Pediatric sedation dentistry is the use of orally administered sedative medication to minimally sedate a child for four main reasons: he or she is unmanageable, has a severe gag response, requires extensive dental treatment, or has a parent with significant time limitations.
Pediatric sedation dentistry is much different than adult sedation dentistry. When children visit the dentist, they are often fearful, anxious, and unmanageable with no desire to have dental treatment performed. In adult sedation dentistry, the adults are also fearful and anxious but seeking to have their fears and anxiety managed in order to have dental treatment completed. The sedative medication and techniques used in pediatric sedation dentistry are designed to help manage behavior, while those used in adult sedation dentistry are geared toward controlling fear and anxiety.
Children that are fearful, unmanageable, or combative; have a severe gag reflex; require extensive dental treatment; or have a parent with significant time limitations benefit the most from pediatric sedation dentistry.
Children are rarely on systemic drugs unless they have asthma, diabetes, cardiac conditions, obesity, blood disorders, disruptive behaviors, etc., and are not good candidates for pediatric sedation dentistry. Dental care for such patients can be better performed with a specialized anesthesiologist.
Children undergoing pediatric sedation dentistry can be administered sedative medication that has a rapid onset, can produce an amnesic effect, and has a short recovery time. The postoperative effect is usually continued drowsiness. Due to the medication’s amnesiac effects, the child will normally remember little or nothing about the sedation experience.
Children must have an empty stomach from the time after they have their evening meal to the next morning when they have their appointment.
The goal of pediatric sedation dentistry is to use medication that has the widest margin of safety and reversibility. Children who receive pediatric sedation dentistry are minimally sedated and continually monitored for their responsiveness to verbal communication and physical stimulation to ensure safety at all times. Nitrous oxide/oxygen analgesia can be used in conjunction with the oral medication to allow for lower doses of the medication.
Performing dental care on a sedated child is different than a non-sedated child. The dentist and sedation team must be capable of performing quality dental treatment in a short period of time. They must also be trained to manage sedation procedures with the proper protective equipment, monitoring, and emergency preparedness skills to ensure optimum safety.
All dentists should check with their malpractice carrier to determine whether or not any additional premiums will be added to their policy for performing pediatric sedation dentistry in their state or province. There are carriers who will not increase premiums for pediatric sedation dentistry if the dentist has completed appropriate training and acquired the necessary standard of care equipment.
Certain governmental programs and some private insurance carriers do cover pediatric sedation as part of their benefits. If there is ever a question as to what’s covered in a patients’ policy, the dental office or patients’ parent/guardian should contact their insurance provider to find out additional information.
Specialized equipment will be needed by dentists who perform pediatric sedation dentistry. This includes, but is not limited to: protective and positioning equipment for the child during the sedation appointment, monitoring equipment, emergency preparedness supplies and equipment, DEA-approved drug storage, and administrative equipment.
Depending on the regulatory requirements for pediatric sedation dentistry in your state or province, additional training may be required for certification beyond an approved course in pediatric sedation dentistry. There may be recertification requirements as well to maintain your pediatric sedation dentistry permit. However, DOCS Education recommends all dentists who perform pediatric sedation dentistry also complete an approved Pediatric Advanced Life Support (PALS) course. Their sedation team staff should complete an approved Basic Life Support (BLS) course as well. After receiving certification from these courses, DOCS Education recommends that the doctor and staff continue with recertification in two year intervals. The dentist and sedation team staff should train on a regular basis in their office by practicing emergency drills and codes.
All DOCS programs are AGD PACE-Approved courses. There are four leading reasons for utilizing pediatric sedation. These include when a child is: Fearful, unmanageable, or combative; has a severe gag reflex; requires extensive dental treatment; or has a parent with significant time limitations. Pediatric oral sedation allows for more high-quality dentistry to be completed in less time.