Treatment under anesthesia

Anesthesia and Sedation

Most children can be properly controlled with just local anesthesia if good communication is maintained between the parents and the child and suitable behavior control techniques are used. For a variety of reasons, only a small percentage of them cannot be controlled by the aforementioned techniques; in these cases, drug control is advised.
Reducing or eliminating anxiety is the primary objective of medication control for pediatric patients.
The following techniques can be used to modify the pain response threshold and reduce anxiety:
Conscious sedation
Deep Sedation
General anesthesia
Conscious sedation: This type of minimally invasive sedation preserves the patient’s response to physical cues or commands, such as “open your eyes,” and preserves their capacity to maintain an independent airway.
Deep sedation: This is a regulated state in which the patient is unconscious and finds it difficult to wake up. This results in a partial or whole loss of voluntary responses to physical cues and spoken orders, as well as protective reactions (such the capacity to maintain an autonomous airway).
General anesthesia: a regulated state of unconsciousness that impairs defensive mechanisms like autonomous ventilation and the ability to react voluntarily to verbal or physical cues.

Principal Methods for Conscious Sedation

To achieve the goal of treatment without suffering from pain or anxiety, each of these techniques is applied appropriately.

- Inhalation (limited to N2O material)
- Oral
- Intramuscular
- Subcutaneous
- Intravenous
Advantages of using the inhalation method:
- Rapid effect initiation and rapid effect termination
- The simplicity of titration (controlling concentration)

Disadvantages of using the inhalation method:

The drug’s weakness (it’s only good for those who can collaborate and have mild anxiety)

Oral Method

Oral method: This is the technique typically employed in dentistry offices to put youngsters to sleep.

Advantages of using the oral method:

If prescribed in modest doses and tastes well, it’s easy to utilize.
The youngster can receive the medication at home or at office (of course, our office is supervised).
The method’s affordability (because specific equipment is not needed).
If the appropriate dosage is determined for the individual, it is extremely safe.

Disadvantages of using the oral method:

Instability of the effect: individuals of the same weight may react differently to the same dosage of medication because there are a number of variables that can affect how well the medication is absorbed in the stomach and intestine, including the presence of food, anxiety, fear, the administration of other drugs, fatigue, excitement, and anxiety, as well as the intervals between gastric emptying.
Prolonged time for coming into effect (45–90 minutes)
The child’s resistance to taking his medication.

These factors make oral pre-medication administration unreliable.

Intramuscular Method

Advantages of intramuscular method

Much faster and more consistent drug absorption, compared to oral technique
The patient must collaborate as little as possible, if at all.
There is a high degree of certainty that all medication reaches the patient.

Disadvantages of using the intramuscular method:

The onset of effect of the intramuscular method may be hindered or diminished by various factors. These include a person’s body being cold and anxious, which causes constriction of peripheral vessels and decreases drug absorption. Additionally, if the drug is injected deep into the muscle, faster absorption may occur due to the presence of more blood vessels.
Inability to reach the open vascular pathway under emergency scenarios;
Possibility of tissue damage occurring at the place where the injection is administered;

Subcutaneous Method

It is injected under the skin or under the mucosa.

1. Advantages of the subcutaneous method:
  - In the oral cavity, it can be injected submucosally (it is less objectionable than other organs)
  Disadvantages of the subcutaneous method:
  - The amount of absorption in this method is less (except for the oral mucosa).

Intravenous Method

It is an ideal and desirable way to relax in consciousness.

Advantages of the intravenous method:

Titratable (in this method, it is possible to determine the concentration to obtain the desired effect)
Since it goes directly into the blood, we do not have absorption problems.
We always have an open vein for emergencies.

Disadvantages of the intravenous method:

Vain finding is the most difficult skill in sedation while being awake.
Since the drug enters the vein directly, it is possible to cause more complications.
Maximum care is required in this method.
Expensive for more care and more equipment that is needed.

Drugs used in sedation

Sedative and sleeping drugs
Anti-anxiety drugs (diazepam, midazolam)
Hydroxyzine and diphenhydramine: they have both anti-anxiety, sedative and sleep-inducing effects.

