The Whole Tooth: Sedation “Sleepy Medicines” in Young Kids
By Dr. Robert Kelly, D.M.D.
This month’s article discusses sedation in children. There are times when urgent and important dental work must be completed on a young child and a general dentist or pediatric dentist is not able to do it without some form of assistance from medication, owing to lack of patient compliance. When deciding whether to undergo any form of deep sedation for children beyond nitrous oxide (laughing gas), I have always cautioned against it unless there was absolutely no other way and the child’s condition was urgent and thus detrimental to their future health.
A recent study published last month from Dr Bunmi Tokede, MPH, DMSc from the University of Texas Health Science Center, found that 1 in 12 instances of deep sedation in children performed in outpatient dental offices resulted in an adverse event. Most of these events were minor such as a dizzy patient falling and cutting their head on the checkout desk. However, it has been known for quite some time that very young children have the greatest risk with deep sedation due to respiratory problems during the procedure. For me, professionally and personally, this has always felt very risky and outside of my comfort zone. Some of these adverse events could be more than minor and therefore I prefer a conservative approach when possible.
There may be a handful of dental cases that certainly require intervention at a young age. Sometimes providers and parents are not afforded much choice. However, if the child is very young, especially younger than five years old, I feel it safer and less risky to have the sedation done in a hospital setting and not take the risk of an adverse event happening in an outside clinic setting. That way, if anything does happen, the best emergency care is available quickly.
Laughing gas has been around for quite a while and for most kids has been very safe over the years. This can be a great tool for getting cavities fixed or other procedures done: much safer than taking a medication that sedates them.
When it comes to taking care of some of our most vulnerable groups, I always like to look at what the history and data says when making important decisions. We all want the best for our children and the next generation, and we should all do whatever we can to keep them healthy and safe.