Sedation

Our doctors at Brink & White take oral sedation very seriously. They follow all guidelines set forth by the American Academy of Pediatric Dentistry and the State of Tennessee.

Sedation in our offices is also limited to children who are healthy enough to limit the risks. If there are any questions regarding the health history of your child, a consult may be sent to their treating physician to check if any limitations should be made to treatment or if oral sedation in the office is not the best course of treatment.

Because of these precautions, sedation is very safe in the office setting with very predictable outcomes. However, there are always risks associated with any treatments rendered.

Our office is prepared for these rare outcomes and has all of the necessary equipment and medications should the need arise.

Our in-office sedation is administered orally. This means that your child takes the “Kool-Aid” by mouth when you arrive at our office.

Whenever medication is given by mouth, it takes time for that medicine to begin to have an effect. This is definitely true of oral sedation.

After taking the medication, your child will need to wait anywhere from 20-45 minutes before coming to the treatment area. This time difference is based on what medications were given and the size and age of your child. This treatment is designed to relieve anxiety and is considered a “mild” to “moderate” form of sedation. It is not designed or dosed to cause your child to be rendered unconscious.

Some children do dose off or fall asleep for brief periods of time, but this is typically due to the child’s extreme comfort level and enhanced relaxation and is completely normal. During this process the heart rate and oxygenation of the patient are monitored continuously. This is only a safety precaution and should not be seen as a cause for concern on your part.

These are the common sedation medicines we use at Brink & White:

Vistaril
A mildly sedating drug—like Benadryl—that soothes the child's stomach and counteracts nausea and any allergic tendencies that cause anxiety to be stimulated in a young patient.

Versed
A medication used mainly for children six or seven years old and younger. Its effects are rapid in onset—often in as little as 10 minutes—and it wears off quickly as well. Versed causes anxiety relief and often memory lapse, so we often use it when a young patient may have multiple appointments or we expect the patient to have difficulty with the procedures.

Valium
This drug is well known for relieving anxiety. Its effects begin slowly and last relatively longer—including a rebound effect following the child's first meal after dental treatment. Valium is typically only used on older children (seven and up) and it may have associated memory loss of the visit. This drug is mainly used to help an apprehensive patient relax enough to complete the necessary treatment.

Demerol
This drug is a pain medicine that has sedating effects as well. Its onset of effects is longer—up to one hour—and typically will be used on younger children (under 60 pounds). It lasts up to two hours after treatment, and it causes drowsiness.

Nitrous Oxide
More commonly known as “laughing gas,” we frequently use nitrous oxide to help relieve apprehension during a restorative visit. This gas is administered with a mixture of oxygen and has a calming effect that helps anxious kids relax.

Because it is a very mild analgesic, your child will still be able to interact with the dentist and assistants during the visit. After the patient appears sufficiently relaxed, the nitrous is turned off and the patient breathes only oxygen.

The analgesic effect of the nitrous wears off within five minutes of breathing oxygen only. Sometimes side effects of nausea or dizziness may persist, so we always make sure the patient is feeling normal—not dizzy or flushed—before leaving the office.

Our doctors are licensed to administer nitrous oxide, and our clinical staff members are certified to monitor its delivery during the procedure.

Absolutely. Our doctors at Brink & White understand that this can be a stressful experience for not only your child but for you, too.

We want you to feel comfortable with the setting surrounding your child’s sedation appointment. If being in the room with them helps you feel more comfortable, then by all means, stay with them during treatment.

However, if you don’t want to be present, that’s okay, too. We will notify you with updates during treatment as to how your child is doing.

If your presence is hindering the treatment of your child, then the doctors will discuss with you your options going forward. A child being upset or confused during a sedation visit is completely normal.

If you have any questions about how your child is acting during a sedation visit, please ask the doctors to explain their behavior. Most times it is a behavior that is not surprising to the treating doctor or staff and very well could be behavior we see every day!

