tag:blogger.com,1999:blog-16472438.post6542570187546557084..comments2024-03-19T00:19:27.317-07:00Comments on Pediatric Dentistry: Sedative Drugs Used in Pediatric DentistryDr. Dean Brandonhttp://www.blogger.com/profile/08709454067987829233noreply@blogger.comBlogger81125tag:blogger.com,1999:blog-16472438.post-49060605417556038232011-08-09T16:22:18.808-07:002011-08-09T16:22:18.808-07:00I am closing the comments for this post as I often...I am closing the comments for this post as I often do for older posts that have a large number of comments. There are over 80 comments at this point. There really cannot be enough discussion about this important topic, but as a blog post, what is here is very complete. God Bless.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-13369466168593724742011-08-09T16:02:01.499-07:002011-08-09T16:02:01.499-07:00Usually an oral surgeon will administer whatever m...Usually an oral surgeon will administer whatever medications are necessary to achieve the desired result. We usually use Versed as an oral medication (as they do in the Operating room prior to general anesthesia), which works great most of the time, but can lead to unpredictable results in a few cases. The IV is better and can be used by some oral surgeons. If you can start an IV in an anxious child however, you usually can do the work without any premedication. Still, the oral surgeon can make adjustments to get him where he needs to be to be comfortable even if it means all the way asleep. Talk to the oral surgeon about what they are using if you have further questions.<br /><br />I will refer patients to an oral surgeon for wisdom teeth removal and sometimes for other more routine extractions for patients who do not respond well (like they have a very high anxiety level not amenable to oral medications).Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-9339929941162294722011-08-09T11:43:55.944-07:002011-08-09T11:43:55.944-07:00When I got custody of my grandson he was 2 1/2 and...When I got custody of my grandson he was 2 1/2 and had to have dental restoration under general anesthetic in a hospital. It was quite traumatic for him. He had one molar which required pulptomy & a crown along with many other caps/crowns. Now the molar is abcessed and will be removed along with 2 upper baby teeth due to crowding as recommended by the orthodontist. A spacer for the molar will be put in when it heals using Nitrous Oxide. Our pediatric dentist is sending him to an oral surgeon (so his pediatric dentist's office will remain a "happy place") for the procedure who will use Versed. My grandson is now 6. My concern is that antihistimines, Singular, even Zyrtec all make him hyper. What are the chances of Versed having the opposite intended effect on him? Also I had an abcessed tooth pulled before and it was quite painful even with novacaine. Wondering if the pain level will be as severe since it is a baby molar.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-16472438.post-48598524081803342322011-07-20T15:01:26.292-07:002011-07-20T15:01:26.292-07:00An anesthesiologist should know how to properly an...An anesthesiologist should know how to properly and safely premedicate a child for dental procedures. It is certainly a stressful situation. They usually base dosages on weight or something like body surface area and age, etc. Ask them if you have any specific questions.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-44403284580091860652011-07-20T09:22:16.792-07:002011-07-20T09:22:16.792-07:00Hello,
My son is almost four and he has prescribed...Hello,<br />My son is almost four and he has prescribed a procedure for left molar extraction and two right back teeth crown under IV sedation. he is a small baby like only 3 pounds and very small in height too. I am sooooo worried about IV sedation for him which is kind of general anesthesia any way.<br />He is alreafy delayed in speech and have sensory issues.How much Iv sedation have risks for somebody like him?Is IV is given by weight?The procedure would take place in office with anestheiologist team coming to the office.How long these chemicals would take take to be out of his system.Please help!<br />I am very stressful.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-16472438.post-13637235581329125672011-07-01T07:20:25.526-07:002011-07-01T07:20:25.526-07:00Valerie,
1. Most kids do well without any medica...Valerie,<br /><br />1. Most kids do well without any medications.<br />2. The procedures are not actually that difficult for the patient.<br />3. Some children do benefit from sedative medications.<br />4. A pediatric dentist would not give medications without reviewing the medical history.<br />5. It would be out of the ordinary I think, for the physician to prescribe medications, but not unheard of. Certainly if you have concerns with a medical problem consultation with the patients physician is ok.<br />6. Most pediatric dentist's fees are not based on the medication itself. If it's just a valium at home, then yes, the patient fills a prescription, gives it at home. However, demerol and like medications must be given in the office. Our fee for conscious sedation with the heavier medications like that is the same no matter where the medicine comes from. We provide the medications in our office. Any sedation fee is for the extra monitoring , staff, extra scheduling time, liability and finally the actual medications.<br />7. Some parents ask me the same thing, "can you try without meds first"? It is certainly the parents prerogative to decide what is done-or not, and rarely, the kids do surprisingly fine. However, if medication was recommended, there is a reason. If things do not "go well" then the second appointment attempt may have much less chance of success even with sedative medications, as anxiety levels would be higher. So, not usually a good idea. At least that is what I see often in such cases. I'd rather have a good first experience for a child with sedative medications, then later on, they may not need any medications at all, once they get slightly older and/or realize it's not such a big deal due to their good experience the first time. <br />8. Each child is different.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-88300859545518998932011-07-01T00:24:55.124-07:002011-07-01T00:24:55.124-07:00Hi Doc,
