SUBJECT: Anesthesia for dental work

QUESTION: Our seven-year-old son needs to have a cavity filled but is very uncooperative at the dentist's office. Is there any anesthesia that would help him out? I don't like putting him through such a traumatic thing and I hate to have him go under a general anesthesia, but we are thinking about it. Any advice?

RESPONSE: It is very common for children to be anxious and even fearful in a dental setting. Our children with CdLS present a few additional barriers to being able to undergo routine dental procedures and therefore it is imperative that some form of sedation or anesthesia be utilized.

If there is good access for the dentist to the tooth that needs to be filled, that is, if the tooth is near the front of the mouth, then a mild sedative might just do the trick. As pediatric dentists we are trained in conscious sedation. If you need a referral in your area, please let us know.

The pediatric dentist might use nitrous oxide (laughing gas) or a combination of laughing gas and an oral sedative (Vistaril or Attarax or Demerol). Everyone has their own preference, but they all do the same thing--they take away anxiety and offer you a calm child that is able to accept the treatment at hand.

This conservative approach, conscious sedation, does not put the child to sleep and it does not always work. It might not be enough to gain the level of control and cooperation that the doctor might need to do the filling safely and effectively. If a deeper level of sedation is required, it might be necessary to have an anesthetist come in to the office and give an IV sedation. This is safe and effective in the proper setting, with the properly well-trained personnel and taking into consideration any other medical problems the child might have. For instance, heart or lung problems might not make the patient a good candidate for any of these sedation procedures and the operating room at the hospital might be the best environment to treat him in. Unfortunately, there are quite a few things to take into consideration when attempting to help children accept the dental procedures that must be done.

Do not be afraid of general anesthesia. It, often times, is the safest approach. The child is intubated and the anesthesiologist is breathing for him, monitoring him and all in a safe environment. If that is your last resort, it is not a bad one.

I would suggest having the doctor try the more conservative approaches first. If totally unsuccessful, then general anesthesia would be indicated.

DM (11-01-01)


RESPONSE: Conscious sedation or general anesthesia should be fine, but I would highly recommend doing it with a pediatric anesthesiologist. Try to combine other procedures with this (if Botox injections require anesthesia, do these simultaneously). The filling, x-rays and sealants should all be done at the same time.

DC (11-01-01)