Visits to the dentist usually begin in childhood. Very often, it is possible to treat a child’s teeth only with the use of anesthesia. Treatment under anesthesia - in what cases is it carried out, to whom is it contraindicated, what drugs are used today in modern pediatric dentistry? Anesthesia in pediatric dentistry

In what cases is dental treatment required under general anesthesia?

Many parents are prejudiced against general anesthesia for dental treatment for children. They are afraid of the possible negative effects of strong painkillers on the body. But there are situations when you simply cannot do without general anesthesia:

• are allergic to drugs for local anesthesia;
• the small patient suffers from neurological diseases, which complicate the doctor’s contact with him;
• diagnosed with heart disease, bronchial asthma, allergy to local anesthetics;
• if a surgical procedure that is known to be painful is planned;
• urgent surgery is required to treat acute inflammation in the oral cavity (abscess, periostitis);
• the baby has an increased level of anxiety - a panic reaction to any unusual situations;
• the child already has a negative experience of treatment at the dentist and is very afraid of visiting the doctor;
• advanced state of the teeth - multiple caries, pulpitis, periodontitis will be treated;
• The doctor needs to do a large amount of work in one session - treat several teeth at once.

Dental treatment for children under general anesthesia today is carried out with modern drugs. The harm from their use will be less than stress and hysterics in children who are terrified of the dentist. And how can you force a baby into a treatment chair, knowing that it will hurt?

IMPORTANT: General anesthesia in pediatric dentistry is used in special cases. If parents monitor their child’s oral cavity, then it is very rare to use such a forced measure. But, when treatment is unavoidable, it should be carried out painlessly and comfortably for the little patient.

What harm can you get from anesthesia?

It is not difficult to understand parents who are afraid to treat their children under general anesthesia. Still, this is a special state of the body, which is immersed in deep sleep. And, although the negative impact of such anesthesia is greatly exaggerated, there are also objective reasons for concern:

• Allergic reactions to anesthetic drugs cannot be ruled out. In pediatric dentistry, safe anesthetics are used, but in order to avoid unnecessary risks, clinics must always have quick-acting antiallergic agents at the ready;
• aspiration pneumonia may occur - to exclude it, parents receive detailed instructions in advance on how to prepare for treatment. They should be strictly followed so that anesthesia does not cause complications;
• exacerbation of chronic diseases leading to deterioration of the child’s condition. To prevent this from happening, before using general anesthesia, children are carefully examined and various tests are prescribed;
• medical error or equipment malfunction. There will be no such problems if you choose the right clinic where to treat your child’s teeth. In addition to qualified dentists with experience working with children, anesthesiologists and resuscitators should work there.

Inhalation method of drug administration

What drugs are used for anesthesia?

Local anesthesia for children is carried out in stages:

• First, topical anesthesia is given to reduce the sensitivity of the place where the anesthetic injection is to be injected. This area is frozen with a pleasant-tasting and odorable gel or aerosol (based on benzocaine or lidocaine).
• Then (after 2 - 3 minutes) an injection of a local anesthetic is given. In pediatric dentistry, articaine-based anesthetics are often used. It is considered safe, non-toxic, and does not cause allergies. It can be used by children over 4 years of age.

There are two types of general anesthesia used in pediatric dentistry:

• inhalation – this type of anesthesia is recognized as the most gentle. The child is carefully introduced into medicated sleep. It takes no more than 2 minutes to fall asleep under the influence of a special mixture, which includes medical oxygen, anesthetic and air. The patient inhales the mixture through a mask. Today, the drugs Sevoran, Supran and Sevoflurane are widely used. They are the safest and do not cause side effects;
• intravenous - the drugs Propofol or Diprivan (as well as its analogues) are administered by injection. The anesthesia takes effect within a minute, and its effect lasts a maximum of 1 hour. The young patient regains consciousness easily.

REFERENCE: To ensure the safety of the child during treatment under general anesthesia, during this period all body functions are monitored using special equipment. The anesthesiologist continuously conducts visual observation. In case of any complication, a team of resuscitators will be involved.

