Dental treatment under General anesthesia in children: sedation, anesthesia
Going to the dentist parents with a small child is quite difficult because dental treatment under General anesthesia is a kind of salvation. It is no secret that the pathology of the hard tissues of the tooth and oral mucosa causes not only discomfort, but also pain, the severity of which can sometimes be quite high. Children, especially toddlers, are the most susceptible to the fear of stomatological manipulations of people. And therefore, not to provoke further stamatopolou dental treatment should be carried out with anesthesia, both local and General.
Why is there fear of interference
Checkups, for both children and adults is recommended every six months. But when a toothache is to wait and be delayed. You should contact the dentist pediatrician appointment. Sometimes a visit to the doctor can cause increased anxiety in the child.
In order to prevent the emergence of a dentophobiya, you must consider the following points:
- Threshold of fear: the earlier a child first visit the dentist with the purpose of routine inspection, the less alarming follow-up visits;
- Especially the first meeting with the doctor: the initial visit should be based on acquaintance with the doctor, examination of the teeth and tissues of the mouth, hygiene education;
- The development of motivation: upon successful completion of the first visit of the child should aim at further communication with your dentist. This can be achieved through the promotion (for example, small toys or dental accessories);
- The example of parents: the child can look at the situation of dental treatment from their parents.
On admission the child when the parents are emotionally withstanding treatment, understand that the anxiety caused by the dentist, in vain. So the effect was pronounced and persistent, it is recommended that parents walk with children to the reception in a private dental clinic and at off-peak hours, preferably in their pre-dinner time on weekdays. Often also the child can see mom or dad doing the production of anesthesia to reduce the pain. It will be a analgesia, your child will not be afraid, because parents have been through this manipulation.
However, not always all of the recommendations can be completed on time. Sometimes parents begin to think seriously about the condition of the teeth of the child only after the appearance of momentary or prolonged pain in the tooth. In such a situation, do not panic and contact a doctor a dentist appointment. To reduce the level of pain for the child at the present time invented many ways of pain relief.
The range of interventions with the use of anesthesia
Modern clinic contains a large dental facilities in terms of pain relief prior to performing the intervention on the teeth. In the Arsenal of a dentist, there are pharmacological and non-pharmacological methods of analgesia. For the implementation of General anesthesia, the dental clinic should have a staff of highly skilled team of anesthesiologists and resuscitation specialists, necessary equipment and medicines. Before General anaesthesia, try to use a different method of treatment of children’s teeth under sedation. Dental treatment under General anesthesia in children should be carried out with an appropriate license.
The least common methods of anaesthesia without the involvement of pharmacological agents: audio, electroanalgesia, hypnotherapy. This type of intervention has not received proper distribution due to low performance in terms of eliminating pain in a patient. In rare cases, use of analgesia by means of electric current.
Medical intervention is sometimes local and General modalities. Anesthesia in pediatric dentistry local action takes effect or at the point of injection, either half of the jaw corresponding to the region of intervention. Apply application, infiltration and conductive anesthesia. Anesthesia with topical application for surface anesthesia of the mucosa of the gums and transitional fold. The implementation of this method of pain relief used in a mobile children’s teeth or to prepare the site of puncture to the main anesthesia.
Depending on the situation or carry out infiltration anesthesia jaw on the floor. The infiltration operation is performed in the region of the root apex of the affected tooth. Anesthetic solution, by injection into the narrow space, compresses the nerve branches innervating the tooth, thereby bezbolevaya place for manipulation in the tooth. Conduction anesthesia differs from infiltration what setting it is in division of major branches of the nerve Innervate the upper and lower jaw respectively.
The application of anesthesia is accomplished by applying the gel or spray on the selected area. After 1-2 minutes, you can begin the manipulation or staging of infiltration or block anesthesia. Treatment of milk teeth is carried out with the use of anesthesia based on articaine. Products based on this component is able to numb in the shortest time and retain their effect throughout the period necessary for intervention. The articaine is 5 times stronger, has a pronounced toxicity compared with novocaine, the half-life is 20-25 minutes.
So the effect of anaesthetic was expressed and maintained for the time required and possibly the use of sedation in children. This is shown in the presence of strong anxiety, a certain group of diseases of the body.
Premedication is required when:
- Diseases of the nervous system and mental disorders (temporary and permanent): epilepsy, hysteria, prolonged stress, increased anxiety before treatment;
- Diseases of the respiratory system: bronchial asthma;
- Defects in the endocrine system: thyroid lesion;
- Diabetes mellitus;
- Increased tone of skeletal muscles.
Used products must have a sedative effect. Approximately 1-3 days before a doctor can begin treatment for the correction of General state. When using pharmacological preparations of industrial production, such as diazepam and other anxioliticeski funds, it is recommended to start premedication 1 day before visit to the dentist. Diazepam is used in children starting from 4 years. Dosage appropriate to the age, specified in the instructions to the drug. Medication is recommended to perform for 2-3 sets a day for 15-20 minutes before your appointment.
