Nitrous Oxide
Although nitrous oxide is commonly called “laughing gas”, it does not make your child laugh. It is a very safe drug with children. It is a very good analgesic (pain reliever) and anxiolytic (anti-anxiety) agent and has the added benefit of being administered with 50% oxygen. The American Academy of Pediatric Dentistry recommends this safe and effective technique to reduce anxiety and enhance effective communication with anxious children about to undergo dental treatment. The purpose of nitrous oxide sedation is to reduce anxiety, enhance communication, increase the pain threshold, increase tolerance for longer procedures, promote amnesia and to inhibit the gag reflex. Nitrous oxide is generally indicated for nervous, fearful children and those undergoing restorative procedures where local anesthesia is required. Nitrous oxide has many desirable properties: it has a rapid onset of action, the depth of sedation is easily adjusted specifically to your child’s needs and it has a rapid and complete recovery (approximately three minutes). The most common side effect with nitrous oxide is nausea and vomiting. Contraindications with children are few.
In-Office Sedation
At All Kids Dental the vast majority of children easily tolerate restorative dentistry using local anesthetics with the aid of supplemental nitrous oxide administration. However, an in-office sedation approach is sometimes helpful in accomplishing care with very young children or those children with substantial dental need. The doctors at All Kids Dental are pediatric dental specialists who are hospital trained in providing this appealing alternative. We are not only licensed by the State of Colorado but also have a specialized sedation permit that is required to offer this approach. The sedation permit requires specialty certification, ongoing continuing education, as well as an office inspection by a State of Colorado qualified professional. We follow guidelines established by the American Academy of Pediatric Dentistry. These are guidelines that are shared with the American Academy of Pediatrics and ensure against adverse events. All Kids Dental has been a Colorado entity for twelve years and during that time, no patient undergoing an in-office sedation has ever had a negative event.
The goal of an in-office sedation approach is to safely accomplish necessary dental treatment as gracefully as possible by utilizing a medication that minimizes the potential for negative memories toward future dentistry. Our office employs two sedation protocols that are proven safe and effective. One employs a Valium based drug called Versed®, used in combination with Benadryl® and Advil® to create a minimal to moderate state of sedation. The second protocol includes Demerol in a sedative combination cocktail to create a moderate state of sedation. These medications have a rapid onset and you will quickly see the sedative effects. During the procedure, nitrous oxide and oxygen will be used to enhance the sedative and amnestic properties of Versed® while also supplying supplemental oxygen. Your child will not be unconscious and may occasionally cry during the procedure. This does not mean your child is hurting as the teeth will be completely anesthetized with Lidocaine®. The doctor and two assistants will be taking care of your child who will be continuously monitored with pulse oximetry and other monitoring devices. The doctor will give your child an occasional break during the procedure. When the treatment is complete, parents are reunited with the patient for the recovery and observation period. During this time postoperative instructions are reviewed and questions answered. The family is allowed to leave when standard discharge criteria are met.
This following is intended to answer common questions concerning our in-office sedation protocol and provide information that will be helpful before, during, and after your child’s appointment. Should you have specific questions, please feel free to call and talk with either the treatment coordinator or the doctor.
Before the Appointment
No eating or drinking after midnight before the appointment – The sedative medications work best on an empty stomach. The medicines may cause nausea and vomiting and an empty stomach reduces the chances of this happening.
Report use of other medications – Notify us of any medicines given to your child within 24 hours of the sedation appointment. Any daily medication that is used at the direction of a physician should be given with only a sip of water.
Report any change in health status – Should your child have a cold, runny nose, cough, or fever within two days of the sedation appointment, it may be necessary to reschedule the appointment. For your child’s safety, please call if there is any change in your child’s health before the appointment.
Call if unable to keep the appointment – Since a minimum of two hours has been reserved exclusively for your child, it is extremely important to keep your scheduled appointment. With your cooperation, we will be able to provide more efficient care for your child and others.
Adult supervision – Since you will have to closely attend to your child after the sedation appointment, we strongly recommend a second adult travel with you. In addition, it would be best to leave other children at home.
During the Appointment
Arrival – Upon arrival, your child will be weighed and vital signs recorded. The proper dose of medications will then be administered, either orally or via nose drops. You and your child will then return to the waiting room. Within minutes you will notice your child become very relaxed, have slurred speech and will not be able to walk without your assistance. It is important for you to watch your child closely.
During dental treatment – Within approximately thirty minutes, your child will be carried by an assistant to the dental operatory. Once in the treatment room your child will be placed in a protective wrap (papoose board) to prevent unnecessary movement that could endanger them when utilizing high speed dental instruments. Nitrous oxide and oxygen will then be placed on your child’s nose to help your child relax prior to local anesthetic administration. A tooth pillow (rubber mouth prop) will be used to help your child keep his or her mouth open. Monitoring equipment (pulse oximeter) and extra staff are used to ensure your child’s well being. Although parents are not present in the dental operatory during the sedation procedure, an assistant will provide periodic updates regarding your child’s progress. The treatment time varies from 45 to 90 minutes.
Getting home – When your child’s treatment is completed, an assistant will reunite you with your child. During the recovery period, the doctor will provide a review of the day’s procedures and discuss questions or concerns that you may have. Your child will be dismissed when standard discharge criteria are met, anywhere from fifteen minutes to an hour following the procedure.
After the Appointment
Constant Supervision – The effects of the sedative medication will dissipate quickly, however a “hang over” effect will last for several hours. Your child may initially be irritable and crabby. This is a drug effect called emergence delirium. The best way to get through this is to hold your child and try to keep them as quiet and relaxed as possible. Do not allow your child to walk unassisted until their balance is regained. Also, do not allow your child to bite or rub their cheeks, gums, lips, or tongue until about two hours after the appointment. Young children do not like the numb feeling from the local anesthetic and will need your help to prevent “lip biting.” Most children will take a long nap or may quickly fall asleep on the way home. Please know that over 80% of the sedative medication is out of your child’s system before you are sent home. Sleeping is a “hang over” effect, not a drug effect. During this time it is important to keep your child’s head extended, do not allow them to snore, and protect against choking should your child vomit.
Drinking or Eating – You should encourage your child to drink clear liquids. Small amounts of water taken repeatedly help prevent nausea and dehydration. Soft, bland food may then be eaten, but only after the local anesthesia wears off. Soup and toast may be a good choice. Dairy products may cause nausea or vomiting so please refrain from dairy products until other foods have been eaten. If your child has trouble with vomiting, continue with small amounts of clear liquids until they are feeling better.
Fever and Pain – It is not unusual for your child to have a temperature of up to 100° for the first 24 hours after treatment. Children’s Advil® or Motrin® (both ibuprofen products) should be given as directed to help with fever and any oral discomfort. If necessary, you can alternate the Ibuprofen with a Tylenol® product every four hours. Use as directed on the bottle, based on your child’s weight.
Problems – The doctor is available at all times and should be contacted if one of the following occurs.
- Vomiting that persists beyond four hours after the appointment.
- A fever that goes above 101° or lasts longer than 24 hours.
- Your child has any difficulty breathing.
- Oral bleeding that seems excessive.
If you have any concerns or questions please call 303.670.KIDS (5437).