Nitrous Oxide / Conscious Sedation
Outpatient General Anesthesia / Common Procedure Explanations


Nitrous Oxide

Some children are given nitrous oxide/oxygen, or what you may know as laughing gas, to relax them for their dental treatment. Nitrous oxide/oxygen is a blend of two gases, oxygen and nitrous oxide. Nitrous oxide/oxygen is given through a small breathing mask which is placed over the child’s nose, allowing them to relax, but without putting them to sleep. The American Academy of Pediatric Dentistry, recognizes this technique as a very safe, effective technique to use for treating children’s dental needs. The gas is mild, easily taken, then with normal breathing, it is quickly eliminated from the body. It is non-addictive. While inhaling nitrous oxide/oxygen, your child remains fully conscious and keeps all natural reflexes.

Prior to your appointment:

  • Please inform us of any change to your child’s health and/or medical condition.

  • Tell us about any respiratory condition that makes breathing through the nose difficult for your child. It may limit the effectiveness of the nitrous oxide/oxygen.

  • Let us know if your child is taking any medication on the day of the appointment.

Conscious Sedation

Conscious Sedation is recommended for apprehensive children, very young children, and children with special needs. It is used to calm your child and to reduce the anxiety or discomfort associated with dental treatments. Your child may be quite drowsy, and may even fall asleep, but they will not become unconscious.

There are a variety of different medications, which can be used for conscious sedation. The doctor will prescribe the medication best suited for your child’s overall health and dental treatment recommendations. We will be happy to answer any questions you might have concerning the specific drugs we plan to give to your child.

Prior to your appointment:

  • Please notify us of any change in your child’s health and/or medical condition. Do not bring your child for treatment with a fever, ear infection or cold. Should your child become ill, contact us to see if it is necessary to postpone the appointment.

  • You must tell the doctor of any drugs that your child is currently taking and any drug reactions and/or change in medical history.

  • Please dress your child in loose fitting, comfortable clothing.

  • Please make sure that your child goes to the bathroom immediately prior to arriving at the office.

  • Your child should not have solid food for at least 6 hours prior to their sedation appointment and only clear liquids for up to 4 hours before the appointment.

  • The child’s parent or legal guardian must remain at the office during the complete procedure.

  • Please watch your child closely while the medication is taking effect. Hold them in your lap or keep close to you. Do not let them "run around."

  • Your child will act drowsy and may become slightly excited at first.

After the sedation appointment:

  • Your child will be drowsy and will need to be monitored very closely. Keep your child away from areas of potential harm.

  • If your child wants to sleep, place them on their side with their chin up. Wake your child every hour and encourage them to have something to drink in order to prevent dehydration. At first it is best to give your child sips of clear liquids to prevent nausea. The first meal should be light and easily digestible.

  • If your child vomits, help them bend over and turn their head to the side to insure that they do not inhale the vomit.

  • Because we use local anesthetic to numb your child’s mouth during the procedure, your child may have the tendency to bite or chew their lips, cheeks, and/or tongue and/or rub and scratch their face after treatment. Please observe your child carefully to prevent any injury to these areas.

  • Please call our office for any questions or concerns that you might have.

Outpatient General Anesthesia

Outpatient General Anesthesia is recommended for apprehensive children, very young children, and children with special needs that would not work well under conscious sedation or I.V. sedation. General anesthesia renders your child completely asleep. This would be the same as if he/she was having their tonsils removed, ear tubes, or hernia repaired. This is performed in a hospital or outpatient setting only. While the assumed risks are greater than that of other treatment options, if this is suggested for your child, the benefits of treatment this way have been deemed to outweigh the risks. Most pediatric medical literature places the risk of a serious reaction in the range of 1 in 25,000 to 1 in 200,000, far better than the assumed risk of even driving a car daily. The inherent risks if this is not chosen are multiple appointments, potential for physical restraint to complete treatment and possible emotional and/or physical injury to your child in order to complete their dental treatment. The risks of NO treatment include tooth pain, infection, swelling, the spread of new decay, damage to their developing adult teeth and possible life threatening hospitalization from a dental infection.

Prior to your appointment:

  • Please notify us of any change in your child’s health. Do not bring your child for treatment with a fever, ear infection or cold. Should your child become ill, contact us to see if it is necessary to postpone the appointment.

  • You must tell the doctor of any drugs that your child is currently taking and any drug reactions and/or change in medical history.

  • Please dress your child in loose fitting, comfortable clothing.

  • Your child should not have milk or solid food after midnight prior to the scheduled procedure and clear liquids ONLY (water, apple juice, Gatorade) for up to 6 hours prior to the appointment.

  • The child’s parent or legal guardian must remain at the hospital or surgical site waiting room during the complete procedure.

After the appointment:

  • Your child will be drowsy and will need to be monitored very closely. Keep your child away from areas of potential harm.

  • If your child wants to sleep, place them on their side with their chin up. Wake your child every hour and encourage them to have something to drink in order to prevent dehydration. At first it is best to give your child sips of clear liquids to prevent nausea. The first meal should be light and easily digestible.

  • If your child vomits, help them bend over and turn their head to the side to insure that they do not inhale the vomit.

  • Prior to leaving the hospital/outpatient center, you will be given a detailed list of "Post-Op Instructions" and an emergency contact number if needed.

