Pediatric Oral Sedation Dentistry

Upon completion of a competency course in minimal sedation, the dentist must be able to:  

1. Describe pediatric anatomy and physiology of the respiratory, cardiovascular and central nervous systems, as they relate to sedation.  

2. Describe the pharmacological effects of drugs.  

3. Describe the methods of obtaining a medical history and conduct an appropriate physical examination.  

4. Apply these methods clinically in order to obtain an accurate evaluation.  

5. Use this information clinically for ASA classification and risk assessment.  

6. Choose the most appropriate technique for the individual patient.  

7. Use appropriate physiologic monitoring equipment.  

8. Describe the physiologic responses that are consistent with minimal sedation.  

9. Understand the sedation/general anesthesia continuum.  

10. List and discuss the advantages and disadvantages of enteral and/or combination inhalation-enteral minimal sedation (combined minimal sedation).  

11. List and discuss the indications and contraindications for the use of enteral and/or combination inhalation-enteral minimal sedation (combined minimal sedation).  

12. List the complications associated with enteral and/or combination inhalation-enteral minimal sedation (combined minimal sedation).  

13. Discuss the prevention, recognition and management of these complications.  

14. Comprehend how oral sedative drugs produce their effect in the oral cavity, esophagus, stomach, small intestine, liver, cardiovascular system, and into the brain.  

15. Discuss how other drugs and common medical conditions can influence the effect(s) of the sedative drug(s). 

16. Review of drug regimens 

17. Identify and adjust for the complicated patient 

18. Understand the metabolism of drugs and drug-drug interaction 

19. Recognize and respond to pediatric emergencies 

20. Discuss the pharmacology of the enteral and inhalation drugs selected for administration.  

21. Discuss the precautions, contraindications and adverse reactions associated with the enteral and inhalation drugs selected.  

22. Describe a protocol for management of emergencies in the dental office and list and discuss the emergency drugs and equipment required for management of life-threatening situations.  

23. Demonstrate the ability to manage life-threatening emergency situations,  

24. Determine appropriate cases for treatment 

25. Confidently communicate with both patient and parent 

26. Select appropriate drug/s, dosage and delivery method 

27. Observe live patient video feed of sedated pediatric patient 

28. Identify the guidelines for monitoring, stabilization and staff support  

29. Prepare consent forms and appropriate documentation 

30. Discuss and recommend treatment for actual cases and review results 

31. Identify considerations for treatment planning 

32. Learn intricacies of local anesthesia use 

33. Integrate nitrous oxide/oxygen sedation with and without other sedatives 

34. Review the legal and regulatory issues surrounding sedation 

35. Recognize and fulfill staff support and training requirements 

36. Complete the hands-on portion of the PALS or PALS Recertification (Add On, additional tuition)

37. Test emergency skills on High Fidelity Human Simulation in 6 emergency scenarios 

Scientific support and additional resources are available here. 

Advanced Pediatric Airway Management (APAM) with High-Fidelity Human Simulation Module

A pediatric emergency could occur on any patient in your practice. If this situation arises, you are the first responder. Are you prepared? Can you recognize pediatric emergencies and manage successful outcomes? Are your “hands-on” life support skills current?

APAM stands for Advanced Pediatric Airway Management and the simulator used in teaching is a replica of a pediatric patient. By perfectly mimicking real patient behavior, the module helps in the training process to provide doctors with the skills for safe and effective airway management.

James Bovia brings his 30 years of experience in emergency medical services in order to lead attendees through six emergency scenarios.

These six scenarios will be programmed into the high-fidelity human simulators that have direct application for pediatric dentists who sedate children in their office. These scenarios include:

• Asthma: A patient may experience an attack while under sedation, thus causing an airway emergency.

• Excess of local anesthetic: A patient could experience an overdose (toxicity) of local anesthesia causing a biphasic (excitation then depression) reaction.

• Allergic reaction: This could result in first a cutaneous reaction progressing to anaphylaxis with airway emergency.

• Sinus Tachycardia (ST) or Supra Ventricular Tachycardia (SVT): Possibly from elevated temp, stress, etc. during sedation requiring initial vagal stimulation.

• Foreign body introduction: Gauze, tooth, crown, bur, etc. in oropharyngeal area during sedation causing an airway emergency.

• Diabetes: Patient could experience an episode of hypoglycemia during sedation.