My six year old had his first visit and ev...Hi Doc,<br />My six year old had his first visit and everything went well. He has one cavity that will require a crown, and six back teeth that need fillings. I took him to MY old pediatric dentist, which was very neat by the way, and he did great! I had a lot of dental work done on my teeth when I was younger (milk-teeth) and my mom doesn't remember my dentist ever using conscious sedation...only the "elephant nose" (laughing gas). They didn't even have the freezing stuff so you wouldn't feel the shot. I can't tell you how many times I heard "Okay, here's the little bee sting." It never FELT little! Hahaha.<br />Still, knowing this and growing up with no fear of my dentist...I am now faced with the dilemma of being told I have to give my son Demerol before his procedures. I have asked that we try to have the procedure done without it first...and if it doesn't go well, then I'll use the sedative. Here's my question: Can I go through my son's pediatrician for sedation meds? I'd rather have her input since she knows his medical history a bit better...plus it might actually be covered under my insurance, since my dental doesn't consider it a necessity. What are your thoughts?Valerie G.https://www.blogger.com/profile/14089685604464326478noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-54385642713468303122011-06-29T06:32:26.651-07:002011-06-29T06:32:26.651-07:00If a child already has sedative medications on boa...If a child already has sedative medications on board Tylenol or Motrin is all that is usually needed for any post op discomfort. It may depend on what is done. A couple baby teeth are usually no problem. Even bicuspids are easy to care for. A large surgical extraction may need post op narcotics but you gave to adjust based on what premedication drugs were used. It's up to the doctor. You can ask them what they recommend in your particular case.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-28109318101033744052011-06-29T05:52:05.587-07:002011-06-29T05:52:05.587-07:00What about afer care ? My ten year old daughter ne...What about afer care ? My ten year old daughter needs a tooth pulled, what medication is prescribed after ?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-16472438.post-64110462302709166082011-06-23T17:08:24.847-07:002011-06-23T17:08:24.847-07:00I am aware of these studies. As of this time, the...I am aware of these studies. As of this time, there is still no evidence of any problem for shorter procedures, like less than four hours. Most dental procedures are less than 2 hours. Still, it's always of concern. We rely on anesthesia and physician professionals to get more data and make recommendations. So, far they have not seen anything to make a change at this time.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-13987550291408117712011-06-23T16:45:57.743-07:002011-06-23T16:45:57.743-07:00Dr. Brandon, Thanks for maintaining such a good bl...Dr. Brandon, Thanks for maintaining such a good blog! As to sedation and anesthesia, what do you think of the following information? FDA is re-evaluating whether General Anesthesia is causing cognitive risks in young children.<br />http://www.nytimes.com/2011/03/10/science/10anesthesia.html<br /><br />I talked to several pediatric dentist, they seemed to dismissed it right away!Lingnoreply@blogger.comtag:blogger.com,1999:blog-16472438.post-83059312910786484722011-06-18T10:32:40.333-07:002011-06-18T10:32:40.333-07:00My 2 year old daughter needs to have extensive den...My 2 year old daughter needs to have extensive dental work. Her pediatric dentist told me that she would need to use chlorahydrate and phenergan in order to perform all of the work required for cavities and root canal and other treatments. I am nervous about having this sedation administered to my daughter but I am also nervous that if I wait until she is older, it may end up getting worse. Some people have also said that her baby teeth will fall out anyway, so I should just wait... but I dont know if thats a smart idea either.<br />Ultimately my questions are the following:<br /><br />1. Is there many risks involved to administer chlorahydrate and phenergan to a 30 pound 2 year old?<br /><br />2. Is there harm in waiting until she is older to have the dental work done?<br /><br />Thanks.snowflake130.52https://www.blogger.com/profile/00980877409192494534noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-36001519157217615992011-06-10T16:45:14.665-07:002011-06-10T16:45:14.665-07:00I cannot say. A three year old can, but I don'...I cannot say. A three year old can, but I don't see it that often. By the way, you may want to look up here on the blog "what is a pulpotomy."Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-17437802041919072752011-06-10T14:47:02.347-07:002011-06-10T14:47:02.347-07:00Thank you Dr Brandon for your response . My child ...Thank you Dr Brandon for your response . My child is very co-operative. the procedure he needs is pulpotomy . In your experience can a 31/2 yr old can do good with nitrous oxide.rwadhnoreply@blogger.comtag:blogger.com,1999:blog-16472438.post-66185110992770629072011-06-09T19:18:02.320-07:002011-06-09T19:18:02.320-07:00Read more here on the blog about Nitrous Oxide or ...Read more here on the blog about Nitrous Oxide or Laughing gas. It's pretty mild but does help. I do not consider it "sedation" but light analgesia. To me sedation involving the drugs you mentioned is a more profound sedative. Still, as you can read here, there are a lot of variation in behavior. What procedure you are doing matters as well. A cooperative child for a cleaning or even a small filling might not be a cooperative for more involved procedures like pulpotomies and crowns. It's a judgement call for the dentist and parents.