 

Common Procedure Explanations

COMMON PROCEDURE QUESTIONS:
When Dr. Doan informs you your child has a cavity, your child may need a filling, crown or extraction to protect the tooth from further decay. If left untreated, a cavity will only get worse and the decay might ultimately lead to bone loss, pain and infection. Fortunately, treatment is nearly painless thanks to advances in dentistry. So there's no reason to avoid getting dental treatment.
Here are some common treatment questions:

 

GETTING NUMB (local anesthetic):
Getting numb is the part of seeing the dentist that most people fear. Dr Doan and her Team make it easy for children. We begin, in many cases, by using laughing gas (nitrous oxide) to allow the child to relax a little bit. At that point, Dr Doan and her Team will address the child, and using calming and distraction techniques, place a small amount of topical cream anesthetic (“jelly”) next to the gums. We allow that to “sink in” a little. We will then finish getting your child fully numb so as to allow your child the best possible, pain-free experience. Please avoid using words like “shots” and “needle,” when talking to your child about this procedure. A majority of patients feel only the “jelly" being applied with a cotton swab. Please keep your child from biting his/her lips and cheek after the procedure. This will result in swelling and painful ulcers.

 

FILLING (composite restoration or tooth-colored filling):
Composite fillings are made of a tooth-colored mixture of glass and resin. Composites can match the color of your teeth, but they are not as compact as metal and may need to be replaced occasionally and more prone to staining.

Depending on the depth and tooth location, local anesthesia or numbing may be needed. Please read section under “Getting Numb.” We will explain to your child that there will be lots of water as we “wash” the cavity away. He / she will also hear a whistle and it may feel like it is tickling the tooth. We want to be honest with children, but not use wording that could scare them. As your child becomes older, we become more technical in our terminology, but a lot depends on the patient’s anxiety level. Dr. Doan will then fill and polish the tooth; checking to make sure there are no rough areas.

 

PULPOTOMY (root canal therapy for a primary tooth):
If the cavity is deep and the bacteria has begun to invade into the live nerve tissue of the tooth (called the pulp), we must sterilize the nerve tissue as to avoid an infection and abscess. After removing all decay, Dr Doan will open the nerve chamber and remove the affected tissue. At that point the doctor will use medicines that sterilize the remaining tissue to ensure that any microscopic remnants of bacteria are destroyed. Next the nerve chamber must be closed with a filling material to ensure a proper seal. Finally, a crown is placed on the tooth to maintain the tooth’s structural integrity. If a filling is placed after a root canal procedure or a pulpotomy, the tooth will fracture under the biting pressures of the mouth. Depending on how large and how long the cavity has been present; determines the success rate of the pulpotomy. Pulpotomies may still fail if not treated in time. This will result in an infection.

 

CROWN / STAINLESS STEEL CROWN:
Crowns for primary teeth are different than crowns for permanent teeth. Crowns for permanent teeth require multiple visits for preparation, impression, and seating. They are also much more expensive than crowns for primary teeth. Crowns for primary teeth are done in a single visit due a child’s inability to tolerate multiple visits. Crowns on primary teeth are necessary to preserve the tooth if the tooth is either badly decayed or if the tooth requires a pulpotomy. After removing all decay, the tooth is shortened in height and relieved between adjacent teeth to accommodate the placement of the crown. (Remember that the crown is replacing all of the lost tooth structure.) We then will use a special “tooth glue” that cements the crown to the remaining tooth. We finish by removing all excess cement and checking the bite.

 

EXTRACTIONS (“wiggling teeth”):
Extractions are performed for several reasons. Some of these reasons are: infection, badly decayed, impaction, trauma, and crowding (ie orthodontic purposes). We attempt to keep the procedure very simple. We avoid using words that may scare children, so we sometimes use wording like: “check how loose the tooth is” or “I’m going to push on your tooth”. Please avoid any wording that may be more honesty than the child can handle, such as “yanking your tooth.”

 

IMPRESSIONS FOR SPACE MAINTAINERS:
Space maintainers are used to control the space in the mouth were a tooth or multiple teeth are missing or have been removed. Baby teeth are not only good for chewing and chomping food, but they maintain space. As the permanent teeth push out the baby teeth, they take the space where the baby tooth was. If that space has collapsed, then the permanent tooth has no place to erupt and either becomes impacted or erupts into the wrong place causing gums problems and additional orthodontic problems.
In order to fabricate a space maintainer, an impression of your child’s mouth must be taken. We will place small orthodontic bands around one or more teeth, then take the impression. The orthodontic bands are removed and placed in the impression. Both the bands and the impression are sent to the laboratory to custom fabricate your child’s space maintainer.

 

PLACEMENT / CEMENTATION OF SPACE MAINTAINERS:
After the space maintainer has been custom fabricated at the laboratory, we will schedule a follow up appointment to deliver your child’s retainer. At that appointment, we will make sure the retainer fits properly and make any adjustments that are necessary at that time. We will then use special “tooth glue” to fix the retainer to the molars. We finish by removing excess cement and giving you and your child “care instructions” for the retainer.


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Oklahoma City Pediatric Dentist - Dr. Thai-An Doan
Dental care for infants, children, and teens ~ Oklahoma City, OK

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