Dental treatment is one of the most common reasons for giving general anesthesia to children. Most pediatric surgical dentistry is performed to treat tooth decay, a preventable disease of the mineralized tissues of the teeth. This may involve restoring teeth, extracting or surgically removing teeth that cannot be restored, and scraping teeth to prevent periodontal problems. As these procedures are often associated with a significant amount of pain and anxiety, pharmacological behavioral treatment is required. Children in this age group can cooperate with dental treatment performed under local anesthesia, with or without sedation.
This anesthetizes the bone of the mandibular body and the pulps of all the teeth on that side of the mouth, except perhaps the central incisor, where there may be some cross irrigation from the lower dental nerve on the opposite side. In Alberta, dentists are no longer allowed to administer anesthesia and perform a dental procedure to a patient. More extensive dental surgery, such as wisdom tooth extraction, may require tracheal intubation. Therefore, it is important to talk to your child's dentist or oral surgeon about the type of sedation or anesthesia that he or she recommends (and practices regularly) for your child's dental treatment before the appointment. In some states, nurse anesthetists can administer anesthesia in a dental office without the supervision of a dentist or doctor. Children who cannot tolerate dental procedures with local anesthesia can only be treated with a conscious sedation technique, which causes a moderate decrease in the level of consciousness.
After discussing sedation and anesthesia options with your child's dentist or oral surgeon, find out exactly who will administer the medications and who will monitor your child during the dental procedure. As in all episodes of pediatric anesthesia, the goal should be to ensure that the child is in the best possible physical and psychological condition to undergo the dental procedure. The dental surgeon usually places a pharyngeal pack to prevent breathing through the mouth and to protect the respiratory tract from dirt. Anesthesia can be given in a specially equipped dental office, in an ambulatory surgical center (ASC), or in a hospital. A Ferguson mouthpiece or McKesson mouth accessory is then used to keep the mouth open during tooth extractions. Unless specifically recommended by a cardiologist, antibiotic prophylaxis against infective endocarditis is no longer indicated for children with heart injuries who are undergoing dental procedures.
Once your child is considered to be a good candidate for general sedation, you should ensure that the person administering the general anesthetic is a licensed dental anesthesiologist or a dentist who has received authorization from the dental authority in your province to administer general anesthesia. Conscious sedation can be used as an alternative to general anesthesia for dental treatment in older children.
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