Children’s Sleep Dentistry Brisbane

Children with dental infection or pain require dental treatment at any age. In some cases, that calls for dental sedation or general anaesthesia. Whether the dental procedure requires your child to lie still or your child is afraid of the dentist, the goal is to offer the most pain-free and safest treatment.

Sleep dentistry for children in Brisbane is usually very safe, and there are things you (the parent) can do to make it safer. (That is, reduce stress and risk levels before, during, and after treatment.)

The following is an overview of the different types of sleep dentistry, their requirements, and other vital considerations. (The goal is to help you know your options and get familiar with your child’s dental work – before and after the appointment.)

Sedation dentistry (or dental sedation) uses calming drugs to manage anxiety, panic, or special needs when your child is undergoing dental procedures. Sedation is necessary when:

• Several dental procedures are performed at the same time
• The safety of your child is compromised
• Your child is uncooperative
• Your child has a strong “gag” reflex

Sleep dentistry may be categorised into four types, as discussed below.

One: Happy Gas or Laughing Gas

Dental treatment under happy gas is not really considered sleep dentistry, but it can ease dental anxiety in some children and adults. Happy gas is also commonly called laughing gas. It is a safe, mild sedative that may help kids remain calm and relaxed while undergoing dental treatments. The sedative is administered using a “space mask” that carries oxygen mixed with the “laughing gas”.

Your child should breathe through the nose (not the mouth) for best results. The sedation technique takes effect within 5 minutes, but the mask remains on throughout the dental procedure.

Being a conscious technique, your child remains awake throughout dental treatment using laughing gas and may experience a “happy” feeling. Once the treatment is complete, the dentist turns off the”laughing gas,” and the child is left to breathe pure oxygen for approximately 5 minutes – to clear out the remaining nitrous oxide gas.

Nitrous oxide is ideal for:

• Kids who (willingly) accept the nasal mask
• Kids can comfortably breathe through their nose

Precaution

• Limit your child to very light meals before the procedure – think bagel and toast.
• Advise your Brisbane kids dentist if your child is congested, has flu/cold, or cannot breathe via the nose

Side effects

Nitrous oxide gas can cause kids to be a little lightheaded and silly.

Two: General anaesthesia (GA)

Dental treatment of toddlers and young children under General anaesthesia is very common because it avoids traumatising very young children who are not very cooperative in a normal dental chair. With GA (dental treatment under general anaesthesia), your child is fully asleep, and their sleep will be monitored by a paediatric anaesthetist. GA is usually done in a hospital environment because it provides the best protection.

The technique requires specially-trained anaesthesia specialists and nurses to administer the medication and monitor the sleep – while a paediatric dentist performs the dental care.

GA is ideal for kids:

• With disability and other special needs like ADHD, severe autism, and Cerebral Palsy
• Needing complex dental care like fillings, stainless steel dental crowns, zirconia crowns, composite crown, kids root canal and kids extractions
• Who’s uncontrollable with other sedation procedures
• Who’s extremely uncooperative
• With extensive dental trauma

For children with large tonsils, sleep apnea and chronic upper respiratory disease, a thorough evaluation by the anaesthetist will need to be performed prior to the surgery day.

Three: Oral Sedation

Oral sedation is a conscious technique in which your child is given a pill (form sedative) and instructed to ingest it before the treatment begins. The sedative is taken through the nose or by mouth.

Oral sedatives do not put your child to sleep. However, the child may feel a little drowsy or sleepier depending on the dose of the drugs used. Regardless, your child will be calm and relaxed – and sometimes able to do as the paediatric dentist or dentist instructs. According to Brisbane Paediatric Dentist, anaesthetists may provide children with oral sedation before general anaesthesia to make the process smoother and more comfortable for them.

The sedative begins to work within 20 minutes; your child’s dentist will have them take the pill once you arrive at the clinic.

Oral sedation may be suitable for older children who:

• Are relatively less afraid of the dentist
• Have minimal dental needs
• Healthy and cooperative

Once administered, older kids can breathe on their own and wake up quickly. Most kids do not remember anything about the treatment session.

Side effects

Oral sedation is known to cause the “angry child syndrome,” which is self-limiting once the medication wears off. If the reaction is severe, the dentist may opt to reschedule the appointment.

This method of sedation is not recommended.

Four: Intravenous sedation

Intravenous sedation techniques are usually not used in paediatric dentistry. Here, the dentist inserts a needle into your child’s vein on the hand or arm. The oral surgeon can administer more medications in cases of lengthy procedures to keep your child relaxed.

The Dental Board of Australia recommends administering the “laughing gas” before inserting the needle into the child’s veins.

While your child can make noise and move, they may not breathe well on their own. Thus, a tube may be inserted into their throat to aid breathing. One or more qualified professionals, such as anesthesiologists, must serve as independent observers. The added professionals must monitor your child’s heart rhythm, heart rate, oxygen saturation, and blood pressure throughout the treatment – until the child wakes up.

