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What Types of Sedation Are Used in Pediatric Dentistry?

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What Types of Sedation Are Used in Pediatric Dentistry? Karimi. Clin Oral Sci Dent (2021), 4:1 P a g e | 1 CLINICAL ORAL SCIENCE AND DENTISTRY [ISSN 2688-7428] Opinion Article Open Access What Types of Sedation are used in Pediatric Dentistry? Mohammad Karimi1* 1 Department of Pediatric, University of Shiraz School of Dentistry, Sepideh Dental Clinic, Iran. Received date: March 04, 2021, Accepted date: July 27, 2021, Published date: August 09, 2021 Copyright: ©2021 Karimi. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. *Corresponding Author: Karimi, University of Shiraz School of Dentistry, Sepideh Dental Clinic, Iran. Abstract Some children are not able to cooperate in dentistry for reasons such as low age, physical and mental disabilities, or severe and uncontrolled anxiety. Therefore, performing dental treatments in the office may be a risk factor for them. Besides, one of the important goals in children's dentistry is to maintain mental health while in evolution; and also create a positive memory of dentistry. In the event of an unpleasant childhood memory, the whole future of a person's dentistry may be affected. Consequently, for these children, dental treatments are recommended under anesthesia or sedation. Nowadays, there are several drugs available to help patients' comfort and relaxation during dental works. Oral sedation, nitrogen oxide, intravenous relaxation, and ultimately general anesthetic are major types of Anesthetics that are used in pediatric dentistry. Factors such as the age of the child, the severity and extent of dental caries, the dentist's expectation of the outcome of the treatment, the risk of treatment, and the satisfaction of the parents would affect the decision of the dentist to select the appropriate type of anesthesia. Keywords: Anesthesia, Physical and Mental Disability, Fear, Nitrous Oxide, Bitter Dental Experiences, Low Age. Introduction impossible to perform child's dental treatment. Non-cooperative children with uncontrolled anxiety and In the past and even now, in many Pediatric dental centers, anxiety in dentistry are one of the most important challenges for the dentist has no other choices except to let his assistants and both dentists and parents. Many factors, such as information even parents immobilize and hold the child firmly for a while so transmitted from parents and friends, a previous painful the dentist should be able to perform a limited treatment in the experience of dentistry, low age of the child, and fear of the shortest time. In another word, the lack of cooperation of the presence of sound and water during dental procedures, would child will reduce the quality and standard of provided health affect the lack of cooperation of the child, which makes it care. Clin Oral Sci Dent, an open access journal Volume 4 • Issue 1 • 2021 Karimi. Clin Oral Sci Dent (2021), 4:1 P a g e | 2 Also, physical intimidation, in addition to reducing the What is Sedation in Dentistry? accuracy and quality of work, can create unpleasant psychological outcomes in the child. Unfortunately, in many cases, this is the only way to relieve the child from dental pain. Sedation levels which are used are including: An alternative to solving this problem for this group of children • Mild sedation: The patient is alert but relaxed. is to perform dental treatment under general Anesthesia to protect the child from the fear of exposure to dental treatment. • Moderate sedation (scientifically "alertness"): A patient may stutter while talking and does not remember much of About 50 years ago, the dangers of Anesthesia were the treatment. enormous, but nowadays, due to the needs of patients’ referral to well-equipped facilities with general anesthesia, and the • Deep sedation: The patient is on the border between sleep development of monitoring and monitoring systems in the and awakening, but can still be awake and alert. operating rooms, the level of Anesthetic risks and complications • General Anesthesia: The patient is completely anesthetized. for patients are very low. When a dentist is performing dental procedures, the Anesthesiologist simultaneously examines the symptoms of the patient, including blood pressure, respiration, What children can use sedation techniques for and Anesthetic state; and fully controls the condition of the dental treatments? patient. The sedation technique is the most appropriate method for History of application of Anesthesiology in Pediatric those who have a lot of fear or anxiety that prevents them from Dentistry going to dental offices. Dental procedures in sleep may also be The history of using anesthesia will be very long and appropriate for these people, those who have the following tedious. As a result, the following explanation is a brief conditions. overview of the application of dentistry in the last 150 years. • Have a low pain threshold. Gardner Colton revived nitrous oxide use