The current guidelines when providing deep sedation or general anesthesia in dental procedures to children from the American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry for dentists and oral surgeons was updated this year (2019).
The guidelines require there is at least 2 people in the room who are trained to provide advanced life support measures in case of any problems. One of these people will be the dentist or oral surgeon performing the procedure and the other will be an independent observer. This independent observer must be “a physician anesthesiologist, a certified registered nurse anesthetist, a second oral surgeon, or a dentist anesthesiologist.”
Types of Sedation and Anesthesia Used on Children
- Nitrous oxide: This is a mild sedative and the least invasive. It’s commonly known as ‘giggle gas’ or ‘laughing gas.’
- Mild sedation: This medication (or a combination of medications) are commonly used on older children and adults. Your child would be calm and awake—and sometimes able to do what the dentist or surgeon asks him or her to do.
- Moderate sedation: Under moderate sedation children are sleepier, but they are usually able to do what the dentist or oral surgeon asks them to do. Older children and young adults do better with moderate sedation than younger or more fearful children. They breathe on their own and will usually wake up easily.
- Deep sedation: This involves intravenous (IV) medications to help your child sleep through the procedure. While your child may still move a little and sometimes make noises, he or she may not be able to breathe well on his or her own. There must always be at least one additional qualified professional (independent observer), such as an anesthesiologist (see Who’s Who list below) who can monitor your child’s heart rate, heart rhythm, blood pressure, and oxygen saturation (breathing) during the procedure and until he or she wakes up. This professional can also determine when your child is ready to go home.
- General anesthesia: Under general anesthesia, your child will be completely asleep and pain free. Specially-trained anesthesia professionals (physicians, dentists, or certified nurse anesthetists) will administer medications and monitor your child while a separate dentist or oral surgeon performs the dental procedure or surgery. Anesthesia can be given in a dental office that is specially equipped, an ambulatory surgical center (ASC), or a hospital.
Anesthesia In Dental Procedures
Once you have discussed sedation options with your child’s dentist or oral surgeon, be sure you know who else will be involved in the administration of sedation and watching your child during the procedure. Here’s an overview of the various medical and dental professionals who may be involved in your child’s dental procedure. Knowledge is power—familiarize yourself with the list below.
Note:The new AAP and the AAPD new guidelines state that an anesthesia professional or a another dentist or oral surgeon who is licensed and trained in anesthesia be with your child while the dentist or oral surgeon concentrates on the procedure. This person will deliver and monitor deep sedation and general anesthesia while the dentist or oral surgeon is performing dental surgery on your child. Other personnel may also be present to assist with deep sedation and general anesthesia or the dental surgery.
- General dentist: Has completed college, dental school, and passed all required exams through a State Dental Board. A general dentist has also obtained a dental license through his or her state.
- Pediatric dentist: Has completed all the above training and licensure as a general dentist, as well as a pediatric dental residency (usually 2-3 years). Pediatric sedation training is included in the residency training. Pediatric dentists may be board certified by taking and passing a national exam.
- Oral and maxillofacial surgeon: Completes an oral maxillofacial residency after dental school (4-6 years). Most oral and maxillofacial surgeons have a dental license, and some also have a medical license. In addition, some are granted a general anesthesia permit by a State Dental Board. Oral and maxillofacial surgeons may be board certified by taking and passing a national exam.
- Anesthesiologist: A physician or dentist who completes a 3-5-year anesthesiology residency after medical or dental school and passes all required exams. Anesthesiologists can administer anesthesia for dental procedures and oral surgery, and they may have a permit from a State Dental Board to deliver anesthesia in a dental office. Physician and dentist anesthesiologists may have specialized training to treat children, and they may have board certification by taking and passing a national exam.
- Nurse anesthetist: A registered nurse who completes a 2-year program after nursing school and has additional clinical experience. In some states, nurse anesthetists can administer anesthesia in a dental office without the supervision of a dentist or physician.
- Dental hygienist: Completes a 2-year dental hygiene degree after high school—usually an Associate’s Degree. Some dental hygienists have additional education and training such as a Bachelor’s Degree. They are licensed by their state and can give local anesthesia (numbing shots) in the mouth.
- Dental assistant: No formal training is required. Training may be “on the job.” There are also 10-12-month certificate programs. Dental assistants may be registered by their state dental board. Dental assistants do not qualify as independent observers for deep sedation or general anesthesia.
- Dental sedation assistant: Requirements vary from state to state, but the dental sedation assistant can obtain a certificate allowing him or her to help watch patients under anesthesia. Certificates can be obtained via an online education program or at an approved on-site educational program. Dental assistants, however, cannot administer sedation or rescue medications on their own in a dental office.
For any child receiving deep sedation or general anesthesia an anesthesia professional or another dentist/oral surgeon who is trained in anesthesia must be present to help care for your child.
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