There are risks associated with sedation, and our doctors and staff take this treatment very seriously at Brink & White. However, the risks are minimal to oral conscious sedation when the appropriate guidelines are followed.

Our doctors follow all guidelines set forth by the American Academy of Pediatric Dentistry to minimize any side effects such as changes to cardiovascular function or respiratory disruptions. We’re prepared to act if an unexpected event occurs, but these occurrences are quite rare.

This varies from one child to the next. Appointments for sedation require more time in the office. This is due to the waiting period associated with an oral medication having to be absorbed by the body to be effective.

The actual treatment time is similar. In fact, because sedated patients many times or so comfortable and compliant, the appointments can actually be shorter.

We might be able to complete all of your child’s treatment in one visit, but this depends on the work needed and how much local anesthetic is required to complete treatment.

One thing that the doctors must consider is the patient’s numbness once they leave the office. Children are more prone to accidentally chew on a numb lip, cheek, or tongue and unintentionally cause soft tissue trauma to themselves. Therefore, the doctors will limit the area treated in many instances to help avoid this post-operative concern.

Oral conscious sedation prescribed at the doses used in our offices is not designed to render your child unconscious. Many children dose off during treatment because they’re very relaxed and also drowsy from the medication.

But, in these instances the child will still respond to verbal instructions, open their eyes regularly, and maintain all breathing and airway reflexes. This type of sedation is different from sedation done via an IV and is very different from general anesthesia administered in a hospital setting.

Any procedure done other than a very small filling will almost certainly require numbing, even if your child is sedated.

This is due to the minimal level of sedation achieved by oral sedation combined with the fact that sedation at this level does not have any profound effect on the nerves of the teeth or gums.

Nitrous oxide can help with an overall mild numbing effect, but this effect alone won’t be sufficient enough to keep your child comfortable for most dental procedures.

Nothing! Sedation is not designed to be given to “bad kids” or children who “don’t act right”.

Sedation is designed to help those children who want to behave and do well, but lack the cognitive ability to cope or understand what is happening to them. Some children feel a profound sense of fear or anxiety about a dental visit.

Sedation is a great tool to help them cope with these circumstances. Sedation is also utilized to help the apprehensive patient stay comfortable for a longer period of time.

This allows for more treatment to be completed in a given appointment. Because of this, sedation can also be useful for those apprehensive children with involved or extensive treatment plans to minimize the number of office visits required to complete treatment.

The State of Tennessee requires a Comprehensive Conscious Sedation Permit to orally sedate any patient under 13 years of age. Each doctor who provides sedation at Brink & White carries this permit.

Our doctors completed the traditional four years of dental school along with two years of post-graduate training through a pediatric dentistry residency. While training, your doctors received extensive education and experience in sedating patients.

Our doctors follow the guidelines set forth by both the American Academy of Pediatric Dentistry and the State of Tennessee Board of Dentistry.

The answer depends on what medications your child received at their sedation appointment. Certain medicines have a longer effect than others.

The effects of some sedation medications may begin to wear off not long after leaving the office. Others may last a few hours after treatment has been completed.

Because of the variability of this time period, we ask that your child not return to school or daycare the day that they are sedated. However, most children are fully recovered by the late afternoon and can easily return to school or daycare the day after treatment.

\Like with nitrous oxide (laughing gas) administration, while some insurance plans do provide coverage for sedation, most do not.

Sedation does have a fee and our office can help you know whether this cost will be covered in any capacity by your insurance company or if it will be your responsibility.

Our team at Brink & White generally recommended your child take his or her medications with a sip of water on the day of sedation.

Our office will inform you of any changes that may be recommended by your child’s physician.

Your child should take it easy for the remainder of the day they receive oral sedation. They should NOT attend school or daycare after sedation treatment.

While many children may feel back to normal a few hours after treatment, because of the way medications are removed from the body there may still be periods where your child is somewhat uneasy on their feet. You’ll need to make arrangements for your child to return home after treatment.