www.mddus.com


national UK Guideline for the Use of General Anaesthesia (GA) in Paediatric Dentistry provides a number of situations in which GA is indicated including:


• • • • severe pulpitis


acute soft tissue swelling requiring removal of infected tooth/teeth


surgical drainage of acute infection


single or multiple extractions in a young child unsuitable for conscious sedation.


“ Take time to evaluate the child’s stage of development then plan an overall management strategy”


the operator. A degree of hypnotic suggestion can help the child to feel at ease and progress well with treatment. Breathing 100 per cent oxygen for two minutes after the completion of treatment reverses the effects of RA sedation. Patient selection plays an important role in achieving clinical success as well as the experience of the operator in providing the correct communicative support.


Intravenous sedation IV sedation involves the administration of drugs directly into the venous blood stream via a cannula. Most commonly the drug of choice is the benzodiazepine, midazolam, which provides the useful effects of sedation, anxiolysis muscle relaxation and anterograde amnesia. But midazolam is also a central nervous system depressant and the patient must be carefully monitored throughout sedation. IV sedation should only be provided by suitably trained practitioners.


It has the disadvantage of involving a needle to introduce the cannula and it is generally reserved for adolescent and adult patients.


Transmucosal sedation This involves administrating a sedative across a mucous membrane, such as sublingual and intranasal membranes. It is useful particularly with needle phobic patients. The use of midazolam by a transmucosal route is off licence and thus patients and their parents/guardians must be given this information in order to provide informed consent.


General anaesthesia (GA) Although there are a range of techniques available for the management of the anxious child it is unfortunate that some patients will still require GA in order to co-operate with treatment. GA must be carried out by an anaesthetist in a hospital setting. The


The decision to use GA should not be taken lightly and the small but catastrophic risk of death must be highlighted in order to gain informed consent. As a result of this risk, all other avenues of anxiety management should be considered before referral for GA. Treatment planning for GA will involve the removal of any teeth of questionable long-term prognosis in order to prevent a repeat GA. In conclusion, there are a range of


techniques that can be utilised effectively to assist the anxious child in co-operating with treatment and developing a positive outlook to holistic dental care. Careful assessment by an experienced clinician and referring when appropriate are essential. Well-considered treatment planning with a long-term overall oral health strategy focusing on prevention and achieving oral health is paramount.


Mr Stuart Davidson is a dentist and Mr Michael Dhesi a VDP at the Clyde Dental Group (www.clydedental.com), which takes referrals for RA and IV sedation in anxious children


Sources Non-Pharmacological Behaviour Management Clinical Guidelines – The Royal College of Surgeons of England (www. tinyurl.com/sbbmgt).


Non-Pharmacological Approaches to Behaviour Management in Children – J. Tim Newton et al – Dent Update 2003; 30L 194-199.


Managing Anxious Children: The use of Conscious Sedation in Paediatric Dentistry – M.T. Hosey – International Journal of Paediatric Dentistry 2002; 12: 359-372 (www. tinyurl. com/sbpsed).


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