PRE-OP TECHNIQUES

Nitrous Oxide | Conscious Sedation | Outpatient General Anesthesia

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.

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POST-OP INSTRUCTIONS

Please follow the instructions below. Contact us with questions or if unusual symptoms develop.

NUMBNESS: The mouth will be numb approximately 2-4 hours and sometimes longer if a longer acting local anesthetic was used. Watch to see that your child does not bite, scratch, or injure the cheek, lips, or tongue during this time.

BLEEDING: Bleeding was controlled before we discharged your child but there may still be slight bleeding. Hold gauze with firm pressure against the surgical site until oozing has stopped. You may need to change the gauze or repeat this step. If bleeding continues for more than 2 - 4 hours, contact us.

DAILY ACTIVITIES: Today, avoid physical exercise and exertion. Return to normal activities as tolerated. Smoking is never good for one’s health and may delay healing following oral surgery.

DIET: Encourage your child to drink fluids to help avoid dehydration. Cold soft foods (eg, popsicles, jello, Instant Breakfast®, pudding, yogurt) are ideal the first day. Do NOT USE STRAWS if patient had extractions.

ORAL HYGIENE: Keeping the mouth clean is essential. Today, teeth may be brushed and flossed gently, but avoid stimulating the surgical site. Soreness and swelling may not permit vigorous brushing of all areas, but please make every effort to clean the teeth within the bounds of comfort.

PAIN: Because some discomfort is expected, you may give your child acetaminophen (Tylenol®) or ibuprofen (Motrin®, Advil®) before the numbness wears off. Follow the instructions on the bottle for dosing based upon your child’sage/weight. If pain is not relieved by one of these medications, a prescription may be needed. Take prescription pain medication with a small amount of food to avoid nausea.

Watch for:

Swelling: Slight swelling and inflammation may occur for the next 2 days. If swelling occurs, ice packs may be used for the first 24 hours (10 minutes on then 10 minutes off) to decrease swelling and/or bruising. If swelling persists after 24 hours, warm/moist compresses (10 minutes on then 10 minutes off) may help. If swelling occurs after 48 hours, call our office.

Fever: A slight fever (temperature to 100.5°F) is not uncommon the first 48 hours after surgery. If a higher fever develops or the fever persists, call our office.