PlayWell Publications

At PlayWell Pediatric Dentistry, we sometimes recommend sedation – a medically guided nap – in order
to provide comprehensive dental care only when necessary and, ideally, only as a short-term solution to
the problem of dental treatment needs with imminent health risks experienced by a child who is unable
to otherwise receive said treatment. The long-term solution is to prevent future treatment needs while
continuously working together in the doctor-patient relationship to engender confidence, trust,
exposure, and to allow for maturity such that going to the dentist becomes fun and easy. If ever
treatment needs arise in the future, the long-term goal is for a child to receive care without the need for
sedation especially if discovered early when needs are small/few.
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Sedation is utilized, for example, with teenagers with only 1-2 teeth requiring treatment when they
cannot cope or have other obstacles to receiving care. Sometimes, it’s needed for a 4-year-old who
enjoys their dental visits, but who will not developmentally be able to cope with their restorative dental
treatment or the complexity if it amounts to four 1-hour appointments to fix 12 total teeth. Generally
speaking, I think of 3 main pillars: Amount/complexity of treatment needs, behavior for
exam/cleaning/x-rays, and age. Regarding age, I find that younger kids have a shorter time-clock. I think
in terms of time and/or patience - THIS is the currency in the pediatric dental realm. Nitrous oxide and
ceiling TV’s can buy an extension on a child’s patience, the time during which they’ll sit still happily. A 4-
year-old may let me do anything for about 5 minutes and then turn on a dime and become frustrated
that compliance STILL requires sitting still, that they’re DONE, and do NOT like the dentist anymore. The
more complex the treatment needs, the more invasive and insulting it is (insult is the word surgeons use
to name the initial surgical “cut” in a procedure – the surgical “insult”). The more treatment that’s
needed, the more appointments that are needed, the more patience deteriorates. And if a child comes
to us for an exam/cleaning/x-rays and struggles behaviorally to tolerate anything during a far LESS
insulting experience, that means I have even less of a child’s patience to work with from the outset.
Patience may not always be the right word – it’s not that some children are impatient, just that they
may have developmentally normal patience. My goal is to challenge kids at or slightly above their
developmental capabilities and help guide them to rise to the challenge. For some kids, an
exam/cleaning/x-rays is an appropriately large challenge, and for very young children it’s a challenge
enough to have a lap-to-lap exam with parents for looking and touching with fingers.
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At PlayWell Pediatric Dentistry, we use a sedation service where an anesthesiologist comes to our dental
home to medically guide your child to take a nap via gas they breath in through a mask. Only after they
are asleep will an IV be established to give longer lasting medications as well as those relevant in
recovery, e.g. for pain, nausea, inflammation, etc. An endotracheal tube is inserted both to support the
child’s still spontaneous breathing and to protect the airway from water & dental materials. Post-
operatively, kids wake up on their own time usually within 15-20 minutes after the procedure ends.
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They can wake up a little groggy but recovery proceeds well especially once home in their comfort space
where snuggles from mom or dad do the rest.
What about safety? Nothing is risk-free, but we take small risks all the time when there is a significant
benefit. For example, we drive to get to the grocery store, to bring kids to school, to go to work, to go to
the dentist, etc. Fatality statistics show that sedation is about 35x safer than riding in a car. To be fair,
the stats are annual. If you do sedation once per year and you drive every day of the year, then sedation

is as safe/risky as 10 days’ worth of driving. We still drive almost every day because there are important
things we need to do like driving to the LEGO store. While I really like going to the LEGO store, your
child’s dental health is probably more important even than a LEGO store trip. For our otherwise healthy
kids without significant medical history complications, in-office sedation is extremely safe especially with
all the safety precautions, and well worth it for the dental and mental health benefits your child
receives.

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