Sedation for Kids

Q&A With Dr Emma

Hi Dr Emma, We have been advised that our five year old will need two teeth removed due to abscesses. The Dentist we saw recommended a general anaesthetic in order to have it done. But I have also made an appointment with another dentist that performs 'Sleep Dentistry’ or 'Twilight Anaesthetic’ – is this a safer option? Obviously I would prefer to avoid the G.A. if I can. I’d appreciate any advice you could provide. Thank you, Anthea from Romsey, VIC

Dear Anthea,

While it's unfortunate to hear your little one isn't well, it's great that you're taking action to make sure fear isn't an issue when having the teeth taken out. I see too many people who had horrible childhood experiences that have turned them off dentistry for life. A lot of those could have been avoided if they'd been asleep for treatment!

There are a few key differences between a general anaesthetic (G.A.) and "twilight sedation", commonly known in the industry as conscious sedation.

General anaesthetic

• Must be carried out in hospital.
• Can only be administered by an anaesthetist, i.e. a specialist medical doctor.
• There is complete loss of consciousness, the patient is not rousable until the drugs wear off or the anaesthetist administers additional drugs to wake them.
• The patient has no memory of the procedure.
• The patient is intubated to hold their airway open, they have no gag reflex so are at risk of inhaling things they shouldn't.

Conscious sedation

• Can be carried out at the dental clinic.
• Must be administered by someone who is not doing the dental treatment, so their full attention is on monitoring the patient. The sedationist can be a doctor or dentist who has had additional training, and is registered with their national board to provide conscious sedation.
• The patient is in a state more like sleep, rather than being completely knocked out. They are usually able to respond to simple requests for them to move or open their mouth.
• Despite being potentially conscious, the patient still has no memory of the procedure.
• The patient is "awake" enough to cough if something gets in their airway, so intubation is not needed.

Relative analgesia

• Can be carried out at the dental clinic.
• Must be administered by a dentist, but does not require a separate person just for patient monitoring, so there can be just one dentist doing treatment and giving the gas.
• The patient is fully aware of what is going on, but anxiety is greatly reduced and the patient will feel "out of it".
• The patient will be able to remember the procedure.
• As the patient is completely conscious, intubation is not needed.

With every form of sedation there are risks of reactions to the drugs. These range from mild nausea, to allergic reactions, to severe life-threatening complications. The more drugs used, the higher the risk. However, good health care professionals are there to manage and minimise those risks, hence the requirement for hospitalisation for G.A., and the requirement for a dedicated sedationist for conscious sedation. 

I would encourage you to ask as many questions of your dentists, doctors, anaesthetists and sedationists as you like in order to make the best decision for you and your family. That way you can be confident in the decision you have made, and know that your child is in the best hands possible.

Thanks,