Sedation

Sedation dentistry refers to the use of sedation during dental treatment. Sedation is most commonly used during extensive procedures, for patients with dental phobia or for patients who find it difficult to sit still. There are different types of sedation, including general anesthesia, conscious sedation, nitrous oxide ("laughing gas"), Midazolam and Valium.

Sedation is endorsed by the American Dental Association and is an effective way to make many patients comfortable during their dental visit. Before using a sedative or anesthetic, it is important to tell your Dr. Barbee about any medications or medical treatments your child is receiving. Before administering any sedative or anesthetic, Dr. Barbee will talk to you about the process of sedation and pre- and post-sedation instructions.

General Anesthesia  |  Conscious Sedation  |  Nitrous Oxide  |  Midazolam  |  Valium

General Anesthesia

What is general anesthesia?
General anesthesia provides a way of effectively completing dental care while a child is unconscious.

Who should receive general anesthesia?
Children with severe anxiety and/or the inability to relax are candidates for general anesthesia. Usually these children are young or have compromised health issues and helping them control their anxiety is not possible using other methods.

Is general anesthesia safe?
YES! In addition, to ensure the best possible care of your child, Dr. Barbee requests that all of his general anesthesia cases be covered by a pediatric anesthesiologist. They are responsible for delivering the general anesthesia, monitoring and medical care of the child. Many precautions are taken to provide safety for the child during general anesthesia care. Patients are monitored closely during the general anesthesia procedure by anesthesia personnel who are trained to manage complications. Dr. Barbee will discuss the benefits and risks involved with general anesthesia and why it is recommended for your child’s treatment.

What special considerations are associated with the general anesthesia appointment? Most of the time, your child’s surgery will be done on an “outpatient” basis. This means they will have their surgery in the morning and be allowed to go home in the afternoon.

  • A physical examination - is required prior to a general anesthesia appointment to complete dental care. This physical examination provides information to ensure the safety of the general anesthesia procedure. Dr. Barbee will advise you about any evaluation appointments that may be requested.
  • Prior to surgery- Minimal discussion to your child about the appointment may reduce anxiety, Explain they are ‘going to go to sleep when their teeth are being fixed’.
  • Eating and drinking - It is important NOT to have a meal the night before general anesthesia. You will be informed about food and fluid intake guidelines prior to the appointment.
  • Changes in your child’s health - If your child is sick or running a fever, contact Dr. Barbee immediately! It may be necessary to arrange another appointment.

Usually, children are tired following general anesthesia. You may wish to return home with minimal activity planned for your child until the next day. After that, you can usually return to a routine schedule.

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Conscious Sedation

What is conscious sedation?
Conscious sedation is a way of using medication to relax a child without the loss of consciousness.

Who should be sedated?
Dr. Barbee recommends that those children with severe anxiety and/or the inability to relax are candidates for sedation. Usually these children are young or have trouble managing their anxiety.

Why does Dr. Barbee use conscious sedation?
Conscious sedation aids in calming a child so that he or she can accept dental treatment in a more relaxed state. This can prevent injury to the patient and provide a better environment for delivering quality dental care - it is hard to do dentistry on a moving child!

What medications are used?
Dr. Barbee has many different agents that are used for conscious sedation, from inhalation agents (laughing gas) to medicines that are drunk from a cup. None of these sedatives render the child unconscious. Dr. Barbee will base his recommendations of medications to be used based on the child’s age, level of anxiety, amount of dental work that needs to be completed and length of appointment.

Is sedation safe?
Dr. Barbee has had two years of advanced training to administer, monitor and manage sedated patients. He also exceeds the standard of care in his monitoring and emergency equipment.

Dr. Barbee is trained and certified in Pediatric Advanced Life Support.

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Nitrous Oxide

Many children are calm, comfortable and confident in Dr. Barbee’s pediatric dental office! Because Dr. Barbee specializes in treating children, he makes them feel special. His office is especially designed for children and adolescents) Sometimes, however, a child feels anxious during treatment. Your child may need more support than a gentle, caring manner to feel comfortable. Nitrous oxide/oxygen is a safe, effective technique that Dr. Barbee offers to calm a child’s fear of the dental visit.

What is nitrous oxide/oxygen?
Nitrous Oxide/oxygen is a blend of two gases - oxygen and nitrous oxide. When inhaled, it is absorbed by the body and has a calming effect. Normal breathing eliminates nitrous oxide from the body.

How will my child feel when breathing nitrous oxide/oxygen?
Dr. Barbee will give your child the opportunity to choose a “flavor” of air to breathe. Your child will smell this “flavored air” and experience a sense of well being and relaxation. If the sights, sounds or sensations of dental treatment worry your child, he or she may respond more positively with the use of nitrous oxide/oxygen.

How safe is nitrous oxide/oxygen?
Very Safe! Nitrous oxide/oxygen is perhaps the safest sedative in dentistry. It is non- addictive. It is mild, easily taken, then quickly eliminated by the body. Your child remains fully conscious - keeps all natural reflexes - when breathing nitrous oxide/oxygen.

Are there any special instructions for nitrous oxide/oxygen?
First, give your child little or no food before the dental visit (occasionally, nausea or vomiting occurs when a child has a full stomach). Second, tell Dr. Barbee about any respiratory condition that makes breathing through the nose difficult for your child (a common cold, asthma, sinus problems, etc.). It may limit the effectiveness of nitrous oxide/oxygen. Third, tell Dr. Barbee if your child is taking any medication on the day of the appointment.

Will nitrous oxide/oxygen work for all children?
Dr. Barbee knows that all children are not alike! Every service is tailored to your child as an individual, Nitrous oxide/oxygen is not effective for some children, especially those who have severe anxiety, nasal congestion or extensive treatment needs, Dr. Barbee has comprehensive specialty training and can offer other sedation methods that are right for your child.

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Midazolam

Dr. Barbee will often choose to use Midazolam (Versed) for children under the age of four for invasive, short procedures involving brief stressors. Midazolam is an excellent short- acting agent with a rapid onset of 15 - 20 minutes. Midazolam will NOT cause your child to go to sleep, but will act as a retro-amnesia medicine (usually they will not remember the dental procedure).

Benefit characteristics include:

  • decreased anxiety
  • short acting sedative
  • retro-amnesia of appointment

Potential risks and side effects may include:

  • persistent agitation after the procedure (hydration with glucose seems helpful in reducing this)
  • can expect poor results when extending treatment time (>25-30 mm.)

Dr. Barbee will dose your child’s medicine based on their weight, NOT their age! Midazolam comes as a cherry flavored syrup that is usually delivered by mouth through a “squirter” (similar to children’s Tylenol or Advil).

Please be sure that your child does not eat or drink 3 hours prior to their dental appointment! If they eat or drink anything, Dr. Barbee will reschedule your appointment (broken appointment fee will apply).

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Valium

Valium is used for management of anxiety and to provide light sedation and amnesia, This medication will NOT cause your child to be asleep during the dental procedure.

Route & Absorption: administered orally and well-absorbed from the gastro-intestinal tract, the onset of medication occurs within 60-90 minutes of administration. The amount of valium given will be based on your child’s weight.

Pre-Valium Appointment Instructions

  1. Your child should have NOTHING to eat or for the following times:
    • Morning dental appointment: nothing after midnight the night before the appointment.
    • Afternoon dental appointment: nothing after 10 am the day of the dental appointment.
  2. If you are going to be unable to keep your appointment, please call Dr. Barbee’s office at least 24 hours in advance.

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