in dentistry in • Cannot stay motionless on the dental unit. 1863, and by 1868 he claimed that he had treated 20,000 cases • Difficulties to control their movements. and extracted 75,000 teeth using N2O anesthesia. In the meantime, other agents were also introduced that provided • Have Very sensitive teeth. conscious sedation and/or pain relief, or general anesthesia. The • With severe gag reflexes. first general Anesthetic drug was Ether introduced in 1846, and Chloroform followed a year later. [1] • Full Dental treatment. By 1895 there was enough literature available to support • Limited time for dental treatment. the continued use of nitrous oxide and oxygen for prolonged • There are pathologic experiences with dentistry. dental cases, mainly based on the work of Herbert Paterson, and Clover, and Coleman. Reports of dentists using nitrous oxide to • Local anesthesia works hard for them. provide inhalational conscious sedation, rather than general • Fear of injection anesthesia, started to appear in the early 1900s. This was done by an American dentist on children for the first time. • Cerebral Palsy or Parkinson's disease By the 1930s, an intravenous barbiturate, hexobarbitone, was in use in UK dental practices for sedation. During the Some children become anxious when they visit the dentist. 1950s and 1960s, the teaching of nitrous oxide inhalation Consequently, they are unable to sit motionlessly and cannot sedation was introduced in US dental schools. [1] remain for prolonged treatment. In this case, the dentist may Today, nitrous oxide is still widely used in both dentistry prescribe an Anesthetic that the child can tolerate the treatments. and medicine. It has proven to be a very safe and popular Children are divided into the following groups for Anesthesia. sedative agent and a Mild Anesthetic agent at higher [2] concentrations. Administered properly, the nitrous oxide-oxygen 1. Non-cooperative children: Children who are not technique has a very high success rate with a very small number normally prepared to cooperate with a dentist. This is of adverse effects and complications. the most common cause of referral pediatric patients for application of anesthesia (85%) (3). 2. Disabled and mentally retarded children: Those who have less ability and cooperation with a dentist Clin Oral Sci Dent, an open access journal Volume 4 • Issue 1 • 2021 Karimi. Clin Oral Sci Dent (2021), 4:1 P a g e | 3 specialist. In the oral sedative method, taking into account the specific circumstances of the child, his age, and weight, the 3. Young children (toddlers): Those children with a large sedative medications are used to reduce the patient's anxiety and number of decayed teeth (5 to 10 cases) whose stress. This method has been used for many years in dental and physical control is partially impossible and medical services. overwhelming. One of the best medications that can have minimal side 4. Shy and timid children: Because of unnecessary fear, effects in addition to its beneficial effects for kids’ relaxation is this group of children is not willing to treat their teeth. Midazolam a member of the Benzodiazepines group. [7, 8] Sedation is the only way that they can be treated to reduce their fear and anxiety over time. If this medication is taken orally and at a controlled dose, there will be no sustained side effects. The drug should be taken 5. Children with a wide range of dental works: under the supervision of the dentist at the office, and the exact Numerous referrals for dental work will cause fatigue amount of use should be determined by the pediatric dentist. and reduction of self-confidence in children; and This sedation is done in non-cooperative children who need therefore, results in not coming back again to the limited treatments. When choosing a drug type, the dentist will dental office for further dental procedures. consider the following factors: level of anxiety, cooperation, and 6. Children with bad dental experiences: This is one of types of treatments. the most common cases in which children do not With oral sedation, the baby becomes slightly sleepy, but allow the dentist to work with a local Anesthetic. Such can still respond to simple stimuli and instructions. Some minor kids scream and shout from the time they enter the side effects include nausea or vomiting in some of these office because the dental office looks like a terrifying medications. After the treatment, the dentist should provide a place for them. With this action and behaviour, they care pamphlet for parents. It is necessary to stay in the recovery want to stop the dentist's work. room for some time after he becomes conscious so that his physical condition is controlled by the dentist. Dental staff should be assured of the complete recovery, and they should Types of sedation applied in pediatric dentistry monitor the child for any problems in responding to stimulation. Nowadays, there are several drugs available to help patients' comfort and relaxation during dentistry.
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