How does the procedure work?

Treatment under general anesthesia takes place in stages:

1. Preparing for the procedure is to create a relaxed atmosphere and playfully encourage the child to breathe into the mask. This could be a game of astronauts, aliens, brave rescuers.
2. After putting the patient into a state of sleep, the dentist needs to re-evaluate the situation and the amount of work. Parents should leave the treatment room.
3. The child is connected to special equipment so that the equipment monitors the functioning of the body. The anesthesiologist observes the process.
4. Direct treatment of the child's teeth. The procedure takes place in a calm environment, which allows the doctor to solve all problems that local anesthesia does not allow.
5. Recovery from anesthesia. An anesthesiology specialist conducts it in the presence of parents so that the child is not frightened and feels calm.
6. For rehabilitation, children are sent with their mothers and fathers to the playroom. The doctor needs at least an hour to observe the child’s condition and help him if complications occur (vomiting, dizziness). If everything is in order, the little patient is sent home.

Pros and cons

General anesthesia for dental treatment has its advantages and disadvantages. There are many more advantages:

• The procedure is painless, the child sleeps and does not feel anything.
• In one visit, the dentist will be able to cure or remove all problem teeth.
• Treatment under general anesthesia is of better quality, since nothing prevents the dentist from gaining full access to each tooth and using any technology.
• You cannot do without general anesthesia if the child is allergic to local anesthetic drugs or has a very strong gag reflex.
• The child’s psyche is not seriously tested by the sight of doctors, instruments, or blood. He does not feel frightening sounds and smells.
• There is a greater chance that the next time children will not be afraid of visiting the dentist, because they did not experience any negative feelings.

The general anesthesia procedure also has its disadvantages:

• This is a very serious intervention in a child’s body with possible effects on the nervous system, brain function, respiratory processes and blood circulation.
• Some children have a hard time recovering from anesthesia, and their health may deteriorate over several days.
• There are health risks if preparation for treatment is not carried out according to all the rules.
• The cost of quality treatment using general anesthesia is quite high.

Dental treatment for a child under general anesthesia

Who should not have dental treatment under general anesthesia?

Anesthesia for dental treatment in children has its contraindications. General anesthesia is not used if the child:

• chronic respiratory diseases – asthma, bronchitis, pneumonia;
• heart failure, heart disease;
• anemia – low hemoglobin content (less than 100 g/l);
• diabetes mellitus;
• infectious diseases (acute respiratory infections, acute respiratory viral infections, etc.);
• recent vaccination;
• low body weight;
• high intracranial pressure;
• allergic reaction to drugs used for general anesthesia.

ATTENTION! When there are a number of serious contraindications to treatment under general anesthesia, an experienced resuscitator will not undertake this procedure. He is responsible for the consequences. To minimize possible complications, it is the responsibility of parents to provide doctors with complete and reliable information about the child’s health status.

How to prepare a child?

It is impossible to treat a child’s teeth under anesthesia without special preparation. They begin to prepare the little patient a few days in advance:

• it is necessary to undergo mandatory examinations - an ECG and a blood test (general, biochemical, sugar);
• obtain a certificate from a pediatrician stating that there are no contraindications to general anesthesia for dental treatment;
• on the day of a visit to the dentist, the child is not fed 6 hours before the appointed time of treatment and is not given anything to drink 4 hours before.

Parents also need to meet with the anesthesiologist - the doctor must assess the amount of work ahead.

Treating a child’s teeth under anesthesia – local or general, depending on the indications – is much more humane, safer and more comfortable. The harm from anesthesia is often greatly exaggerated. Why bring a child to a nervous breakdown, stress and forever instill in him a panic fear at the mere sight of a dentist? But you shouldn’t abuse anesthesia without special indications either. The task of parents is to find a good pediatric specialist and receive treatment from him on time.

