Pre-Op Care and Sedation

• Care of the Mouth After Trauma
• Care of the Mouth After Extractions
• Care of Sealants
• Oral Discomfort After a Cleaning
• Nitrous Oxide
• Conscious Sedation
• I.V. Sedation
• Outpatient General Anesthesia
• Laughing Gas

Care of the Mouth After Local Anesthetic

• If the procedure was in the lower jaw the tongue, teeth, lip and surrounding tissue may be numb or “asleep.”
• If the procedure was in the upper jaw the teeth, lip the surrounding tissue will be numb or asleep.
• Often, children do not understand the effects of local anesthesia, and may chew, scratch, suck, or play with the numb lip, tongue, or cheek. These actions can cause minor irritations or they can be severe enough to cause swelling and abrasions to the tissue.
• Monitor your child closely for approximately two hours following the appointment. It is often wise to keep your child on a liquid or soft diet until the anesthetic has worn off. It is common as the anesthesia wears off that a child will cry and state they are hurting when in actuality they are at a loss for words for the tingling sensation that occurs when anesthesia dissipates. TLC and Motrin or Advil may help with their complaint. 

Please do not hesitate to call the office if there are any questions.

Care of the Mouth After Trauma

• Please keep the traumatized area as-clean-as possible. A soft bristled brush often works well during healing to aid the process.
• Watch for darkening of traumatized teeth. This could be an indication of a dying nerve (pulp), is not an emergency but does need to be seen by one of our Doctors for evaluation. 
• If the swelling should occur, our office needs to see the patient as-soon-as possible. Ice should be administered during the first 24 hours to keep the swelling to a minimum.
• Watch for infection (gum boils) in the area of trauma. If infection is noticed – call the office so the patient can be seen and the area evaluated. A gum boil is a localized infection and is not an “urgent” situation, however an appointment needs to be made to prevent further complications. 
• Have you child maintain a soft diet for two to three days, or until the child feels comfortable eating normally again.
• Avoid sweets or foods that are extremely hot. Cool foods can provide some comfort to a traumatized area and are commonly recommended. 
• If antibiotics or pain medicines are prescribed, be sure to follow the prescription as directed.

Please do not hesitate to call the office if there are any questions.

Care of the Mouth After Extractions

• Do not scratch , chew, suck, or rub the lips, tongue, or cheek while they feel numb or asleep. The child should be watched closely so he/she does not injure his/her lip, tongue, or cheek before the anesthesia wears off.
• Do not rinse the mouth for several hours.
• Do not spit excessively.
• Do not drink carbonated beverages (Coke, Sprite, etc.) for the remainder of the day.
• Do not drink through a straw.
• Keep fingers and tongue away from the extraction area.

Bleeding – Some bleeding is to be expected. If unusual or sustained bleeding occurs, place cotton gauze firmly over the extraction area and bite down or hold in place for fifteen minutes. This can also be accomplished with a tea bag. Repeat if necessary.

• Maintain a soft diet for a day or two, or until the child feels comfortable eating normally again.
• Avoid strenuous exercise or physical activity for several hours after the extraction.

Pain – For discomfort use Children’s Tylenol, Advil, or Motrin as directed for the age of the child. If a medicine was prescribed, then follow the directions on the bottle.

Please do not hesitate to call the office if there are any questions.

Care of Sealants

By forming a thin covering over the pits and fissures, sealants keep out plaque and food, thus decreasing the risk of decay. Since, the covering is only over the biting surface of the tooth, areas on the side and between teeth are not coated with sealant. Good oral hygiene and nutrition are still very important in preventing decay even on teeth which have received sealants.

Your child should refrain from eating ice or hard candy, which tend to fracture the sealants. Regular dental appointments are recommended in order for your child’s dentist to be certain the sealants remain in place.

The American Dental Association recognizes that sealants can play an important role in the prevention of tooth decay. When properly applied and maintained, they can successfully protect the chewing surfaces of your child’s teeth. A total prevention program includes regular visits to the dentist, the use of fluoride, daily brushing and flossing, and limiting the number of times sugar-rich foods are eaten. If these measures are followed and sealants are used on the child’s teeth, the risk of decay can be reduced or may even be eliminated!