General Anesthesia Dentistry

Under certain circumstances, general anesthesia is seen to be the best option. These include:

Patients who are younger than the collaborating age, which is roughly three years old and occasionally older.
A child or teenager with significant dental requirements who is uncollaborative, fearful, , apprehensive, resistant, or uncommunicative and no further behavioral change is anticipated.
patients whose complete care cannot be achieved by alternative means and who require immediate, comprehensive dental treatment.
Dental patients, for whom general anesthesia lowers the danger of complications or safeguards their mental growth.
Patients requiring medical or surgical procedures for whom there is no viable local anesthetic option because of an acute infection, allergy, or anatomic variation.
Patients with serious medical, psychological, or physical conditions.
Patients with severe damage to their mouths, faces, or teeth.

There are several situations in which general anesthesia should not be used, including:

A youngster who is healthy and able to get dental care with limited needs.
A child who is medically prohibited from receiving general anesthesia;

There are two ways to administer general anesthesia.

The first approach involves outpatients, who have received medical care in a hospital or clinic and do not require admission to a hospital.
The second approach pertains to patients who need care subsequent to their therapy for a variety of medical reasons and require hospitalization.

An outpatient surgery can be regarded appropriate for a child or teenager who needs general anesthesia and does not have any significant medical condition that would prevent them from obtaining anesthesia. Patients who are under medical care may be eligible for outpatient surgery after consultation with an anesthesiologist and a relevant specialized physician. The selection of the appropriate general anesthesia method is determined by the availability of facilities and the medical history of a child or teenager. The anesthesiologist has the final authority in this case.
The patient visits the anesthesiologist for guidance after taking any necessary radiographs, if at all possible, prior to anesthesia (if not, the radiographs are received from the patient during anesthesia). Any relevant medical history, behavioral issues, disabilities, and prescriptions should be shared with the anesthesiologist in order to ensure that the patient is appropriately evaluated before receiving general anesthesia.
If necessary, a test or medical consultation will be carried out. A reservation for the operating room is made if the anesthesiologist gives his approval for general anesthesia.
The anesthesiologist consults with the parents over the length of time the child or teenager should refrain from eating before the surgery.
The patient is usually accompanied by their parents and arrives at the outpatient surgical center one to one and a half hours prior to the procedure, in order to administer general anesthesia in the morning of the surgery.
The equipment used for restorative procedures in the operating room is similar to those used in a dentist’s office. The efficacy and caliber of restorative procedures performed under general anesthesia surpass those conducted under conscious sedation due to the absence of patient compliance issues, complete clearance of the working area, and uncomplicated access to the mouth cavity. Moreover, the reduced anxiety is observed by both the patient and the dentist throughout the process, facilitating the expedited treatment of a greater number of teeth. The dentist should utilize materials with the longest durability and require minimal upkeep. For example, steel veneers are superior to multi-level restorations.
The treatment plan involves the removal of the candidate teeth, followed by the use of absorbable sutures in the afflicted area.
The advantage for the patient, parents, and physician is that all necessary treatments for the patient, while they are under anesthesia, are performed in a single session.
The anesthesiologist initiates the process of restoring the patient’s awareness once the dental operation is finished.
After regaining consciousness, the child is transported to the recovery area. The dentist swiftly offers the nurses the necessary guidance, and after confirming the child’s good health, he meets with the parents to review a summary of the treatments that were performed.
After completing the process, the dentist documents the job done for the patient, along with the operation report.
If the patient receives outpatient treatment, he will need monitoring for a few hours before leaving the hospital.
For patients receiving general anesthesia, parents shall be strongly warned of the importance of fully adhering to oral and dental hygiene practices and controlling their child’s sugar intake. Failing to do so will result in the reoccurrence of tooth decay, which would be a waste of resources including money, time, and effort.

Items on the site that can be translated: Home; About Us; Contact Us; Information; Office Treatment; Oral Hygiene; Anesthesia Treatment; Parent’s Guide; Pediatrics Dentistry