Oral Sedation

OVERVIEW

We have recommended sedation for your child’s safety and comfort during dental procedures. The doctors and staff of Frederick Pediatric Dentistry take the safe sedation of children for dental treatment very seriously. We are one of only a select few dental practices in Maryland to have undergone a rigorous office inspection, and we have been approved by the State of Maryland for a Class I Sedation Permit.
We do not administer intravenous (IV), intramuscular (IM), or general anesthetic medications in the office setting. If necessary, these services are offered by Dr. Camacho and Dr. Virts in conjunction with a full anesthesia team at Frederick Memorial Hospital.
Unlike general anesthesia, sedation is not intended to make a child unconscious or unresponsive. However, some children doze off during treatment; this is normal. Your child will not receive a general anesthetic; only medication to make him/her drowsy. All needed care will be accomplished in this “sedated” state. If necessary, a local anesthetic (numbing) will be used during treatment so your child will not feel any discomfort or pain. Your child may have little or no memory of the treatment.
To make your child’s dental experience a pleasant one, your child will be given a moderate strength liquid sedative or a mixture of sedative drugs to calm him/her for the appointment. The medications will be given by mouth. They will relax your child and enable us to attain the best results possible. It is extremely important that your child have an empty stomach before the treatment in order to avoid nausea and vomiting that can accompany an anxious, sedated patient, and also so the medications can work effectively. For this reason, we reserve early morning appointments exclusively for patients requiring sedation.
Children often sense a parent’s anxiety, which makes them more fearful. They tolerate procedures best when their parents understand what to expect. If you have any questions about the sedation process, please ask. As you become more confident, so will your child.
Please plan to spend approximately two and a half to three hours with us the morning of your child’s appointment.

To help you understand the sedation procedure, the following are important points to remember:
BEFORE ARRIVING FOR THE SEDATION APPOINTMENT

1. Give your child a light dinner the night before the appointment.
2. Your child must have NOTHING to EAT or DRINK for at least 6 hours before the scheduled appointment. However, it is best to give your child nothing to eat or drink after midnight the night before. We will not proceed with the sedation if you do not comply with the previous requirement.
3. Please be prompt for your appointment because it takes approximately 60 minutes for the medication to take effect.
4. A parent or legal guardian must remain at the office throughout the sedation appointment and may not leave the office for any reason.
5. In order to minimize any health risks to expecting mothers, we request that if you are pregnant (or think you may be) that you not accompany your child into the treatment room, where nitrous oxide will be used.
6. Please notify our office if your child develops a fever, productive cough, or a cold within 2 days of the scheduled appointment.
7. To avoid drug interaction, it is best that your child take only those medicines prescribed for dental sedation, except those prescribed for ADD, ADHD, asthma, or other systemic conditions. Please be sure to inform the doctor prior to the sedation appointment if your child takes ANY medications on a regular basis.
8. Dress your child in loose-fitting, comfortable clothing. This will allow us to place monitors that evaluate your child’s response to the medications and help ensure your child’s safety. If your child has long hair, please do not pull it back because it may place pressure on the back of their head and distract them. Female patients should have NO nail polish on hands or feet. Please do not let your child wear tights to the appointment.
9. In order to help your child achieve maximum relaxation, please do not bring other siblings, food, or portable video games to the appointment.
THE SEDATION PROCEDURE

1. Your child will be given the chosen medication by mouth approximately 60 minutes before treatment will begin.
2. The appropriate dosage for your child’s weight and age will be given. Since all children metabolize medications at different rates, the dosage and medication given may not be sufficient to achieve the desired sedation level. If treatment cannot be completed safely under the desired conditions, the doctor will discontinue treatment, and no additional medication will be given at that appointment.
3. After administration of the medication, your child may become quite active. This is similar to the “life of the party” effect that one experiences during a celebration. It is important to watch your child carefully now because they will have little balance control. Shortly after this, your child will relax to a restful condition that will enable treatment to follow.
4. Some children will doze off during the treatment. A small percentage of children may become very irritable and hyperactive before becoming sedated. During the procedure, your child may wake occasionally when stimulated but should have little memory of the treatment. If necessary, your child will receive a local anesthetic so that she/he will not feel any discomfort or pain. Nitrous oxide (laughing gas) and oxygen will also be used for an added effect. This will make the procedure more comfortable for your child.
5. On rare occasions, we may request that, for sedation procedures, parents remain in the reception area during treatment to allow the dentist to concentrate on your child and work quickly.
AFTER THE DENTAL TREATMENT

