© Springer-Verlag Berlin Heidelberg 2015
Stephen Wilson (ed.)Oral Sedation for Dental Procedures in Children10.1007/978-3-662-46626-1_1
Division of Pediatric Dentistry, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA
Invasive dental procedures with its barrage of instrumentation, smells, sounds, and reputation are often considered as one of the most anxiety-producing events in our society. The behavior of children in the dental setting during these procedures is interesting and often tricky for the clinical team. Most children are easily managed with behavioral guidance techniques and parental support. Some will require pharmacological management to endure the procedures. Pharmacological management is a continuum ranging from mild anxiolysis to general anesthesia. Many children undergoing invasive dental procedures will be managed with agents that produce mild, moderate, or deep sedation which represents a portion of this pharmacological continuum. The oral route of drug administration is the most popular and frequently used for sedating children in the dental operatory. Safe sedation requires appropriate training of the clinician and his/her understanding and adherence to clinical guidelines. This chapter introduces the concept of sedation of children for dental procedures as well as sets the tenor of the rest of this book.
Dental caries occurs in our society despite preventive interventions that could theoretically eliminate its occurrence. Furthermore, evidence suggests that preschool-aged children in recent years are incurring an increased rate of caries experience. Often these younger children present behavioral challenges for the dental team which may be complicated by a host of issues (e.g., parenting styles). Many of the behavioral dynamics can be managed with good communication, empathy for the patient’s situation, and a dental team characterized as having a positive attitude and approach. However, a significant portion of these patients cannot be persuaded to cooperate for routine dental procedures. Thus, there is a need for more advanced approaches for managing behavior including pharmacological interventions.
The pharmacological options include the use of an inhalation agent (i.e., nitrous oxide), sedatives, combination of sedatives and/or inhalation agent, and general anesthesia. General anesthesia has its own set of considerations some of which can be significantly daunting, especially for parents. For example, anesthesia can be quite expensive and many insurance plans do not cover general anesthesia for dental procedures. As a result, the options for sedation may become more viable.
Sedation is as much a part of behavioral guidance tools as is a communicative alternative such as “tell, show, and do.” In fact, the seasoned clinician understands that a variety of behavioral guidance techniques could and should be used regularly during sedation to achieve the best outcomes of behavior and care. Unfortunately, little opportunities are presented during undergraduate dental training guaranteeing a widespread cadre of general practitioners who are competent in sedation techniques. Consequently, for general practitioners, sedation procedures involving children (and adults!) become an empirically learned process that can be fraught with potentially dangerous outcomes. Some specialties provide training in parenteral (mainly intravenous route) techniques of sedation administration to the level of competency (e.g., oral maxillofacial surgeons); but only advanced training programs in pediatric dentistry provide experiences with orally administered sedatives for children. Some of these pediatric dentistry training programs also provide some training in other non–intravenous, parenteral sedation techniques (e.g., submucosal route of drug administration). And from this writer’s perspective, disappointingly, there is fairly wide variability among programs in sedation experiences for trainees in pediatric dentistry.
There is a need for oral sedation primarily for preschoolers and older healthy children who have significant anxiety or dental phobia or have temperamental and personality characteristics that interfere with effective coping skills. Indirect evidence consistently suggests that children who require sedation for invasive dental procedures represent 20–30 % of children who visit a dental office each year – and that is probably an underestimate [1–3]. As of the present writing, there is no book specifically dedicated to oral