Comments on Pediatric Dentistry: Sedative Drugs Used in Pediatric Dentistry

Anything we do is in accordance with AAPD guidelin...

2008-09-01T09:35:00.000-07:00

Anything we do is in accordance with AAPD guidelines on conscious sedation. It is not the case that we are not aware of alternative techniques. I agree it would be nice to use IV titratable sedative medications with an anesthesiologist present. If we feel it is indicated we usually do cases in the OR at he hospital, a much more controlled environment. There are several barriers to IV in-office sedation:

1. It is difficult to start an IV on a disruptive young child.
2. Liability insurance rates are much higher and the laws different for IV sedation (depends on the state)
3. To account for the increased costs involved in having an anesthesiologist present and taking into account other cost and insurance, it can become cost prohibitive for the patient. For instance, the cost of doing the sedation alone could be many times the cost of the actual procedure. If you get into these large costs, it is often more reasonable to do it in the OR.

Now, I do know of instances where this(in office IV/inhalation with anesthesiologist) is done with some practical success, Florida comes to mind. Each state is different. I fit were practical, believe me we (pediatric dentists) would use it more.

Anything we do is in accordance with AAPD guidelin...

2008-09-01T09:31:00.000-07:00

Anything we do is in accordance with AAPD guidelines on conscious sedation. I agree it would be nice to use IV titratable sedative medications with an anesthesiologist present. If we feel it is indicated we usually do cases in the OR at he hospital, a much more controlled environment. There are several barriers to IV in-office sedation:

1. It is difficult to start an IV on a disruptive young child.
2. Liability insurance rates are much higher and the laws different for IV sedation (depends on the state)
3. To account for the increased costs involved in having an anesthesiologist present and taking into account other cost and insurance, it can become cost prohibitive for the patient. For instance, the cost of doing the sedation alone could be many times the cost of the actual procedure.

Now, I do know of instances where this(in office IV/inhalation with anesthesiologist) is done with some practical success, Florida comes to mind. Each state is different.

A hospital environment is one of the most controll...

2008-08-31T22:17:00.000-07:00

A hospital environment is one of the most controlled environments for any medical procedure.

Dear Doc:What are the risks for having my 9 year o...

2008-08-31T20:19:00.000-07:00

Dear Doc:

What are the risks for having my 9 year old be sedated with Versed for dental procedure at a Children's Hospital environment where an anetheisologist does the procedure for the dentist? They recommend have her tubed during the procedure even thought they state she would breathe on her own? Is this really necessary?

Larisa,I cannot advise on specific treatment..In g...

2008-08-29T05:53:00.000-07:00

Larisa,

I cannot advise on specific treatment..

In general, the more treatment needed, the younger the child, the more "head strong" the child is--I am thinking general anesthesia. Still, much can be done with conscious sedation which I do nearly every day. These kinds of decisions rest with your pediatric dentist and you based on the child's specific situation.

Dr. Brandon,My daughter is 4.5 y old and she needs...

2008-08-29T02:38:00.000-07:00

Dr. Brandon,
My daughter is 4.5 y old and she needs 4 fillings and 2 baby root canals to be done (all for molars). At 1st we tried to do it without sedation, because she was very cooperative during regular check-ups, but it looks like her fear of drilling (even its sound) was stronger than her desire to cooperate... So now I'm trying to decide between sedation and general anesthesia. The thing is that she is very emotional and sensitive and very active. She had allergic reaction to dimetapp (became hyperactive) and some complications after DTP vaccination (wasn't able to sleep for several days), when she fall asleep she always need TO TUMBLE a lot. To your opinion, what type of treatment should I choose for her: general anesthesia or conscious sedation ???
Thank you very much beforehead,
Larisa

The gases and medications used in general anesthes...

2008-06-28T05:50:00.000-07:00

The gases and medications used in general anesthesia can cause nausea afterwards. I think that is fairly common. If you are concerned about the discomfort, I'd contact your dentist.

ps- regarding my last post, about the extractions,...