At home you can use a mixture of Valerian root and motherwort. Use the advice of a doctor or according to instructions noted on the package. If the production of anesthesia is planned for the first time or whether you have a predisposition for allergies to the introduced substance, it is also recommended to receive within 2-3 days of taking antihistamines. It is better for children to use the tools of the latest generation: cetirizine, cyproheptadine. Both drugs are used, starting from 6 months of life. Loratin use with 2 years.
A sedative effect on the reception
Not always using premedication and local anesthesia, it is possible to do the treatment and leave fear at the child before following dental manipulations. Sedation in dentistry for children is a great way of exception, the conduct of sedation does not leave any painful sensation after themselves, does not affect the nervous system. Applied surface sedation in pediatric dentistry when a child is able to hear the doctor’s request, can make contact. After falling anesthesia perhaps the preservation of individual moments in treatment.
Performing this type of anesthesia immediately before the intervention, making it impossible to breathe child ZACKS (nitrous oxide and oxygen). Originally supplied pure oxygen, which gradually begin to add the nitrous. In children mostly is 70% oxygen, 30% nitrous oxide.
Supply and gas exhaust is carried out using automated electronic equipment. By the end of the intervention the level of oxygen was raised to 100% and only after that remove the inhalation mask. The remains of nitrous oxide come from exhaled air for 5-10 minutes after cessation of inhalation.
One sedation is not enough to perform dental procedures and therefore will need the production of local anesthesia to the child. This intervention is used with a 4 years of age, when you can establish a good eye contact between doctor and child. In addition to drugs to provide a sedative effect on the nervous system, the Cabinet can be broadcast cartoons or tell a tale. But in some cases still need to treat the teeth under General anesthesia.
The need for systemic analgesia
Anesthesia General mode of action is a form of anesthesia in which under the influence of drugs is the inhibition of operation of the cerebral cortex. Modern range of drugs has a minimal adverse reactions for the child and therefore this type of intervention, especially when getting informed the child’s psychological trauma from contact with a dentist, also takes place. How to treat and under what conditions of the body of the child?
- A large amount of interference: if necessary, in the treatment of 6 teeth in one appointment. This may be due to psycho-emotional stress of the child, lack of time of parents, provision of emergency assistance;
- In diseases of the nervous system and mental disorder: epilepsy, cerebral palsy,down syndrome and others. Shutdown of consciousness will allow to carry out dental procedures in diseases such as when performing local anaesthesia, sedation, and also informed sedation will not give the necessary effect;
- Loss of contact between doctor and patient persuasion and persuasion have no effect;
- The lack of effect of local anesthetics;
- Allergy to local anesthetics.
There are the following types of General anesthesia:
In dentistry used only inhaled anaesthesia. To not formed stamatiou, dentist and a team of anesthesiologists and reanimatologov should carefully evaluate the condition of each child.
To influence the development of anxiety at the reception can:
- Persistent pain: lack of effect of anesthesia;
- Dental settings: vibration, noise;
- Kind of used as a dentist instruments;
- Blood on cotton swab.
These factors along with the presence of psycho-emotional stress, fear, defects of the circulatory system and breathing, earlier trauma, the formation of a dentophobiya almost for life. Assist teams of anaesthesiologists and reanimatologists the dentist anesthesia during dental treatment in children should be based on several principles. Should be taken into account: efficiency in the performance of anesthesia, persisting for the required time and exit without consequences for the child from fully depressing the nervous system.
These principles are achieved by performing brigade of the series of tasks:
- Before use of General anesthesia should be picked up by the drug, which will have a marked impact on the child’s body, and thus will not have a toxicity;
- Maintaining anesthesia throughout the period of dental procedures;
- The elimination of psycho-emotional tension and anxiety;
- Control over the functioning of all the vital organs and systems through the monitor;
- Creation of conditions for the obstacles of spiritbane in the bronchopulmonary system of blood, mucus, detritus of teeth, materials and drugs used in the treatment of teeth in children under General anesthesia;
- Recovery in the short term after termination of inhalation, minimizing the risk of complications from reception of a dentist.
Teeth under anesthesia is subjected to a treatment under the influence of drugs: «Sevoflurane», sevorane has, «Supran»:
- Non-toxic: can be used in debilitated and premature infants. No increase in intracranial pressure, the development of kidney failure and liver. Not noted on the admission of irritation in the respiratory tract;
- The rapid development of inhibition of the nervous system: within 2 minutes the child falls asleep. Recovery from anesthesia occurs after 10-15 minutes after inhalation;
- Combined with all drugs used in pediatric practice;
- The minimum number of adverse reactions: drowsiness, or hyperactivity upon awakening.
A few hours before start of dental treatment under General anesthesia, the child should not eat or drink. During treatment in the office there are 4 people: the doctor, the anesthesiologist and the nurse controlling the functioning of the body and dentist and assistant in performing dental procedures. After recovery from anesthesia was carried out, you must take your child to a specially prepared room (preoperative, relaxation room), where the anesthesiologist will spend some time for more control over the functioning of the body. In the absence of complications, adverse reactions, the parent can go home with your child.
Dental treatments for children under General anesthesia is only indicated. If parents wish to cure a large number of teeth at a time, it is recommended to pre-consultation with the dentist and physician intensive care services.
Possible the treatment can do other, easier implemented and more cost ways relieve pain before hiring the dentist.