Today I had a four year old boy from Molalla and a three year old girl from Gladstone needing deep sedation.  Deep sedation is not quite general anesthesia like for medical operations but keeps patients just barely asleep.

There are options to treat while awake or to get sleep dentistry in a hospital or in our office.

Sleep Dentistry Advantages:

• Able to complete all treatment at one time
• Comfortable during treatment

Sleep Dentistry Disadvantages:

• More expensive than without
• Some drug risk

In-office Sleep Dentistry Advantages: 

• No uncomfortable breathing tube is used.  
• Recovery time is much faster with the drugs we use.  
• Kids leave for home within about 30 minutes.

Hospitalization Advantages:

• Sick children have emergency doctors close by.

Hospitalization Disadvantages:

• Much more expensive than in-office care.
• More uncomfortable afterwards due to sore throat and nausea.
• Takes much longer to check in, do work, recover, and check out.

I use an anesthesiologist in my office to give the kids a quick shot in the arm that within a minute has them not paying attention to their surroundings.  He will then start an IV and keep them asleep while we finish their dental care. 

The kids wake up within minutes and go home after about half an hour.

This has become my preferred treatment method for children that need to go to sleep for their dental care.

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Sleep Dentistry or Deep Sedation

This is just not the case for almost every extraction that we do.  A little push and squeeze, and you are done.

Sedation is an option for the faint of heart but most do not need it.  Often we can amaze the little ones when we take the tooth out “magically” with a magic mirror and sleight of hand because they do not know the tooth was already gone.  See our section on Sedation for more information.

Today a girl from Lake Oswego needed several teeth out for her braces.  After soaking her gums with a powerful anesthestic gel, the shot was so comfortable that she did not know what I was doing.  Once the anesthestic was working well, we had to explain the difference between a push and a pinch and how teeth are connected to ears through the jaw bone.

Little ones often worry about the numb feeling or confuse pressure with pain.  Explanations of what to expect using carefully chosen words make kids much more comfortable.

The gums are gently pushed away from the tooth to be extracted and then the tooth is rocked back and forth.  Shaking the whole head a little bit helps distract from the sensation of firm pressure.  

Once the tooth is out, a guaze pad stops the bleeding.  And a prize brings out a smile.

Post from: Great Grins

Extractions

This child had several decayed molars and the cavity on one tooth was especially deep. Since his older sister had told him that we were going to use a big shot and yank out his tooth, he got really scared.

To reduce his anxiety, we recommended using a medicine called Triazolam (Halcion) and nitrous oxide gas (laughing gas). His mother asked about the safety of these sedation medications.

Nitrous oxide advantages:

• it is a pretty good analgesic pain reliever
• giving a good euphoric feeling
• used with more oxygen than room air
• the effects go away as soon as it is turned off

Triazolam advantages:

• reduces anxieties for kids that understand the need
• does not put kids to sleep at the dose we use
• is completely reversed by another drug we keep available called Flumazenil or Romazicon.

We have never had to use it, but it is nice to know Flumazenil is there for emergencies.

Triazolam has a fairly short half life so it takes about 45-60 minutes to take effect, then it is worn off usually after three hours.

Often kids become stumbly with poor balance while the Halcion is effective. Paraents should stand by to hold hands and remind their child to not move around much until the medicine is worn off.

Much more relaxed after taking the triazolam, this Milwaukie kid was able to sit in the dental chair, breathe the nitrous oxide gas, and get a pulpotomy and a composite white filling without any worry.

Post from: Great Grins

Oral Conscious Sedation

Midazolam (MID-ay-zoe-lam) and triazolam (trye AH zoe lam) are in a class of drugs called benzodiazepines. They are used to produce sleepiness or drowsiness and to relieve anxiety before surgery or certain procedures. Midazolam is also sometimes used to produce loss of consciousness for patients in hospitals before and during surgery.

In our facility, midazolam and triazolam are given under the supervision of a doctor trained to use this medicine. Our staff will give your child the medicine and closely follow your child’s progress.