<br /><br />There are three year olds that can do surprisingly well without any pharmacologic sedation, but it's not too many--or if they do well, maybe for not too long. All kids get tired after a while.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-6010131821386055562011-06-09T18:48:46.623-07:002011-06-09T18:48:46.623-07:00My 3 yr 4 month old needs pulpotomy done on tooth ...My 3 yr 4 month old needs pulpotomy done on tooth S and L. I'm confused between Nitrous oxide and Sedation( i think office uses chloral hydrate and phenargan) . He is a very cooperative child. In you experience at this age, can they do good with nitrous oxide.Rwadhnoreply@blogger.comtag:blogger.com,1999:blog-16472438.post-83468723604682338932011-04-27T18:01:27.107-07:002011-04-27T18:01:27.107-07:00My son is 6 and has to have a tooth filled tomorro...My son is 6 and has to have a tooth filled tomorrow am and the dentist gave him valium 5mg for 57lbs before we go, usually he don't use anything and my son cooperates like a trooper, is this ok I am really nervous about giving it to him it sounds like alot for a child..Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-16472438.post-7182537169028794172011-04-18T16:12:11.680-07:002011-04-18T16:12:11.680-07:00I'm glad you have such a profound knowledge......I'm glad you have such a profound knowledge...<br />This is a list of drugs often used by pediatric dentists. CH is not used in every case and only in appropriate dosages. Patient selection and evaluation and proper protocols and monitoring is what it's all about.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-22318117664574702732011-04-18T15:18:44.391-07:002011-04-18T15:18:44.391-07:00chloral hydrate! That tells me all I need to know ...chloral hydrate! That tells me all I need to know about your training.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-16472438.post-18299715741967024912010-11-16T13:50:34.948-08:002010-11-16T13:50:34.948-08:00That is, best to WAIT. Sorry a typo there.That is, best to WAIT. Sorry a typo there.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-49224469052705544282010-11-16T12:49:57.826-08:002010-11-16T12:49:57.826-08:00Jessica, we advise our patents to reschedule if a ...Jessica, we advise our patents to reschedule if a child has a cold or fever. I suppose they would evaluate his airway and health prior to sedation. It is very important to have a good airway. Sometimes it is ok if it's just a slightly runny nose. All that can be evaluated the day of treatment, but sometimes you can just tell that it's best to eait. Ask your dentist.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-80673105258969807292010-11-16T10:50:08.627-08:002010-11-16T10:50:08.627-08:00I don't know if the questions are still being ...I don't know if the questions are still being answered, but I thought I would try. My son is supposed to go in for a couple caps and a filling tomorrow. They want to concious sedate him. What I wanted to know is he has had a cold. All he has right now is a stuffy nose and it hasn't escalated from there. I called the dentist's office and let them know and the lady told me that they would check his lungs before they started to make sure they were fine and if anything looked wrong then we would reschedule. Would it be best to re-schedule his appointment or go forward with it since he only has a runny nose? Thanks!Unknownhttps://www.blogger.com/profile/15536560055961130404noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-17209700555386335972010-08-26T17:06:59.837-07:002010-08-26T17:06:59.837-07:00BCG asks: "Is it common to sedate a 4 year ol...BCG asks: "Is it common to sedate a 4 year old with 50mg of demerol to repair cavities? " There are many four year olds that weigh a lot and some do not and dosage id often calculated based upon weight. Demerol is used for children of that age usually in combination with other meds. The usual dosage is 1mg /kg. It can be higher, up to 2mg/kg if used alone or with milder drugs like Atarax. No matter the weight, I personally do not go over 50mg.<br /> <br />Dosage is also dependant ot behavior and the procedure comtemplated and medical conditions. Oral dosages are often higher than IV for narcotics due to first pass metabolism in the liver before it ever gets into the bloodstream. In addition, IV dosages are much lower for the same behavioral response. So, there is not a yes or no answer. It is important to not overdose. If you are unsure, ask your pediatric dentist. Any medication in children should be given in accordance with the Academy of Pediatric Dentistry guidelines, and in my opinion by a specialist in Pediatric dentistry who has experience in using sedative medications in children.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-9288330111445243562010-04-06T12:11:53.513-07:002010-04-06T12:11:53.513-07:00Fees for things like that also take into account t...Fees for things like that also take into account the liability of handling and administration of drugs as well as monitoring equipment and staffing, etc. Actually, sounds like those fees are even on the low side. Certainly, non coverage by insurance would make anyone mad. Often, conscious sedation is not covered by insurance. Fees for general anesthesia can run thousands.Dr. Dean Brandonhttps://www.blogger.com/profile/08709454067987829233noreply@blogger.comtag:blogger.com,1999:blog-16472438.post-37505420512202942402010-04-06T09:33:44.098-07:002010-04-06T09:33:44.098-07:00I can't believe I just received a bill from my...I can't believe I just received a bill from my pediatric dentist with 2 charges one for $22 laughing gas and one fo $83 sedative. Neither of these are covered by insurance and I must say $83.00 seems extremely high for a small cup of liquid sedative! I'm not happy about this. Seattle, WAAnonymousnoreply@blogger.com