Sedation and general anesthesia for dental work in children

What is the difference between sedation and general anesthesia?

Sedation – calming medication leading to different levels of consciousness. Sedation can be ‘light’, where the child is able to respond to external stimuli and to voice or it can be ‘deep’, where only very painful stimuli will elicit a response. When a child is under light sedation, they will able to breathe on their own, they do not feel pain and most of the time they will also not remember the procedure.

General anesthesia – a sleep-like state. There are also different levels of general anesthesia. Full general anesthesia means a complete loss of consciousness, loss of essential reflexes, muscle paralysis (which means the patient is unable to breathe on their own) and loss of response to external stimuli/pain.

In most places, sedation can be performed in outpatient dental offices in the community. If general anesthesia is required, the procedure can only be done at a hospital under special circumstances.

When is sedation advised for dental work?

Our general tendency, both as caretakers and as parents, is to try and perform all required care and procedures without sedation or anesthesia. That is, if we can maintain full control over pain, so that the child agrees to return for further care fearless.
But here and there we may come across situations when sedation is required for treatment.
In certain scenarios, the use of sedation to complete dental work in children is very effective and can help turn the experience into a positive one, without any discomfort or pain for the child. At the same time, it increases the chances of having a successful treatment.

So, when would I advise a family to perform treatment under sedation?

– When the child is completely non-cooperative due to anxiety, mental or physical challenges
– When the planned procedure is long and requires several visits
– When the planned procedure is complex and difficult, and I know that the child will not be able to handle being awake throughout

How is sedation carried out?

Sedation can be done in one of several ways:
– Nitrous oxide inhalation, also known as laughing gas.
– A conscious or ‘light sedation’ using a calming medication taken by mouth or through suppository, combined with laughing gas
– A deeper sedation with the help of an anesthesiologist who is present throughout the procedure

What will the child feel when they are under sedation?

Depending on the type of sedation performed, the child will feel sleepy, will have clouding of consciousness, but will be able to respond to orders.
The length and manner of recovery may differ among children. Some children will wake up and immediately return to normal activity while others may feel sleepy for a short period of time.
Regardless, the child will only be discharged from the dental office once they are fully awake and have had something to eat and drink.

Are these practices considered safe in children?

All of the practices performed at dental clinics are considered safe and must be approved by the local health authorities. Obviously, one must take into consideration that any type of treatment or procedure has its potential complications, and you must be made aware of these complications in advance. So, despite sedation being a safe practice, it could still cause complications such as shortness of breath, extensive vomiting episodes, apathy, or difficulties upon awakening. However, these complications are rare.

To make sure the treatment is as safe as possible, it should be performed by a pediatric dentist who has had lots of experience; one who knows how to examine the child prior to the procedure (including an examination of the adenoids and airways) and determine what type of sedation best fits the child. Each case should be assessed individually.

In summary, a good pediatric dental clinic is one that offers dental work under sedation following careful consideration and is able to offer sedation with the presence of an anesthesiologist as well.

I wish you well and that your child is able to undergo dental work pleasantly, without sedation. But if sedation is required, make sure to do it at a place that specializes in children, provides them with the best and kindest care, and follows all the safety protocols needed.