Dental Sedation: Frequently Asked Questions

Pre-Operative and Post-Operative Instructions for Dental Sedation

What are the different types of dental sedation?

Nitrous Oxide (Laughing Gas)

Commonly referred to as “laughing gas”, nitrous oxide is the combination of two gases: nitrogen and oxygen. When nitrous oxide is inhaled into the body,
it has a mild calming effect that works well for mildly-apprehensive children. Once your child is comfortable in the dental chair, a sterilized nosepiece is placed on his or her nose and they begin to inhale a sweet, pleasant aroma (of their choice). This gives them a calming sensation that relaxes them after 5 minutes.

PROS:

  1. Least expensive method of sedation.
  2. Multiple appointments allow for you to maximize your insurance benefits.

CONS:

  • Ineffective for children with severe anxiety, extensive treatment needs (more than four teeth require treatment), very young children and children with developmental delays and special needs.
  • Your child will still need to get local anesthetic in the area where dental treatment will be completed. They will also need to be monitored closely to avoid biting their tongue, lips or cheek.
  • Your child will have full memory of the dental procedure.
  • More appointments are usually necessary in order to complete dental treatment and your child may experience dental fatigue after the second appointment.

Oral Conscious Sedation

Prior to the initiation of dental treatment, your child is given an oral medication to drink that is dosed according to his or her weight. The oral medication usually takes 30 to 45 minutes to work. Oral sedation is not intended to make your child unconscious – it IS NOT GENERAL ANESTHESIA. Reactions to oral sedation include drowsiness.

PROS

  • May have some minor memory loss of procedure.
  • Can get more treatment completed in one visit.

CONS

  • Most dental insurance companies will not cover this type of sedation. **Our office will complete a pre-authorization of your insurance to determine if this service is a covered benefit**.
  • Your child will still need to get local anesthetic in the area where dental treatment will be completed and they will need to be monitored closely to avoid biting their tongue, lips or cheek. 
  • After the procedure, a prolonged altered drowsy state of consciousness may persist, resulting in sleepiness, motor imbalance (unable to walk a straight line), nausea and combative behavior.
  • If your child does not like to drink medication, they might spit out the medicine (***We are unable to re-dose if your child spits out the medicine because their is no way to calculate the amount they actually consumed. WE DO NOT RE-DOSE TO AVOID OVERDOSE). When this occurs, the sedation is usually ineffective.

IV Sedation

IV sedation provides a controlled sleep that provides a buffer for your child during dental treatment so that treatment can be completed in a safe and efficient manner. An anesthesiologist administers this type of sedation. A sedative medication is usually given in the upper arm while your child is distracted; this sedation works quickly and reliably within about 3 minutes. Once sedated your child is moved to the dental procedure room and is monitored with blood pressure, heart and breathing monitors. The intramuscular sedatives are then supplemented with intravenous (IV) sedatives.

PROS

  • Your child will have no memory of the dental procedure.
  • If x-rays were not taken before they can be taken while the child is sedated.
  • All treatment can be completed in one visit.
  • The procedure is completed in the dental office.

CONS

  • This type of sedation is expensive and dental insurance will not cover it. Our anesthesiologist will assist you with filing a claim to your medical insurance so that you may be reimbursed after the dental sedation. You will need to check with your medical insurance to determine is this is a covered benefit first.
  • If dental x-rays were not obtained, the original treatment plan will change because the extent of the cavities cannot be determined without the appropriate x-rays, which may lead to a higher dental estimate on the dental treatment plan. 

Hospital Based Dentistry (Out-Patient General Anesthesia)

Dr. Smith is credentialed at the Children’s Hospital of Plano and Dallas to perform dental treatment alongside a Pediatric Anesthesiologist. Children’s Hospital is a state-of-the-art facility dedicated to treating children and special needs adults for dental care. Pediatric Anesthesiologists and a medical/nursing staff certified in ACLS/PALS will care for your child. Outpatient General Anesthesia is recommended for apprehensive children, very young children, and children with special needs that would not work well under conscious sedation or I.V. sedation. General anesthesia renders your child completely asleep. Dr. Smith will help your family to decide if this option is right for you.

PROS

  • Your child will have no memory of the dental procedure.
  • If x-rays were not taken before they can be taken while the child is sedated.
  • All treatments can be completed in one visit.
  • The procedure is completed in the dental office.

CONS

  • This type of sedation is expensive and dental insurance will not cover it. Children’s Hospital will assist you with filing a claim to your medical insurance so that you may be reimbursed after the dental sedation. You will need to check with your medical insurance to determine is this is a covered benefit first.
  • If dental x-rays were not obtained, the original treatment plan will change because the extent of the cavities cannot be determined without the appropriate x-rays, which may lead to a higher dental estimate on the dental treatment plan. 

How can dental sedation help my child?

Sedation helps children that:

  • Are very young and need extensive dental treatment done (more than 4 teeth).
  • Are developmentally delayed, special needs or medically compromised.
  • Are very fearful or anxious at the dentist.
  • It can provide an emotionally positive experience to children that have a history of traumatic dental experiences.
  • Have strong gag reflexes.

What are the risks associated with dental sedation in children?

  • Although small, there are certain risks associated with dental sedation, as with any medical or dental procedure. Our top priority is your child’s safety. Prior to performing any sedation technique, our staff and doctor will review any and all risks with you in person and answer any questions you may have.

Does my insurance cover dental sedation?

Coverage for sedation will depend on your dental insurance and for IV or hospital sedation on your medical insurance coverage. Our patient care coordinator will be happy to discuss the options available to you for dental sedation coverage.

Who decides if my child needs dental sedation?

Ultimately the parents decide if the child requires oral sedation. Our pediatric dentist will help you to make an informed decision based on your child’s behavior, dental treatments needs (based on exam and x-rays) and medical history. You can be assured that if you select dental sedation you will be in good hands.

What are the types of sedation drugs that will be used?

Oral Sedation (Oral Medications):

  • Hydroxyzine, Meperidine, Midazolam (Versed), Diazepam (Valium)

(IV Sedation) Intramuscular:

  • Ketamine, Glycopyrrolate, Midazolam 

(IV Sedation and General Anesthesia) Intravenous Medications:

  • Propofol, Lidocaine, Ketamine, Glycopyrolate, Midazolam, Dexamethasone

What type of care will my child require after dental sedation?

  • For oral sedation, refer to our oral sedation post-operative instructions.
  • For IV sedation, refer to our IV sedation post-operative instructions.
  • For hospital care, refer to our hospital sedation post-operative instructions.

How will my child be monitored during sedation?

The following methods will be used during sedation to ensure your child’s safety:

  • EKG: This monitors heart rate and rhythm continuously beat to beat.
  • Pulse Oximeter: This measures oxygen levels and pulse rate continuously.
  • Blood pressure: Taken automatically every few minutes.
  • Precordial stethoscope: doctor listens to heart rate and breathing.
  • ETCO2: This can register breathing via a small tube that measures exhaled gases.