Dental Treatment for Children under General Anesthesia in the Hospital Setting
Dental treatment (dental surgery) under general anesthesia (GA) may be provided in the hospital operating room (OR). This article aims to educate and help prepare parents and children for their planned hospital GA visit for dental treatment which may also be referred as a hospital dentistry or hospital dental surgery treatment visit.
In the United States each year more than a million children under age 4 have general anesthesia (GA) for surgical procedures. The overwhelming majority of these children were treated in a hospital operating room or an ambulatory surgery center (ASC). Dental surgery due to advanced severe early childhood caries is by far the most common reason children require such treatment and in fact made New York Times science section front page a few years back. This is unfortunate considering tooth decay can most often be prevented if children begin early oral assessment (by age one) and caregivers are able to maintain vigilance on proper oral hygiene and healthy diet at home. In cases where decay has advanced causing pain and or oral infection for a child that is not able to cooperate for chair-side treatment, dental surgery with sedation may be advisable as a safe and effective option to help restore the child’s quality of life.
General anesthesia is always administered by an anesthesiology specialist (dental or medial anesthesiologist). Most often all of the needed dental treatment is completed during a single GA visit. Children are generally induced or have the anesthesia/sedation started by breathing gas anesthetics from a mask and can be fully sedated within just a few seconds. The treating dental surgeon/dentist works closely with the anesthesiologist who administers the anesthesia and monitors the patient during the entire procedure.
A medical clearance form may be required to be filled out by the child’s primary care provider (PCP) to assure no contraindication to general anesthesia exits. Also, any adverse family history with general anesthesia should be discussed with the treating dentist. Also depending on the child’s age no food or drinks (NPO) should be taken for 6-8 hours prior to the day of the GA appointment.
Also if the child has come down with a upper respiratory infection (URI), be sure to inform the office to assure the child does not need be re-evaluated by the PCP or the treating dentist/anesthesiologist. Sometimes URI will require the a GA appointment to be postponed.
Parents should plan to devote the bulk of their day for completing of this hospital based GA visit. Patient needs arrive about two hours prior to the time of dental surgery to be fully registered and evaluated by the nursing team and anesthesiologist. The dental examination and treatment can typically take one to two hours to complete depending on how extensive the needed treatment is. This may be difficult to predict since most children that need such treatment do not have any diagnostic radiographs (X-ray images) prior to their GA appointment. The Dr’s will be asking for consent for providing GA and completing the dental exam, radiographs and all needed dental treatment (complete dental rehabilitation). This may include dental fillings, crowns, pulp therapy, dental extraction and space maintenance therapy. Children will need about 1-2 hours to recover in the post-operative anesthesia care unite (PACU) from GA and be discharged to go home. There is ample pain medication provided for the child during and after the procedure in the PACU.
Children rarely require any additional pain medication after a complete dental rehabilitation. In cases of multiple extractions, children Tylenol or Motrin may be used as an over the counter medication. Be sure to follow the instruction based on the child’s age. Some children may experience a slight sore throat for 1-2 days due to the breathing tube. Children are also susceptible to post anesthesia nausea and vomiting. Parents should have a change of clothes and be prepared for this. It is best for a child to have clear soup and juices for the first several hours after GA to minimize chances of nausea and vomiting.
It is always helpful to prepare children for the experience of having GA. This may be done in a variety of ways from doing role play to reading books that explain GA to children and or visit My Kids Surgery website. Some pediatric hospitals offer a pre-appointment tour for the parents and children to help prepare for this visit. For hellosmile patients who will be treated at Mount Sinai St. Luke’s, parents may contact the “Meet Me At Mount Sinai” program at (212) 241-9403.