Paediatric Dental Sedation: What about It?

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Prior to now, sedation dentistry has not been a part of dental practices. It has only been in recent times that more dental practitioners are incorporating sedation into their dental practices and are undertaking and completing the requirements needed to do so. Until recently, sedation dentistry was in use mainly for third molar removal and other types of oral surgery.

When it comes to paediatric dental care, performing invasive procedures can be downright unmanageable even when nitrous oxide is used. Drugs such as midazolam can be administered to children to make their dental experience trauma free. It acts fast and its effects wear off fast as well. It produces post sedation amnesia such that the patient does not recall what went one while she was in the chair.

On October 24, 2016, Brazilian researchers published a study in Brazilian Oral Research where they investigated if the behaviour of child patients was improved over time during future dental visits as a result of moderate sedation. At the end of the study, the researchers discovered that the behaviour of the children who received moderate sedation did improve over time. The sum of their scale scores, which according to their study implies that behaviour is improving the lower it is, kept decreasing with follow-up visits. When the study began and the children were first given the treatment, the combined for all the groups of children tested was 12.4 and by the time follow=up visits were concluding the score had become 6.8. All the children that partook in this study were younger than 6 years old as at the time the study commenced.

Updated guidelines on the use of dental sedation for paediatric patients have been released by the American Academy of Paediatrics and the American Academy of Paediatric Dentistry. The new guidelines were released in June 2016. They noted that patients younger than 6 years, especially the ones that are not up to 6 months old, are likely to bear the greatest risk of the occurrence of a contrary result or event during a sedative procedure. According to them, this age group is “particularly vulnerable to the sedating medication’s effects on respiratory drive, airway patency, and protective airway reflexes.”

Dental sedation has far reaching effects all the way into the central nervous system where it affects consciousness and airway reflexes, therefore it is important that there are trained personnel and required equipment that will be responsible for and used in monitoring the vital signs of the patient.

Dr. Cecilia L. Luong, member of the American Dental Association and a general dentist with Tiger Smile Family Dentistry in Baton Rouge, LA, is of the opinion that paediatric dental sedation is beneficial to everyone one involved, child, parent and dentist. She says “In our dental practice, we use conscious sedation, by way of combining benzodiazepines with nitrous oxide, to soothe our patients and because of this everyone involved has a trauma free experience. Conscious sedation is a safe procedure once it is done following the laid down guidelines, the people administering it are experienced and trained personnel and proper monitoring of the patient is carried out.”

There is a planning and preparation outline, released by the American Society of Anesthesiologists and American Academy of Paediatric Dentistry (AAP-AAPD), for a sedation procedure which has been simplified to follow the acronym, SOAPME.

S = suction must be present

O = oxygen; an adequate reserve supply must be provided

A = airway; there must be size-appropriate equipment present to manage a non-breathing child

P = pharmacy; drugs needed to support life and the required sedation reversal agents must be at hand

M = monitors; there have to be size-appropriate oximeter probes, electrocardiogram, non-invasive blood pressure measurement that will monitor the child’s condition

E = equipment; a defibrillator with appropriate size pads must be at hand

Dr. Robert Delarosa, president of the American Academy of Paediatric Dentistry is quoted to have said “Dentistry is not the most innocuous stimulus and a very, very young child has to be made as comfortable as possible. So it’s not uncommon for children to undergo anaesthesia.” Paediatric dental sedation has great benefits dental practices that treat children especially those that are family dentistry practices. There are benefits for everyone all involved as the dentist can take care of the needs of the child, the child is comfortable and experiencing no trauma during the procedure and the parents are not anxious or worried. So long the sedation follows guidelines and involves the right and experienced personnel, this makes it a safe treatment option that is becoming more accepted and widely sought and that can be used safely in dental practices.

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