In pediatric practice, pain relief plays a primary role. If an adult patient is able to endure mild discomfort and spend several hours in a row in a chair, then the child’s psyche is not yet ready for this. A painful procedure can instill a lifelong fear of dentists and interfere with quality treatment. Moreover, anesthesia gives the desired psychological effect and helps the child trust the doctor.

Features of pain relief in children

• Most drugs can only be used from the age of four, which imposes severe restrictions on the treatment of very young patients.
• The anesthesiologist must be highly qualified and be able to correctly calculate the dosage.
• The child may be afraid of treatment and dental instruments, especially needles.
• Children are often allergic to anesthetics.

Types of pain relief in children in dentistry

Local anesthesia

The most common method of pain relief in pediatric practice. Most often, it is carried out in two stages, combining a “freezing” gel or spray with an anesthetic injection.

General anesthesia

Sometimes it may be the only way to carry out treatment. They try not to use it without good reason, since the likelihood of complications after dental treatment under anesthesia is higher than after local anesthesia.

Sedation

This is an inhalation of a soothing mixture that allows the child to relax, but at the same time be conscious. Formally, sedation is not anesthesia, but it provides a slight analgesic effect and is often used in conjunction with an injection of an anesthetic.

Local anesthesia in children in dentistry

Local anesthesia for dental treatment is used everywhere, since it provides the necessary analgesic effect, but at the same time maintains a certain sensitivity and has the fewest contraindications. Children, as a rule, tolerate it well.

Types of local anesthesia

The choice of one type or another depends on the procedure to be performed by the doctor, the age and psychological state of the child.

• Application anesthesia

  Local anesthesia in children in dentistry is not complete without the use of special anesthetic solutions or gels (most often based on lidocaine), which are used to treat the gums before starting treatment. The active substance easily passes through a thin layer of the mucous membrane and dulls sensitivity. As a rule, topical anesthesia is used to numb the site of a future injection - this is a typical feature of anesthesia in children in dentistry. But even one “freezing” with a gel or spray is enough for some procedures - for example, to remove mobile baby teeth, the roots of which have almost completely dissolved.

  Topical anesthesia products in children's clinics have a pleasant taste and aroma to make it easier for the child to tolerate treatment.

• Injection anesthesia

  In pediatric practice, articaine-based anesthetics are most often used, which are administered using a syringe. This drug is approximately five times more powerful than novocaine, but is less toxic and less likely to cause allergies. It can be prescribed from the age of four.

  Injection anesthesia has its own varieties. Pediatric dentists use infiltration or conduction anesthesia depending on the indications. In the first case, an injection is made into the mucous membrane at the border of the alveolar process and the transitional fold so that the anesthetic reaches the endings of the dental nerves. In the second case, the solution has an effect on the branches of the trigeminal nerve. Conductive anesthesia in children in dentistry is permissible from the age of six and is indicated for tooth extraction - mainly in the lower jaw.

• Instruments for injection anesthesia

  In children's clinics, they are gradually moving away from the use of classic syringes and ampoule solutions. They are replaced by more thoughtful and, importantly, psychologically comfortable solutions for the child.

1. Needleless injector. The anesthetic in such a device is supplied through a minimal (up to 0.1 millimeter) hole under very high pressure. The jet penetrates the surface of the mucous membrane or skin and enters the tissue. The analgesic effect with this principle of administration occurs faster, and a smaller volume of the drug is required. The absence of a needle in the injector is the key to a child’s good mood.


2. Carpule syringe is a cartridge with an anesthetic and, as a rule, a vasoconstrictor, which helps to prolong the analgesic effect of the solution. Unlike traditional ampoules, the carpule provides ideal sterility and more accurate dosage of all components. A special needle is placed on the cartridge: it is much thinner than the needle of a regular syringe and minimizes discomfort.


3. Computer syringe It is not at all like a regular syringe, so pain relief will be more comfortable for the child. The supply of solution in such a device is controlled electronically, and for the desired effect a smaller dosage of the drug is required. When the anesthetic is administered using a computer syringe, the child's face will not be as numb, so he will feel better during treatment.