Intravenous injection is ideal for:

• Longer dental procedures
• Relatively younger kids (below two years)
• Older kids who are uncooperative or afraid of the dentist

The appropriate sedation technique for your child depends on below and many other factors that your paediatric dentist will consider:

• The child’s age
• The level of the child’s perceived anxiety or dental trauma
• The complexity of the dental procedure
• The history of the child responding to similar operations
• Existing medical conditions
• Weight of the child
• Current and previous medications
• Allergies
• Developmental, psychological, and physical status of the child
• Airway patency
• And more

Keeping the child calm and panic-free is essential for a smooth dental procedure. To achieve that:

• Dress the child in loose-fitting clothes to keep them comfortable while letting the dentist attach monitors with ease.
• Bring along the child’s favourite blanket or toy.
• Keep your child distracted with soft play items or toys
• Hold their hands, talk, or sing to them
• Avoid words with negative associations, such as pain, injection, or needle.
• Keep calm as kids can perceive when you’re nervous. (If you have trouble keeping calm, have the dentist walk you through the operating room and the entire procedure.)
• Stay with your child during induction to reduce anxiety. (Some kids become upset when in unfamiliar environments.)
• Involve the child when touring the facility

(Be aware that your child will need close supervision after sedation. For maximum attention, therefore:

• Don’t bring other kids besides the one needing treatment. That lets you focus on the child getting treated, which can be reassuring to them.
• Be accompanied by an adult who can do the driving as you focus on the child.
• Avoid physical activities like swimming, running, and sports throughout the treatment.

Depending on the type of dental sedation, you will likely deal with these medical professionals.

• General dentist: Has passed all the necessary dental exams and obtained a dental license.
• Paediatric dentists: Specialises in dental treatment for children
• Oral surgeon: Has completed an oral maxillofacial residency and dental school.
• Anesthesiologists: Has completed the required anesthesiology residency.
• Nurse anaesthetist: a registered nurse who has completed an anesthesiology program residency after nursing school. They have also obtained the necessary clinical experience
• Dental hygienist: Has completed a dental hygiene course after high school
• Dental assistant: Has no formal training but may possess a certificate program.
• Dental sedation assistant: Has a certificate permitting them to observe patients under GA.

When sedation is a necessity, there are some fast guidelines that you must follow before the treatment. Your dentist should inform you of these guidelines a day (or two) before your appointment.

Often, the fasting guidelines depend on the child’s age and the type of sedation. Here’s a brief overview of such requirements – but be sure to follow the instructions outlined by your dentist.

Kids under one year

• Feed formula-fed babies the formula up to 6 hours leading to the appointment
• Breastfeed breastfed babies up to 4 hours leading to the appointment

All children

• Do not give non-clear liquids or solid food to kids beginning at midnight, leading to the appointment. (Non-clear liquids include: juices, coffee, milk, formula, candy, or gum.)
• Give clear liquid to the child up to 2 hours before the appointment. (Clear liquids include water, clear juices, Pedialyte®, and Kool Aid®.)
• Follow the issued instructions with regards to daily medications.

One vital precaution in sleep dentistry for children is providing the oral doctor with your kid’s medical history. The medical history helps the dentist in prescribing any medications, OTCs, or herbal supplements. It is also handy when monitoring the child’s blood pressure, temperature, blood oxygen saturation, heart rhythm, and heart rate.

(Kids with complex medical requirements may need a preoperative health assessment before the dental operation and sedation administration.)

Generally, the medical professional should be aware of:

• Extreme needle phobia or anxiety
• Heart murmur or cardiac disease
• Any congenital defects
• Behavioural disorders such as developmental delay and autism.
• Previous surgeries
• Any airway problems including micrognathia, history of croup, or asthma
• Any syndromes like Down or velocardiofacial syndrome
• Sleep apnea, previous tracheostomy, or the possibility of intubation difficulties
• Neurological conditions such as Cerebral Palsy and epilepsy
• Any gastrointestinal issues like difficulty swallowing and reflux
• Endocrine and metabolic disorders such as genetic metabolic disorders or diabetes
• Any neuromuscular disorder, like muscular dystrophy
• Haematological problems, like thrombocytopenia, haemophilia, and haemoglobinopathies
• Any allergies, such as allergy to latex

Dental sedation is a safe procedure. Be sure to cooperate with the dentist to:

• Solve your child’s dental problems before they become complex – as recommended by the Australian Academy of Pediatric Dentistry.
• Follow the fasting guidelines to the letter.
• Keep the stress and anxiety levels to a minimum.
• Inform the dentist of your kid’s medical history
• The post-treatment instructions are adhered to
• And more

In all, dental sedation is safe.

Cameron handbook of pediatric dentistry estimates the morbidity in kids arising from GA as being lower than 1:150,000. Considering that GA is the most demanding sedation technique – requiring a lot of skills, knowledge, and experience – you can rest easy whenever your child’s dentist recommends dental sedation.

Rejoin your child soon after the treatment – to avoid anxiety (for both you and the child.) There the paediatric dentist will explain the treatment’s outcome and discuss a post-treatment follow up appointment.

Your kid may feel baffled, dizzy, and nauseous. The effect of the sedative can last long; thus:

• Feed your child only soft foods a few hours after the procedure
• Take precaution to ensure your child does not bite the inside of the mouth or tongue when feeding
• Let the kid skip school or daycare for several days – even if the procedure was successful. That’s to allow more resting time – as you observe progress.
• Contact the dentist or medical professional in case of any severe pain, fever, bleeding, and vomiting.
• Show up for the follow-up appointment as instructed by the dentist
• Ensure your kid resumes routine teeth care upon recovery.

What to expect the first few hours after treatment

• Your kid’s mouth, throat, and nose may remain numb up to 2 hours after the dental procedure
• Your child’s mouth and gums may remain sore several days after the dental procedure