Stonewall Dental Associates

Dentistry for Children & Adults

8719 Stonewall Rd, Manassas, VA 20110

703-368-1000

Dawn Crandall, DDS Jerome Granato, DDS

PEDIATRIC DENTAL SEDATION

Dear Parent,

We do, on occasion, find it necessary and desirable to sedate a patient in order to accomplish his/her dental restorative or surgical work. Our sedative medications are considered safe but the slim possibility of an unusual reaction or sensitivity always exists.

The risk of having a bad reaction is very low when these drugs are used properly; your child’s oxygen rate, breathing and heart rate will be carefully monitored during the procedure. Adverse reactions occur in about 2% of the cases with disorientation, vomiting and prolonged drowsiness accounting for over half of these reactions. Other undesirable reactions might include allergy, swelling, itching, seizure, upset stomach, vomiting, headache, depressed breathing, stopping of breathing and shock. A reaction would place a tremendous burden on us to maintain vital body functions until the drug could be cleared from the body systems. An unpredictable and uncontrollable drug reaction might lead to death.

The intent of this letter is not to scare you, but rather to point out that sedation is a risk. If we follow recommended guidelines and instructions, we can minimize that risk to a very acceptable level. You will find in this letter instructions to follow. They are written to provide the greatest safety in dealing with sedation and should be carefully followed.

With oral premeditations, our sedation goal is light or conscious sedation. We do not desire to “put the child to sleep.” Heavy sedation can be an option if you should so consider. This is done by an anesthesiologist here in the office using IV medications. The oral sedation medications used in our office are:

  1. Demerol® (Meperdine) – a narcotic medication which can be reversed if adverse side effects occur.
  2. Local anesthetic- lidocaine
  3. Nitrous Oxide and Oxygen- laughing gas

These medications will be used in carefully limited amounts. It must be realized that for about 10% of children, the desired sedation will not be achieved. For these children our alternatives are: 1) proceed with work despite the child’s protest and possibly require additional visits, 2) schedule the treatment to be done using IV anesthesia in the office at a subsequent visit with additional costs.

I usually recommend that we proceed with care, in the office, because we think it is preferable to IV anesthesia. It is important for the parent to accept this possibility before the appointment and understand:

  1. Experience has shown that children ultimately understand we did not hurt then and theybecome excellent dental patients in the future (like protests at haircuts).
  1. If moving around excessively, your child may be wrapped in a Papoose Board® for their self-protection. We call it a “blanket with bracelets”. We find it actually helps to calm most children down; it makes them feel more secure and they most often fall asleep shortly after being wrapped. A pulse oximeter to measure breathing and heart rate may be placed on your child’s index finger or big toe.

1

  1. Your child may cry loudly at the beginning of procedure and then fall asleep, perhaps awaken at different points during and cry loudly or cry loudly during the entire procedure. This crying does not mean your child is in pain. It is often difficult for young children to understand why they are here in our dental care.
  1. It is very important that you focus on the events positively with your child. Pay careful attention to words you use to describe dental events with your child. We recommend NOT using the words PAIN, HURT or SHOT. Focus on the positive and they will ultimately have a good memory of past dental visits.
  1. In the best interest of your child, we do ask that only the parenting adults of the child be present during treatment, if desired. Other relatives, adults and any siblings must wait in our reception area. Having persons other than our dental assistants in the treatment areas is dangerous and creates distractions for both the patients and dental personnel. Our full attention is directed soley on our patient for the entire visit.

6. If you have any questions regarding the treatment planned, please ask when your appointment is

confirmed the day before your visit.

7. We reserve this appointment exclusively for your child; no other patients are seen by the doctor at

this time. Please be prompt for your appointment. So that you can avoid any charges for a broken or

missed appointment, kindly give our office at least 48 hour notice if you should need to change your

appointment. A fee of $200 per hour scheduled may be assessed for broken appointments.

