Would My Child Benefit From Sedation Dentistry?

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2020

Would My Child Benefit from Sedation Dentistry? ( Part II )

By Dr. Maria Grosman

Last month’s editorial (Part 1) covered the process in deciding upon the need and therefore use of sedation dentistry. This process requires the consideration of many factors ranging from the child’s dental needs and age to family finances. This month’s article will assume the need and focus mostly on available options. In other words, it will tend to be less emotional and more scientifically driven.

The major criteria in choosing a specific sedative agent is the depth of sedation desired. The concept of level of sedation is so important that most professional organizations categorize sedation not by the individual drugs or route of administration but rather through the level of sedation created. The categorized levels of sedation are the following: minimal sedation, moderate sedation, deep sedation and general anesthesia. The importance of this distinction is that a facility must be adequately staffed and equipped to monitor the level of sedation used. It is important to note that facilities offering different modes of sedation are strictly regulated and go through an annual recertification process.

In an effort to simplify the discussion, I will review some sedative medications based on mode of delivery as this is usually how they are presented in the office setting. Nitrous oxide, or “laughing gas,” is the only inhalation sedative used in pediatric dentistry. It is used as a “minimal sedative” mostly for its relief of anxiety. It is mixed in combination with pure oxygen which assures proper concentration of oxygen to the body. Its excellent safety record along with versatility of use makes it the most commonly used sedative agent in pediatric dentistry.

The oral sedatives can potentially span all of the levels of sedation. For example, Diazepam (Valium) or Diphenhydramine (Benadryl), when used by themselves, are mostly used as minimal sedatives. However, when used in larger doses or in combination with other oral sedatives, these agents can cross over into moderate sedation or even deep sedation. There are many factors having to do with their absorption through the digestive system, which make them more unpredictable in terms of the degree of sedation as well as duration of effect. For this reason, their use is not usually recommended for extensive treatment plans and is usually titrated from visit to visit.

The sedatives delivered intravenously are used for the purpose of deep sedation. The use of these agents can be used for extended treatment times and can usually be reversed if needed by antagonist agents. Thus, intravenous sedation is the most versatile and predictable technique used in the dental office. General anesthesia, practically speaking, provides for similar conveniences as intravenous sedation. However, general anesthesia must be performed in a hospital setting and is specifically used for patients who have a higher potential for airway obstruction.

When considering the use of sedation for your child, it is important to recognize that one form of sedation is not inherently better than another. Be open to all options and consider which is most appropriate for the individual patient and situation. The goal of proposed treatment should not only be the effective completion of needed dental work but more importantly doing so with a resultant positive attitude and safety of the child. This cannot be consistently achieved with a one size fits all approach. ▸ The office of Dr. Maria Maranzini-Grosman (Board Certified Pediatric Dentist) and Dr. Alon Grosman (Specialist in Orthodontics) is located at

South Flamingo Road on the NW corner of Griffin and Flamingo Road.

For more info or to schedule an appointment, call 954-236-3434.