Most children do quite well for dental treatment. Remember every child responds differently in the dental office. There might be a three year old getting a filling doing just fine sitting next to a twelve year old who is extremely anxious or defiant. You can get them used to coming to the dentist with regular early visits. The children get used to the water and noises of a cleaning so when more extensive treatment is needed, it is not such a big deal to them. For those children who have a harder time than most, well there are several tools that can be employed. The best and most often used are verbal techniques like positive reinforcement, tell-show-do, and voice tone control. Often, pharmcologic methods are necessary to comfortably accomplish treatment. The most common is Nitrous Oxide or Laughing Gas. It is a fairly benign easy way to help the child. Often additional medications are needed to help kids to be comfortable and cooperate to accomplish treatment. Sometimes it is even necessary to do treatment under General Anesthesia in the Hospital. Many times, however, the hospital is not an option due to lack of insurance coverage, limited treatment needs, or parental preference. The option of in-office Conscious Sedation has been a good option to help kids and parents.
Things can be unpredictable as medications elicit different responses in different children. Different medications (usually oral medications) are used for different situatuions. The younger the child, the more unpredictable the medication's effect. A certain dosage on one child may make them quite sleepy and sedated, while the same exact dose will not seem to do anything for the next child. Studies have found an individual child's temperment has a lot to do with their response. Therefore, some kids are better served with treatment under general ansthesia. In fact, if there is so much work that several sedative appointments will be required to complete the treatment, then the option of general anesthesia is usually discussed.
One problem with sedation in pediatric dentistry is that you can only give what is considered a "safe" dosage. Those chidren who do not respond to that dosage, well, you don't just give twice the dose and hope it will take. That could lead to trouble. Whatever is used, you monitor vital signs in accordance with the AAPD guidelines. The whole process is some what of an art as much as a science.
I am going to start series of posts on Sedation in Pediatric Dentistry and related topics. As this is too big a subject to address in one post, here are some important links to related topics (coming in the next few weeks):
Pulse Oximeters in Conscious Sedation
Sedative Drugs used in Pediatric Dentistry
How Children Behave at the Dentist, What to Expect