General anesthesia in pediatric dentistry

Sometimes in pediatric practice it is necessary to use general anesthesia. There must be serious reasons and indications for treating or removing teeth for children under anesthesia, because anesthesia is a deep depression of the nervous system, and this kind of exposure entails a risk of complications. A lot depends on the qualifications of the anesthesiologist: he must correctly calculate the dosage and take into account all the characteristics of the child’s body.

The anesthetic for general anesthesia is administered by inhalation. The child inhales the vapor of the substance and quickly falls asleep. This way, the doctor has the opportunity to carry out treatment in a calm environment, quickly and efficiently, while the little patient will not receive psychological trauma.

Indications for general anesthesia:

1. A lot of work. It is difficult for a child to sit still, and if several teeth need to be treated in one session or a complex operation must be performed, then this mission becomes almost impossible.
2. Allergy to drugs for local anesthesia. Articaine and other similar anesthetics may cause an allergic reaction. In this case, anesthesia may be the only solution.
3. Ineffective local anesthesia. Sometimes the injection does not provide the required degree of pain relief due to the characteristics of the baby’s body. If the child remains highly sensitive, it is better to use anesthesia.
4. Insurmountable fear of treatment. Severe dental phobia is an indication for general anesthesia if the child cannot be distracted from his worries with affectionate words, cartoons or toys.
5. Some mental and neurological diseases (cerebral palsy, epilepsy, Down syndrome and the like).

What to do if your child has allergies?

Allergy to anesthesia in dentistry in children is a fairly common occurrence. The child's body is more susceptible to unusual reactions to new substances, which include anesthetics. Before visiting the dentist, it is necessary to undergo tests to understand whether local anesthesia is acceptable, and if an allergic reaction does occur, treatment is carried out under anesthesia.

Alternative to general anesthesia

Sedation is considered a safer alternative to general anesthesia. This procedure involves inhaling a special mixture of nitrous oxide and oxygen through a mask. It makes the child feel relaxed and slightly drowsy, lifts his spirits and calms him down. At the same time, the small patient remains conscious and can interact with the dentist.

Sedation is not anesthesia, but has a slight analgesic effect. It is usually combined with an anesthetic injection. The mixture of gases is supplied through a special device that controls the duration and dosage and allows you to smoothly enter and exit the state of sedation. The effect of the procedure wears off within about 10 minutes after stopping the supply of nitrous oxide.

The Nutcracker Clinic uses proven and safe anesthesia methods to make treatment easy and painless.

Why is general anesthesia needed?

Remember that medical intervention is associated with pain and discomfort. We can remove the feeling of pain with the help of local anesthesia (“injection”), but it is difficult to remove unpleasant sensations and memories of past negative experiences. This is precisely why children need dental treatment under general anesthesia.

If left untreated, caries and other oral diseases can cause many chronic diseases. The heart, kidneys, brain, liver and joints are at risk. Dental treatment for children in their sleep is often the only way, because many children are afraid of dentists and the sound of a drill. In addition, this type of anesthesia helps protect the child from psychological trauma associated with pain in the dentist's office.

Our center offers dental treatment for children under general anesthesia at an affordable price! We do our best to make our services available to you.

Features of treatment under anesthesia at the Nutcracker clinic

General anesthesia can be used in all cases - from caries to pulpitis. Anesthesia is performed only by professionals who know the whole process step by step and take into account the individual characteristics of the patient. After the child falls asleep, the specialist acts quickly. The whole procedure takes little time, because nothing distracts the doctor from his work.

