Sedation options if my
child needs dental work

"What sedation options can I consider if my child needs dental work and is scared? Are they safe?Those are very common and important questions. In this article I'm going to explain the various sedation options and how they work.

Here’s a list of sedation options you can consider if your child needs dental work:

A dental procedure with sedation can be completely safe and performed effectively at a dental office. We will explain sedation options in more detail so you know what to expect. It's helpful to know what questions to ask your pediatric dentist when discussing your child’s dental work.

Nitrous Oxide:

Also called laughing gas. This method is useful for the older child who has some minimal anxiety and can be coached through the procedure. The child MUST be calm enough to breathe through her/his nose. If not, the pediatric dentist will get more of the Nitrous Oxide than your child.

This procedure is known for its safety (the only real reported issue is possible nausea, if the patient recently had a meal).

Conscious Sedation:

This is also referred to as Oral Sedation. The pediatric dentist gives the child an oral dose of one or more sedative drugs.

There are many different medications and combinations of medications that your doctor may use based on the degree of sedation required and the child’s weight. This is done in a pediatric dental office and the procedure generally requires a healthy child. The child’s tonsil sizes (and airway) are amongst many factors that need to be evaluated to ensure a safe procedure. Some medications used have amnesic effects. This method requires rigid NPO (nothing by mouth) guidelines to be followed and insufficient and or paradoxical reactions (opposite of expected sedation) could occur in a minority (but significant) percent of children. Oral sedation works in 3 out of 4 kids and the other 25% will need to be aborted and scheduled for Monitored Anesthesia Care.

Monitored Anesthesia Care (MAC):

An anesthesiologist starts an IV that allows quick and direct access of medications to your child’s blood stream. This is the common choice for children that are young, most anxious, and or have extensive treatment needs. While with increased depth of sedation, the chances of an adverse reaction increases, many consider this option the “gentlest and most predictable” option. The cost tends to be similar to oral sedation if more than 1-2 oral sedation visits are needed. However, since all treatment is done in one sitting (as opposed to as many as 4-5 visits with Conscious Sedation), once the cost of missing work is calculated into the picture, IV sedation may be more cost effective.

General Anesthesia (GA) in the Operating Room:

In rare cases, we schedule children who need dental treatment in a hospital operating room (the terminology used often is General Anesthesia). This will commonly increase the costs drastically, and the child will be in a deeper sedation to allow intubation. We commonly avoid this treatment route unless it is for a severely medically compromised child and the medical insurance benefits can be used to cover the significant hospital bill.

In short, there are several options and each have their pros and cons that require careful consideration. Please advise your dental professional for more information and consult a licensed practitioner before proceeding with any of the options discussed.

Consider reading my notes on the safety of sedation as compared to the risks here.

Sedation in a dental office is used on a daily basis by thousands of pediatric dentists all across the US.

Each year in the US more than a million children, 4 years and under, undergo general anesthesia for various surgical procedures. The advancement of early childhood dental caries has made dental surgery even more necessary. Since, it is one of the most common reasons children have to undergo various forms of dental sedation. A few years ago the New York Times published an article regarding the prevalence of preschoolers needing surgery due to a mouthful of cavities. Early childhood caries can be prevented by focusing early on your child’s oral health care and hygiene. Which is why we promote “First tooth, First birthday, First dental visit.” But in situations where there is pain, oral infection or the child is either too young or anxious to sit for chairside treatment, the sedation option is the most advised and safe option.

If you have further questions or would like to schedule a free second opinion for your child’s dental work, please call us: (858) 693-5677 . You can also set up a Virtual Consultation with Dr. J

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J. Shahangian


Dr. J is a board certified pediatric dentist and owner of Scripps Pediatric Dentistry & Brush n Brace, pediatric dental offices located in San Diego, CA. He is not only a Diplomat with the board but now also has Fellow status with the AAPD. He is a proud father of 3 beautiful girls, a San Diego native, loves soccer and is passionate about pediatric oral health. His mission is battling the number 1 disease that he has seen take over our beloved children. #AskDrJ provides answers and solutions to parents questions & concerns regarding their children's oral health. Click here for a full list of articles from #AskDrJ 

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