Note: DOCS Education strongly encourages dentists to enroll in the American Heart Association’s HeartCode PALS Part 1 prior to enrolling in Pediatric Sedation Dentistry. If you successfully complete HeartCode PALS Part 1, you have the opportunity to become PALS-certified or re-certified by attending Pediatric Sedation Dentistry, which fulfills Parts 2 and 3. (Add On, additional tuition) This also applies to completing the APAM course in conjunction with Safe and Effective Pediatric sedation Dentistry (((Live))) Event.

However, spaces for recertification testing will be limited. If you are interested in becoming certified or recertified, please inquire with your Customer Service Representative to learn more.

DOCS Education considers the dental team a vital part of good patient care and urges every dentist to bring at least one staff member to courses. Whether assisting the doctor during the actual appointment or tending to the practical concerns of appointment scheduling and recordkeeping, a doctor cannot perform pediatric sedation without the help of his or her team. Thus, it's imperative your team members be knowledgeable about the pediatric sedation process to better serve the patient and the dentist.

"I brought some of the team with me, including two hygienists and our assistant manager—all of whom are extremely reluctant to try new things. I sat at lunch today listening with amazement as they told me what we need to do to implement this in our practice! Your enthusiasm is infectious, and I will be sending the rest of the team to this course!"

- Karen Harriman, DDS

States differ in their sedation regulations. Visit www.SedationRegulations.com to learn more.

Dr. Roger Sanger is DOCS Education's lead instructor for Pediatric Sedation Dentistry and has personally performed over 13,000 pediatric sedation cases. He explains why, if performed by a skilled and responsible doctor, sedation dentistry is a safe, dependable and important method of treatment for children with anxiety:

I am a believer that with the proper training and regulatory guidance, a general dentist can perform safe and effective sedation to aid in the dental treatment of children and teens. Proper training must include (among many other subjects) the selection of proper drug(s) and their safe use, and MOST IMPORTANTLY, the proper selection of the child or teen.

Minimal oral conscious sedation performed by trained GPs provides children with a much more pleasant dental experience, thus making them better patients for the rest of their lives.

For the majority of cases a general dentist will encounter in practice where oral conscious minimal sedation will be beneficial, the use of one drug (midazolam is the most popular) given at or below the maximum recommended therapeutic dose (MRTD) with nitrous oxide, oxygen inhalation, analgesia and injectable local anesthesia will suffice. Cases requiring a higher degree of sedation because of patient selection or length of treatment can be referred to the pediatric specialist who may want to achieve moderate sedation.

If one drug is sufficient, why use nitrous oxide or local anesthesia? Nitrous oxide is the safest drug we have to achieve analgesia. Along with injectable local anesthesia, nitrous oxide analgesia will reduce pain sensation thus allowing for a lesser amount of the sedative drug to achieve a better and safer level of minimal sedation.

Why do some states allow a GP to administer a second sedative drug? The second sedative drug (hydroxyzine is the most commonly used) will be synergistic to the first drug thus allowing a lower dose of the first. The second sedative drug is usually for great working time and antiemetic, antihistaminic, antisialologue properties.

I believe that allowing a GP to administer one sedative drug without nitrous would not allow the child or teen to whom the sedation is intended to receive the most comfortable dental treatment. I also believe many states are correct in establishing educational requirements for its regs. I also know that in a child it is AIRWAY, AIRWAY, AIRWAY. Therefore, I encourage states to establish a requirement that any dentist sedating a child be certified by the AHA in PALS (Pediatric Advanced Life Support) and recertified every two years by the AHA. I also feel strongly that the dentist should have a CE requirement for recertification of the sedation regulations by a state.

The four major reasons for complications during dentist administered oral sedation are as follows:

1. They picked the wrong patient due to physical, mental, medical, drug, etc. compromising conditions. (EDUCATION)
2. They used an overdose of the sedative drug(s). (EDUCATION)
3. They used an overdose of the local anesthetic drug(s). (EDUCATION)
4. They allowed a foreign body to go down the throat by not protecting the airway (no rubber dam or suitable isolation). (EDUCATION)

All these topics should be educational requirements established by the regulations.

Many dental insurance carriers will pay for sedation. Again, there is wide variability in this area.

25 participation  

1 live case  

10 video cases  

(Hours - AGD Code - Definition

1 - 010 Basic Science: Anatomy

2 - 010 Basic Science: Pharmacotherapeutics

1 - 010 Basic Science: Physiology

7.5 - 142 Electives:  Emergency Training / CPR

6 - 340 Anesthesia & Pain Management

0.5 - 432 Pediatric Dentistry: Prevention/Diet/Nutrition

3.5 - 433 Pediatric Dentistry: Behavior Management

3.5 - 434 Pediatric Dentistry: Management of Child Patient

TOTAL: 25 hours (participation)