2

INSTRUCTIONS TO PARENTS OF PEDIATRIC PATIENTS

WHO ARE TO RECEIVE SEDATION FOR DENTAL TREATMENT

It is important for your child’s safety that you follow these instructions carefully.

EATING AND DRINKINGTo avoid vomiting and complications during treatment with sedation,DO NOT

allow your child any food or drink (even water) unless directed by the doctor.

The following schedule should be followed:

1. No milk or solid food after midnight prior to the scheduled procedure.

GIVING THE MEDICINE1. Pick up your prescription medication at your pharmacy 2 or 3 days

before your appointment. Try 24 CVS (Sudley Rd/Rt 28) or Walgreens

(Sudley Rd across from hospital) *They almost always carry this

medication or can order it for next day delivery*

*DO NOT WAIT UNTIL THE DAY OF/BEFORE APPOINMENT

*DO NOT CALL:By lawthey cannot give that information over the phone.

2. Bring a small amount of your child’s favorite clear drink (a bubbly drink

like ginger ale works well or juice).

3. Our staff will help your child drink all the medicine starting 1 hour

before the scheduled procedure.

4. Following administration of the medicine, your child’s behavior may

change. Within 10-30 minutes your child may become agitated and

woozy; wanting to walk yet being off balance. This is a normal

response and will usually pass as your child relaxes and may drift off to

a nice doze.

5. Supervise your child very closely during this time period.

6. Give your child only those medications or prophylactic antibiotics, and

those prescribed by your child’s dentist.

7. Sometimes a little nausea/vomiting occurs; this is normal. Bring a

change of clothing for your child.

CHANGE IN HEALTHAny change in the child’s health, especially the development of a cold or

Fever, within one day prior to the day of treatment, is very important.

For the child’s safety, a new appointment may be made for another day.

Inform this office of any changes in health prior to your child’s appointment.

ARRIVINGA responsible adult must accompany the patient to the dental office and

must remain until treatment is completed and the patient is dismissed

from the office. Plan to arrive 5 minutes early for your appointment.

3

ACTIVITIES AFTER1. Someone should be available to drive the patient home. The child should be

COMPLETION OF closely watched for signs of breathing difficulty and carefully secured in a car

TREATMENT seat or seat belt during transportation. DO NOT use a bus. Bring a towel and

trash bag in case of nausea.

2. Your child MAY sleep comfortably for 3 to 6 hours. During this time the medi-

cine is wearing off.

3. Upon awakening, your child MAY still be sleepy, irritable, and wobbly.

Though your child may look normal upon awakening, your child’s balance will

be the last thing to return to normal.

4. The office sedation will not take the place of normal night-time sleep. Your

child will still have a normal night’s sleep.

DRINKING OR After treatment, the first drink should be plain water. Sweet drinks can be given

EATING AFTERnext (clear fruit juice). Small drinks taken repeatedly are preferable to taking

TREATMENTlarge amounts. Soft food, not to hot, may be taken when desired. Jello,

Pudding, popsicles, and ice cream are good choices. As the sedation wears off, your child may complain of an upset stomach. A glass of warm milk will help overcome this temporary discomfort. Watch that they don’t bite their lip if novocaine was used. If your child bites himself, expect some swelling and discomfort. Ice will help during the first hour or so if you notice the bite. Give Tylenol or Advil as needed. While healing, expect some white tissue to come off near the area of the bite over the next few days. This is like a scab. Resume normal diet the following day.

TEMPERATUREYour child’s temperature may be elevated to 101°F/38°C for the first 24 hours after treatment. Tylenol every 3-4 hours and fluids will help to alleviate this condition. Temperature above 101°/38°C is cause to notify this office.

SEEK ADVICE1. If vomiting persists beyond 4 hours.

2. If the temperature remains elevated beyond 24 hrs or goes above

101°F/38°C.

PLEASE CALL Dr. Crandall or Dr. Granato at

703-368-1000

IF YOU HAVE ANY PROBLEMS RELATING TO YOUR CHILD’S TREATMENT

4