Not many people enjoy receiving dental treatment. Children who have experienced a difficult or painful dental appointment will be anxious or even uncooperative when they next visit the dental office. As pediatric dentists, we see many children who have had unpleasant dental experiences yet still require dental treatment to be completed. Adults often fail to appreciate that there is no other adult-child interaction in a childʼs life that requires the degree of cooperation that a dental appointment requires. What can parents do in this situation?
One solution is to complete dental treatment under some form of sedation. Over the next few weeks, we will publish a series of columns which will describe the various forms of sedation offered to children in our pediatric dental practice and why parents might consider any one of them for their child.
Prior to providing any form of dental treatment it is essential that we complete a medical history to learn about your childʼs general health and obtain information about existing medical conditions. As well, we will have to examine your child to determine what treatment they require, how long it will take and what it will cost. What do we consider when deciding if sedation is a possibility? First of all, not all children are candidates for sedation in a dental office. Children with serious medical conditions which affect their daily lives are better treated in a hospital setting under general anesthesia with medical supervision. Many children with serious medical conditions can be treated without sedation in our dental office provided they are cooperative and understand what is expected of them during a dental appointment.
Assuming that a child is healthy and of normal height and weight for their age what other factors do we consider? Child temperament and behaviour are primary factors in deciding if sedation will be helpful. Children who are slow to warm in new situations or struggle when they meet new people are definitely candidates for sedation. Children who require a large amount of dental treatment requiring several appointments, those with strong gag reflexes, and those who require dental treatment which will be painful even if local anesthesia is given are also candidates for sedation.
Children who experience more than one appointment for invasive dental treatment without sedation can become increasingly anxious as a series of appointments is completed. Some children will become uncomfortable to the point of refusing to cooperate. Sedation can be used so that the child experiences no pain during treatment and has no memory of the procedure. Readers will note that age has not been mentioned in this discussion. Age, by itself, is not a reason to avoid sedation except in the very young. Sedation for children under the age of 24 months requires special skills that only very experienced and well trained health care providers will possess. Lastly, some parents are keen to avoid any form of sedation or general anesthesia for their childʼs dental treatment for reasons only known to them. We often interact with parents who requesting that we treat their child without sedation or general anesthesia.
In some cases, with well behaved and compliant children this is certainly appropriate. But, when the child is anxious or downright uncooperative, providing dental treatment as requested in these cases will certainly not be compassionate and is completely unacceptable.
We encourage parents to discuss their concerns and their fears so that we can understand and be able to help. Presenting parents with reasonable alternatives is always an important part of each appointment in our office. We encourage all parents to strive to make each and every dental appointment, no matter its purpose, as pleasant as possible. In many cases, sedation accomplishes that goal. The next series of three articles will discuss different sedation modalities.