2008-06-28T03:40:00.000-07:00

ps- regarding my last post, about the extractions, I forgot to mention, that my daughter said her teeth didnt hurt and had never hurt her before. If she had no pain, then why extractions? I was hoping you would have a specific post dedicated to extractions. Maybe next time. Thanks for any response.

My daughter just underwent general anesthesia for ...

2008-06-28T03:35:00.000-07:00

My daughter just underwent general anesthesia for what I thought was going to be cavity treatment with filling and clear plastic sealants. She had 3 extractions(upper molars) and 6 crowns put in on her molars. She threw up alot, we left hosp. at 1:00pm and she was still vomiting afterwards till 9:00pm. Was this too much work done at one time? She was under gen. anesth. for about 4 hours. This was 4 days ago and her jaw is still sore and she hasnt eaten solid foods yet. I feel this is too much done at once for a 7 year old. Is this normal?

I see insurance companies once again deciding wher...

2008-03-09T19:18:00.000-07:00

I see insurance companies once again deciding where and how to treat patients. If they think it is best in the office setting, let THEM (the insurance companies ) come in and do it themselves! They obviously think they know what is appropriate. They really have no idea how to treat children and that children really are different than adults. Realize they are ONLY considering their bottom line.

What I am saying is that I sympathize, but it is something I have seen before. Unless the patient has some sort of significant disability like cerebral palsy, you are not likely to get them to "change their minds". It is a pattern I see too often with 5 yrs and up--bet it's Blue Cross too. If there is something I come across I'll post here, I'll also ask our coordinator for advice as she handles this kind of thing for us. Good Luck.

Hi,My five year old son is having surgery on Tuesd...

2008-03-09T18:00:00.000-07:00

Hi,
My five year old son is having surgery on Tuesday to remove his upper front baby tooth and the impacted extra adult tooth beneath the gumline. The dental surgeon requested permission to have this procedure done under anesthesia in a hospital, but the insurance company denied the claim, stating that their policy is to have children over 48 months be treated for this type of issue under local anesthetic in an office setting. I am appealing the claim and am hoping you can point me to any information you have about a child's age and sedation. Do you know of any references, research or guidelines about what is appropriate for a five year old? Thanks!

As you can see from this post these drugs are used...

2008-02-27T14:41:00.000-08:00

As you can see from this post these drugs are used quite often. I use the ones you mentioned every week. What is best and safest for your child cannot be determined by simply which drugs to use. Every child and every situation is different. It is good to be as informed as possible, but be prepared for the unpredictable. Good Luck.

Hi,My 5 year old son has to have a tooth pulled, s...

2008-02-26T19:35:00.000-08:00

Hi,
My 5 year old son has to have a tooth pulled, space maintainer put in, pulpotomy done, and a cavity filled. They are going to sedate him using Chlorahydrate, demoral, and phenorgan. How safe are these? Because I am terrified about letting them do this. They are also going to be giving the laughing gas, but didn't feel that would be enough. Is this the normal procedure for someone his age? Thanks for your help, any advice would be great! Thanks.

Sounds like you are talking more about a local ane...

2007-10-24T16:36:00.000-07:00

Sounds like you are talking more about a local anesthesia injection like lidocaine to "numb" the area. There are concerns with malignant hyperthermia with general anesthesia. How all this applies to your situation I cannot say. Caution should always be used with drugs especially drugs used for sedation. If the injection is something to "sedate" her, I would try and find out more.

Hi, My daughter is 4 1/2 and needs several filling...

2007-10-24T10:05:00.000-07:00

Hi,
My daughter is 4 1/2 and needs several fillings. She's had one without any pain medication, but it did cause a little discomfort. The dentist is planning to give her an injection before the next one. My concerns are these: what will he be using, and most importantly, there is a family history of malignant hypothermia on her father's side. Are any of the drugs he will be using triggers? He is aware of the condition, though made no comment when I addressed my concerns other than "Everything will be fine. I'll see you in a few weeks" This is the second dentist I've been to and neither seem to be taking my concerns seriously. There are only 2 dentists in my area. There are several more 4 hours away, but travelling is very difficult at this time. I would appreciate any feed back you could give me on this matter. Thank you.