Oral Discomfort After a Cleaning

A thorough cleaning unavoidably produces some bleeding and swelling and may cause some tenderness or discomfort. This is not due to a “rough cleaning” but, to tender and inflamed gums from insufficient oral hygiene. Calculus and tartar which has been on the teeth for a substantial amount of time once it is professionally removed will leave the normal enamel exposed and may be sensitive since it was insulated by buildup prior to the cleaning. It is necessary to remove the tartar as its presence results in decay and gum disease. We recommend the following for 2-3 days after cleaning was performed:

1. A warm saltwater rinse 2-3 times per day. (1 teaspoon of salt in 1 cup of warm water)
2. For discomfort use Children’s Tylenol, Advil or Motrin as directed by the age of the child.

Please do not hesitate to contact the office if the discomfort persists for more than 7 days or if there are any questions.

Sedation

Sedation is a technique to guide a child’s behavior during dental treatment. Sedation is most commonly used during extensive procedures for patients with dental phobia or for patients by no fault of their own have a difficult time remaining still. The major benefit of using these medications is to increase cooperation and reduce anxiety or discomfort associated with dental procedures. There are different types of sedation including nitrous oxide (“laughing gas”), oral sedatives, IV sedation and general anesthetic.

Sedation is endorsed by the American Dental Association, the American Academy of Anesthesiology, and the American Academy of Pediatric Dentistry and is an effective way to make many patients comfortable during their dental visit. Before using a sedative or anesthetic, it is important to tell Dr. Armstrong, Dr. Watts or Dr. Capeci about any medications or medical treatments your child is receiving. Before administering any sedative or anesthetic, Dr. Armstrong, Dr. Watts or Dr. Capeci will talk to you about the process of sedation and pre- and post-sedation instructions.

Nitrous Oxide

Some children are given nitrous oxide/oxygen – or what you may know as laughing gas – to relax them for their dental treatment. Nitrous oxide/oxygen is a blend of two gases, oxygen and nitrous oxide. Nitrous oxide/oxygen is given through a small breathing mask which is placed over the child’s nose, allowing them to relax without putting them to sleep. The American Academy of Pediatric Dentistry recognizes this technique as a very safe, effective technique for treating children’s dental needs. The gas is mild, easily taken, and it is quickly eliminated from the body and it is non-addictive. While inhaling nitrous oxide/oxygen, your child remains fully conscious and maintains all of their natural reflexes.

Prior to your appointment:

• Please inform us of any change to your child’s health and/or medical condition.
• Tell us about any respiratory condition that makes breathing through the nose difficult for your child. It may limit the effectiveness of the nitrous oxide/oxygen.
• Let us know if your child is taking any medication on the day of the appointment.

Conscious Sedation

Conscious Sedation is recommended for apprehensive children, very young children, and children with special needs. It is used to calm your child and to reduce the anxiety or discomfort associated with dental treatments. Your child may become quite drowsy and may even fall asleep, but they will not become unconscious.

There are a variety of different medications that can be used for conscious sedation. Your dentist or orthodontist will prescribe the medication best suited for your child’s overall health and dental treatment plan. We will be happy to answer any questions you might have concerning the specific medicine we plan to administer to your child.

Prior to your appointment:

• Please notify us of any change in your child’s health and/or medical condition. Do not bring your child for treatment if they have a fever, ear infection or cold. Should your child become ill, contact us to see if it is necessary to postpone the appointment.
• Inform the doctor of any prescriptions that your child is currently taking and any drug reactions or change in medical history. 
• Please dress your child in loose fitting, comfortable clothing.
• Please make sure that your child goes to the bathroom immediately prior to arriving at the office.
• Your child should not have solid food for at least 6 hours prior to their sedation appointment, and should only consume clear liquids for up to 4 hours before the appointment.
• The child’s parent or legal guardian must remain at the office during the complete procedure.
• Please watch your child closely while the medication is taking effect. Do not leave them unattended.
• Your child will act drowsy and may become slightly excited at first.

After the sedation appointment:

• Your child will be drowsy and will need to be monitored very closely. Keep your child away from areas of potential harm.
• If your child wants to sleep, place them on their side with their chin up. Wake your child every hour and encourage them to have something to drink in order to prevent dehydration. 
• At first, it is best to give your child sips of clear liquids to prevent nausea. 
• Your child’s first meal should be light and easily digestible.
• If your child vomits, help them bend over and turn their head to the side to ensure that they do not inhale the vomit.
• Because we use local anesthetic to numb your child’s mouth during the procedure, your child may have the tendency to bite or chew their lips, cheeks, and/or tongue and/or rub and scratch their face after treatment. Please observe your child carefully to prevent any injury to these areas.
• Please call our office for any questions or concerns that you might have.