General anesthesia for children during dental treatment is safe

Many people are convinced that anesthesia is unsafe for a child’s body. However, the opinions of experts boil down to the fact that the danger is exaggerated significantly. Treatment of a child’s baby and permanent teeth under anesthesia will go smoothly if all procedures are performed by professionals. In The Nutcracker, your child will be constantly under the supervision of specialists. Our method has a number of advantages:

• Each patient must be examined by an anesthesiologist. We do not prescribe anesthesia for dental treatment to all children, but carefully study the client’s health status before offering him such an option.
• Our staff uses some of the best drugs used to treat children. This "Sevoran" is an absolutely safe product that gives a good effect.
• Unique German equipment Drager Fabius Plus is used.
• Particularly painful treatment and tooth extraction in children is carried out under general anesthesia. The child does not face pain and stress, but simply sleeps.

When parents talk about freezing, they primarily mean some kind of anesthesia method. Yulia Selyutina, a pediatric dentist, Instagram blogger, winner of the competition for pediatric dentists in Russia, told Letidor in detail about the types of anesthesia that are used when treating a child’s teeth.

Types of anesthesia

Baby teeth, like permanent teeth, have nerves and can hurt! Depending on the depth of tissue damage, different types of anesthesia can be used for treatment.

Children typically receive one of three types of anesthesia: application, infiltration or conduction.

One of the easiest to influence the body is a spray or gel, which works only on the surface of the oral mucosa. This appliqué anesthesia is often performed when removing a mobile baby tooth or to reduce sensitivity before conducting conduction or infiltration anesthesia.

But such anesthesia is not enough to treat caries or its complications.

In pediatric dentistry, as in adult dentistry, the method is often used infiltration Anesthesia is an injection. Its effect is aimed at blocking the nerve endings of the area that requires treatment. The latest generation of drugs begin to act instantly, and the dentist can begin treatment almost immediately. Infiltration anesthetic substances block pain sensations.

The use of an anesthetic injection is often used in the treatment of caries, pulpitis, periodontitis or the removal of a fixed tooth.

Considered to be the most powerful conductor anesthesia because it affects the nerve branch of a large area of ​​the jaw. This type of anesthesia is used when it is necessary to treat several teeth nearby, and only if infiltration anesthesia is not enough.

After treatment, the effect of the anesthetic lasts for some time, so it is recommended to refrain from eating immediately after the procedure and ensure that the child does not chew the inside of the cheek.

The duration of the anesthetic varies from person to person.

When we are talking about young children or a large amount of restorative work in the oral cavity, for example, treatment of caries on 5–13 teeth at the same time, the child may be recommended medicated sleep or, in medical terms, conditions of deep sedation, that is, anesthesia.

Children are put under anesthesia using Sevoran gas.

This method is considered the most modern, safe and preferable today, since the gas is quickly eliminated from the body without causing complications.

How this happens: the substance Sevoflurane is administered through a mask, the child takes a few breaths and falls asleep. When treating with Sevoran, a team of specialists works. Among them there is always an anesthesiologist-resuscitator who monitors general indications: blood pressure, heart rate and body temperature. It is this doctor who is responsible for the child’s condition throughout the entire treatment.

As soon as the gas supply stops, the child awakens and returns to consciousness almost immediately. Awakening is also monitored by an anesthesiologist.

When treating with Sevoran, the doctor solves all existing problems at one time.

Remember that the anesthesiologist-resuscitator gives permission for anesthesia only after careful preparation and subject to correct test results.

How to prepare for anesthesia

Before undergoing the procedure, it is necessary to collect medical reports:

The result of a general blood test, which is valid for a month.

Blood clotting test (blood coagulogram) or APTT (activated partial thromboplastin time).

Conclusion from a cardiologist about the functioning of the heart based on an ECG (electrocardiogram).

Conclusion from the leading pediatrician.

Sometimes, according to indications, a neurologist's opinion will be required.

On the day of the examination, you should not drink soda, colored or sugary drinks; dairy and solid foods can be taken no later than 6 hours before anesthesia; water no later than 4 hours. There are special indications according to the age of the child.

Children from one to one and a half years old who are breastfed or mixed fed can drink milk and water no later than four hours before anesthesia, and milk formula and other food no later than six hours before the procedure. For children over one and a half years old, the fasting break should be six hours.