I can't tell you what to do, but a really large am...

2007-08-27T16:42:00.000-07:00

I can't tell you what to do, but a really large amount of swelling (that causes airway restriction) can be an "emergency" --the vast majority are not. Sounds like you are seeing him tomorrow anyways?...If it's really bad, call him (or go to the emergency room).

I've got to run, but Good luck!

Dr Brandon--You just answered my prior post, one m...

2007-08-27T16:25:00.000-07:00

Dr Brandon--You just answered my prior post, one more quick question: at 3 pm snack time I noticed nothing abnormal, however, at 5 pm I noticed my daughter's lower jaw was swelling but her known abscesses are on the top of her mouth--when do you just wait to see the dentist and when do you classify this as an emergency?

Here is a quick response (as you said you have sch...

2007-08-27T16:21:00.000-07:00

Here is a quick response (as you said you have scheduled tx tomorrow):

--antibiotics help, but do not cure dental abscesses, usually the abscessed teeth should be removed or else the problem may return.

--sedation is often indicated for dental treatment and if done properly is a reasonable methodology.--read my posts on sedation to get a better idea on that.

--sometimes you can brush all day long and there still may be decay due to factors beyond our control. Early treatment and examinations (even at one year of age is not too soon) are better than waiting till the problem gets too far along.

--don't take my "internet" word on this, ask your own dentist.

I have a 5 year old whose pediatrician has suggest...

2007-08-27T11:50:00.000-07:00

I have a 5 year old whose pediatrician has suggested she may have a tooth enamel defect because of her severe tooth decay despite FREQUENT tooth brushing (3-5x per day--I brush them morning and evening, she brushes after lunch and snacks). She recently developed 2 abscesses in the top teeth, 1 on each side, 2nd tooth from the back. Her dentist wants to extract them and all 4 lower molars. He gave her an antibiotic and said to return in 4 months for treatment. 2 days after she was done with her antibiotic, her fistulas started growing again and she is complaining of toothache. I called and he now wants to perform the "treatment" (all 6 extractions) tomorrow, using versed for sedation. My question is: is it safe for her to have the extractions while the infection is present? Also, we brush and use the little flouride flossers for kids, is there something else we should be doing to prevent her decay as it is SEVERE and her younger sister seems to be following in her footsteps. Is there a treatment we should seek for her?

Again, I cannot give recommendations for your chil...

2007-02-26T18:47:00.000-08:00

Again, I cannot give recommendations for your child here, but generally Vistaril is a pretty mild, dare I say safe drug. Monitoring is in accordance with the American Academy of Pediatric Dentistry's recommendations. Usually a pulse oximeter is not necessary for minimal sedation, but each case is different. Minimal sedation usually only requires observation and intermittent assessment of the level of sedation. Only when/if they slip into a moderate level of sedation would mechanical monitoring methods be indicated.

You actually might want to be prepared that your child will still be fussy even with the Vistaril. If that is the case, I would suggest a Pediatric Dentist if possible so they can assess the situation. Of course I would recommend that anyways, but I understand your situation as you have explained.

Hello,I'm a mother of a 4 yr. old who just visited...

2007-02-26T13:13:00.000-08:00

Hello,
I'm a mother of a 4 yr. old who just visited our dentist for some fillings. I'm very consistant about our dental care but this was his 1st visit for cavity work. My son had a high level of anxiety before, during & after and with no success of having the fillings completed. We barely made it for a temp. filling. We tried laughing gas and he wanted no part, so my dentist prescribed Visteral 25mg/5ml for a future appt. to be taken 1 hr. prior to his visit. Since I've never had to go this far into dental sedations and after reading yours & other's websites, I'd like to know if my son should be monitored mechanically ( i.e., pulse/heart)while having his fillings done. Is monitoring standard/required for when it's a concious sedation? My dentist seems to get irritated when I question his level of knowledge, etc. I know I should probably find someone else, but I'm limited due to location in the country and don't want a dentist that's an hour away if needed. Thank you for your time.