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make and the following should be considered:

Empty Stomach- Your child should have an empty stomach before taking this medicine.  Eat nothing for six (6) hours before the appointment.  Morning appointments are the best.  Clear fluids can be drunk up to three (3) hours before the appointment.  Clear fluids are white grape juice or water, not like orange juice or milk.   Do NOT drink grapefruit juice before taking this medicine.

Allergies- Tell the doctor if your child has ever had any unusual or allergic reaction to midazolam or other benzodiazepines.  Also, tell the doctor if they are allergic to any other substances, such as foods, preservatives, or dyes.

Other medicines- Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. These sedative drugs may increase the effects of other drugs that cause drowsiness or dizziness, including antidepressants, alcohol, sedatives (used to treat insomnia), other pain relievers, anxiety medicines, muscle relaxants, seizure medicines, and antihistamines. Do not take midazolam or triazolam without first talking to your doctor if you take any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.

Other medical problems- The presence of other medical problems may affect the use of these drugs. Make sure you tell your doctor if you have any other medical problems, especially:

• Heart, Lung, Kidney, or Liver disease
• Obesity (overweight) – The effects of these drugs may last longer
• Glaucoma (narrow angle) – triazolam may make this worse
• Myasthenia gravis or other muscle and nerve disease – midazolam may make this worse

Precautions After Receiving This Medicine

• Midazolam may cause some people to feel drowsy, tired, or weak for the rest of the day after it has been given. It may also cause problems with coordination and one’s ability to think. Therefore, do not allow your child to do anything else that could be dangerous if not alert until the effects of the medicine have disappeared or until the next day.
• Do not take CNS depressants (medicines that slow down the nervous system, possibly causing drowsiness) for about 24 hours after taking midazolam, unless otherwise directed by the doctor. To do so may add to the effects of the medicine. Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds; other sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; medicine for seizures; and muscle relaxants.

Side Effects of This Medicine

Side effects of these drugs are: drowsiness, dizziness or clumsiness with difficulty walking and talking, confusion, headache, dry mouth, and changes in behavior such as the appearance of being drunk.

Most side effects usually do not need medical attention and will go away as the effects of these drugs wear off.  However, check with your doctor if any side effects continue or are bothersome.

Post from: Great Grins

Midazolam (Versed) & Triazolam (Halcion)

Because Oregon, and especially East Portland, is home to many families that care deeply about health and the substances their children are exposed to, some Oregon parents worry about using drugs or medicine with their kids.

We use very safe drugs to sedate children in both our Oregon City and Portland offices.  Our first sedative drug is nitrous oxide gas.  Nitrous oxide is sometimes used for race cars but its first use was as a pain killer.  

In fact, a dentist in the early 1800′s noticed that someone who breathed nitrous oxide gas as a intoxicant was not bothered by a cut on  his leg and after having one of his teeth pulled out using nitrous oxide gas without much pain, he discovered the first medical anesthestic gas.  

Nitrous Oxide gas is often called Laughing Gas, Giggle Gas, Happy Gas, etc. because in addition to its analgesic properties (ability to relieve pain), it is also a euphoric (makes you feel happier).

Another sedative drug that we commonly use in our office for anxious kids is triazolam (Halcion brand). This comes as a pill that has a mild taste that kids do not seem to mind holding under their tongue or chewing up.  

Triazolam is related to Valium and Ativan because they are all in the benzodiazepine group of drugs.  Triazolam is an excellent choice for dental care of scared kids because it is very safe, it works within about on hour, and it wears off after only a few hours. 

The last sedative drug we use for kids afraid of the dentist is hydroxyzine pamoate (Vistaril brand).  This liquid tastes pretty good and it is an antihistamine drug that reduces nausea and also has some sedative effects.  

Nitrous oxide, triazolam, and hydroxyzine can be used singly or in combination to help children who are afraid of the dentist feel more relaxed and more cooperative without going to sleep.

Post from: Great Grins

Oral Conscious Sedation