Types of anaesthesia to manage your child's dental treatment
Simple procedures such as scaling, polishing and fillings are what most people are accustomed to when talking about seeing the dentist. Complex treatment like crowns and nerve treatment (or root canal treatment) for children would usually surprise most parents. Many parents tend to be unaware of the extent of their child’s treatment needs. To deliver the treatment as best as we dentists can, we need to manage the pain and the child’s acceptability of the treatment…which makes things tricky at times. Remember that many children do not tolerate dental treatment as well as adults do. Therefore, some children may require some form of medication or agent to help the child be less anxious and at the same time get the treatment done. Below I’ve outlined three modes of how dentists get treatment done in children (or even for the really anxious adults).
1. Local anaesthesia (LA)
Local anaesthesia is injecting numbing juice at the site of the procedure. It numbs a small area around the procedural site. Local anaesthesia is delivered at the soft tissues (like the gums) at the area where the tooth or teeth to be treated is/are located. Usually, a numbing cream will be placed at the site of injection first before the injection to ensure minimal discomfort during the puncture. Local anaesthesia is required for baby teeth that need extensive treatment such as deep fillings, crowns, nerve treatment or extraction. Note that baby teeth are the same as adult teeth ie they have nerves and roots. Therefore, the baby teeth feel the same as the adult teeth – they can feel toothache, pressure, discomfort. Hence baby teeth treatment require local anaesthesia where necessary. It’s a common misconception that baby teeth do not have roots nor nerves. Only a baby tooth that is about to be replaced by a permanent tooth will not have roots, as the erupting permanent tooth would have caused the baby tooth roots to be resorbed (“eaten away”). Different children react differently to the injection and numbness. Some can tolerate it well while others may be tearful when the numbness sets in. Young children who need a lot of treatment may not be able to tolerate multiple local anaesthesia dental visits if they have many decayed teeth. Imagine us adults already disliking it, what more for a child! Therefore, some children may require sedation or general anaesthesia to get their dental treatment done safely without traumatising them.
Sedation in dentistry is the use of drugs or agents to reduce the awareness and anxiety of the patient so as to be able to carry out the dental procedures as atraumatically as possible. In sedation, there is a spectrum of consciousness involved from minimal to deep. In dentistry, minimal or conscious sedation is the preferred level of sedation for patients as it is safer than deep sedation. This means that the child will still be awake throughout the treatment. Sedation in dentistry is usually administered either through oral, inhalation (gas) or intravenous routes. Oral means the child drinks or eats the medicine through the mouth; inhalation means the child breathes in a special type of “happy gas”; and intravenous means the child receives a small injected tube through the arm for the medicines to go directly into the bloodstream. For children, oral and inhalation routes are more popular and accepted. Appropriate doses of oral or gas sedatives can help make the patient more relaxed but yet awake and able to maintain his/her own breathing. However, a few things that parents should note for conscious sedation:
Local anaesthesia (aka injection) at the affected tooth/teeth will still be needed for dental procedures.
The treatment may need to be divided into several visits if there are many teeth to be treated.
For inhalation gas sedation, the child will need to keep breathing the gas through a nose piece throughout the dental procedure in order to continue being sedated.
Some children react differently to the sedative medicine and therefore may still be agitated and therefore not be able to get the dental treatment done
3. General anaesthesia (GA)
General anaesthesia is the use of a combination of medications to induce a sleep-like (unconscious) state before carrying out a procedure. It is done in an operating room. This is usually reserved for patients who are unable to endure the dental procedure(s) while awake. For some parents, the use of GA is unthinkable for young children because they believe that baby teeth will be replaced some day and that it is unnecessarily costly. But not all baby teeth will be replaced so soon and that would mean the child having to tolerate a bad tooth or teeth in the mouth for a prolonged period. So for some, doing dental work under GA may be the best way to do proper treatment for an uncooperative child and eliminate the trauma from multiple uncomfortable dental procedures. These are some of the instances where children may benefit from having a dental GA:
Multiple huge dental cavities requiring multiple crowns and nerve treatment, with some decayed teeth showing infection or persistent pain.
Young children who are unable to cooperate (very fidgety, tearful) for dental treatment to be done safely.
Surgical procedures that require the child to be absolutely still.
That said, not all children will require sedation for every single treatment. Every child is different and requires a different approach to treatment. In the end, it is about balancing the child’s treatment needs with his/her temperament and emotional/mental well-being. Ultimately the goal is for the child to be confident seeing the dentist as he or she gets older without needing to rely on sedatives.