for safe completion of the dental procedure
  • Discharge the patient safely to home when patient meets stringent criteria

There are some alternatives to treatment under anesthesia. One is to defer treatment when appropriate, which many times is not possible especially if there is active disease in your child’s mouth or your child is in pain. Other forms of sedation like conscious sedation, might be available at other dental offices. If you feel at anytime that our office is not a right fit for you or your child, we encourage you to consider a second opinion from another pediatric dental office.
General anesthesia is commonly employed in the out-patient environment. It is used frequently in most pediatric dental offices to treat specific types of patients. One of the safety measures before anesthesia is to obtain an updated medical assessment and clearance from the child’s primary physician. Beyond basic medical history, things of particular importance are cardiovascular health, history of reactive airway disease, airway obstructive pathologies (snoring, sleep apnea), and family history of adverse reactions to anesthesia.

At Must Love Kids®, Drs. Monisha and Prashant Gagneja and their team are proud of their very experienced, board certified Pediatric anesthesiologist Dr. Bonnie Song from Northwest Mobile Anesthesia. They provide anesthesia services throughout the Northwest at various pediatric dental locations for special needs dentistry.

We follow a very strict protocol for evaluating, scheduling, monitoring and performing dental treatment under general anesthesia. Prior to dental treatment under deep sedation or general anesthesia, your child must undergo a preoperative health evaluation by your child’s primary physician. This is reviewed by the anesthesiologist who is a medical physician (MD) as well. To assure quality of services, strict pre-op instructions are to be followed by the parent(s). Alternatives, risks and benefits are discussed in detail prior to your child’s procedure.

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