Nitrous Oxide (for dental work)
My eight-year-old son’s dentist is suggesting nitrous oxide during a procedure to install a filling and crown. I have concerns that it may not really be necessary, but, more so, that it may have adverse effects. What are your suggestions?
The use of nitrous oxide is very common in pediatric dentistry. A child with a need for a rather involved process must be assessed as to whether he will need some form of support to be able to get through the experience comfortably.
If your son is unable to sit long enough for the treatment (1/2 hour or so), or is unable to communicate his discomfort or fears, or if he dislikes the noise of the drill, the bright lights, the suction, etc., then some form of sedation in required. This is common with most children.
The options are either going ahead and "pushing" through it and ending up with a poor experience and a child who may never want to go back to the dental office, or offering a sedative to help the child accept what needs to be done.
Nitrous oxide is the most conservative approach we have to sedation with children. It has no definable long-lasting side effects. There are no contraindications to its use in children who have CdLS. The only contraindications to its use would be if the child has a cold or lung disease. The way it is used in dental offices is very safe. The machines are pre-set, so that one cannot use it like in the operating room to cause a child to sleep. It basically relaxes the child, takes away fear, allows the child to accept stimulation from noise, etc., without really registering it in the brain. It decreases the sensitivity to discomfort and is easily controlled by the doctor. If a child is getting a bit more relaxed than the doctor needs, then the doctor can lower the level of nitrous oxide and increase the oxygen level. The child will return to a more alert state in seconds. The child is still able to talk and interact while under nitrous oxide. There is no loss of protective reflexes at the levels we use for minor to moderate procedures. This is compared to intramuscular injection or oral sedative, which take a long time to reverse, and the child is more sedated.
Therefore, I believe, through the use of nitrous oxide, your son will be able to comfortably accept his treatment. Only you and the doctor who sees the child in the dental setting can tell if he really needs assistance in accepting the treatment. Children with delays in their development may have fears which will express themselves when placed in a stressful situation. Dental procedures are invasive and can certainly be stress producing.
The other options are a mixture of oral sedation and nitrous oxide or I.V. sedation or general anesthesia in the office or, preferably, operating room in the hospital. I would recommend using the most conservative approaches first and see how successfully things go, although many pediatric dentists do not have appropriate monitoring in their office setting and would recommend hospital-based care.
RM/ TK 7-13-10
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