I.V. Sedation

I.V. Sedation is recommended for apprehensive children, very young children, and children with special needs that do not work well under conscious sedation. Our dentist performs the dental treatment in our office with the child anesthetized under I.V. sedation, which is administered and monitored by an anesthesiologist.

Prior to your appointment:

• Please notify us of any change in your child’s health and/or medical condition. Do not bring your child in for treatment with a fever, ear infection or cold. Should your child become ill, contact us to see if it is necessary to postpone the appointment.
• Please inform the doctor of any prescriptions that your child is currently taking and any drug reactions and/or change in medical history.
• Please dress your child in loose fitting, comfortable clothing.
• Please make sure that your child goes to the bathroom immediately prior to arriving at the office.
• Your child should not have milk or solid food after midnight prior to the scheduled procedure and clear liquids ONLY, like water, apple juice or Gatorade for up to 6 hours prior to the appointment.
• The child’s parent or legal guardian must remain at the office during the complete procedure. 

After the sedation appointment:

• Your child will be drowsy and will need to be monitored very closely. Keep your child away from areas of potential harm.
• If your child wants to sleep, place them on their side with their chin up. Wake your child every hour and encourage them to have something to drink in order to prevent dehydration. At first it is best to give your child sips of clear liquids to prevent nausea. 
• Your child’s first meal should be light and easily digestible.
• If your child vomits, help them bend over and turn their head to the side to ensure that they do not inhale the vomit.
• Please call our office for any questions or concerns that you might have.

Outpatient General Anesthesia

Outpatient General Anesthesia is recommended for apprehensive children, very young children, and children with special needs that do not work well under conscious sedation or I.V. sedation. General anesthesia renders your child completely asleep. This would be the same as if he/she was having their tonsils removed or having a hernia repaired. Outpatient General Anesthesia is performed in a hospital or outpatient setting only. While the assumed risks are greater than that of other treatment options, the benefits of this treatment greatly outweigh the risks. Most pediatric medical literature places the risk of a serious reaction in the range of 1 in 25,000 to 1 in 200,000, far better than the assumed risk of driving a car. If this is not chosen, your child risks having multiple appointments, potential for physical restraint to complete treatment, and possible emotional and/or physical injury to your child in order to complete their dental treatment. The risks of NO treatment include tooth pain, infection, swelling, the spread of new decay, damage to their developing adult teeth and possible life-threatening hospitalization from a dental infection.

Prior to your appointment:

• Please notify us of any change in your child’s health. Do not bring your child for treatment with a fever, ear infection or cold. Should your child become ill, contact us to see if it is necessary to postpone the appointment.
• Please inform the doctor of any prescriptions that your child is currently taking and any drug reactions and/or change in medical history.
• Please dress your child in loose fitting, comfortable clothing.
• Your child should not have milk or solid food after midnight prior to the scheduled procedure, and ONLY clear liquids like water, apple juice, or Gatorade for up to 6 hours prior to the appointment.
• The child’s parent or legal guardian must remain at the hospital or surgical site waiting room during the complete procedure. 

After the appointment:

• Your child will be drowsy and will need to be monitored very closely. Keep your child away from areas of potential harm.
• If your child wants to sleep, place them on their side with their chin up. Wake your child every hour and encourage them to have something to drink in order to prevent dehydration. At first it is best to give your child sips of clear liquids to prevent nausea. 
• Your child’s first meal should be light and easily digestible.
• If your child vomits, help them bend over and turn their head to the side to ensure that they do not inhale the vomit.
• Prior to leaving the hospital/outpatient center, you will be given a detailed list of “Post-Op Instructions” and an emergency contact number if needed. 

Laughing Gas

Nitrous oxide, more commonly known as laughing gas, is the safest analgesic that exists today. Nitrous oxide/oxygen is well tolerated, has rapid onset, is reversible, can be adjusted in various concentrations and is non-allergenic. Due to the fact that it is inhaled verses being ingested, it is quickly eliminated from the body following treatment. Due to its safety and efficacy, it is often used as a conscious sedative during a dental visit. The gas is administered with a mixture of oxygen and has a calming effect that helps phobic or anxious patients relax during their dental treatment. Because it is a mild sedative, patients are still conscious and can communicate throughout the entire appointment. After treatment, the nitrous is discontinued and oxygen is administered for five to 10 minutes. The effects wear off almost immediately with sometimes a rare side effect of nausea.