1. While driving home, please use the seat belt to protect your child. If at all possible, it is best to bring another adult to assist you.
2. Following dental treatment, your child will be groggy and may want to sleep for most of the day even though he/she will probably be awake when the appointment is over. During this recovery time, the medicine is “wearing off.” When your child awakes fully, he/she may be quite hungry and at this time may have something to eat. We recommend a soft diet because the numbness may not have worn off completely. Please provide plenty of fluids to drink to aid in the elimination of the sedatives.
3. In addition to the sedative medications, we may use local anesthetic to numb the mouth during dental treatment. The numbness usually lasts 2-4 hours. Carefully watch to see that your child does not bite, scratch, or injure the cheek, lips, or tongue during this time.
4. Nausea, vomiting and irritability are occasional side effects of the medication. To help your child recover more quickly, give plenty of fluids. For example, milkshakes, ice cream, and popsicles have a soothing effect. Small drinks taken repeatedly are better than large amounts.
5. Because balance is the last function to return to normal, your child may still be “wobbly.” Carefully observe your child’s activities for the rest of the day. Your child may be drowsy for some time after the sedation appointment. Please restrict activities for the remainder of the day. Prohibit potentially harmful activities such as bike riding, swimming, using playground equipment, or any activity where balance is important.
6. If your child experiences discomfort of the mouth after the appointment, you may give your child children’s ibuprofen (Motrin or Advil) or acetaminophen (Tylenol) if they are not allergic to these medications. Follow the instructions on the bottle based upon your child’s age/weight.
7. Office sedation will not take the place of normal nighttime sleep.
8. Please do not hesitate to call the office at 301-682-3887 if you have any questions either before or after the visit. Thank you for your cooperation.
CONSENT

I have been informed and understand that on rare occasions there are complications with the use of local anesthetics and sedative medications which may include, but are not limited to: numbness of the face, cheek, lips and tongue; soreness to injection and operative site; swelling; bruising; nausea; vomiting; allergic reactions; and a reduced breathing rate. I further understand that these complications may be severe enough to require the child to be hospitalized.
The doctor has discussed with me the procedures, the possible complications, and the alternatives to the use of a sedative in order to provide the necessary treatment. I acknowledge the receipt of the treatment instructions. It has also been explained to me that there is no guarantee to the success of sedation procedures.
Our doctors and/or Frederick Pediatric Dentistry, LLC cannot guarantee the successful sedation of every child. Tolerances to medicines are unique to each individual patient. About 10% of the population have a paradoxical or opposite reaction to sedatives, and become hyperactive or combative. Every effort will be made to safely complete the recommended treatment for your child. If, in the professional opinion of the doctor, treatment cannot be safely rendered, then work will be suspended. There will still be a charge for the 2 ½ hours reserved for your child and the medicines, gas, and monitoring provided. If the appointment is determined to be unsuccessful by the pediatric dentist, the fee will be applied to a Same-Day Surgical fee to treat your child in a hospital setting.
If you would like to be 100% sure that the treatment will be completed, then you should discuss a same-day surgery option with a staff member prior to administering the sedatives in the office.
I have read, understand, and agree to follow the procedures and recommendations for the safe, comfortable sedation of my child described in this document. I understand that my child’s appointment time impacts the health of other children. If I fail to cancel this appointment within 48 hours, I will be charged a cancellation fee of $115.00.