Different Ways to Complete Treatment on Children
The following are the ways we have available in our office to help children have needed treatment done in the most positive way. We do not use restraints in our office. It is our goal, with every child, to be as conservative in recommending sedation as possible; however, some children are unable to cope without the help of some type of sedation. We will give you our opinion of which of the following we think would be most successful for your child based on several factors: our initial assessment of your child’s coping skills, information you give us about behavior at previous medical and dental visits, the amount of treatment needed, special health needs and age of the child. If we recommend one of the following, but you request a different procedure, we will do our best to honor your request and do our best to complete the treatment in the way you desire. However, if we are unable to complete the treatment in the way you requested, because the child still could not cope or cooperate, the fees for the visit will include an office visit and the fee for the nitrous or sedation, if used. Often insurance will not cover these fees. Please ask if you have any questions regarding this policy and we will be happy to explain.
- No type of medicine or laughing gas: Easy-going children, with no history of medical/dental trauma, and who have only 1-2 visits of treatment needs, often need nothing more than good old fashioned distraction (TV above chair, singing, story-telling during treatment, etc) to get their work completed.
- Laughing Gas, or Nitrous Oxide: Children who are mildly nervous about new things, vaccinations, doctor’s visits, or shy in general often benefit from using nitrous oxide, or laughing gas, to relax them during their dental treatment. This is also a good alternative if there are only 1-2 visits of treatment to be completed. Nitrous also greatly helps children who have a history of gagging easily during toothbrushing and dental visits.
- Oral Conscious Sedation: Children who are more than a little nervous, have more challenging procedures, like extractions or crowns, or who have not been able to complete their work with nitrous alone, may be good candidates for oral conscious sedation. Dr. Luedemann-Lazar and Associates would decide, based on the amount of treatment, the child’s age and weight, and any health concerns, if it is safe and if so, which medication to give the child. Most of the time nitrous oxide is used in conjunction with this option, because less oral medicine is needed and they work well together for the best result. For this option, the child is still awake, just more relaxed than with nitrous alone. Also, one of the medications used in sedatives causes secretions to dry up, so for kids with really strong “gag reflexes” this is often a good choice.
- Ketamine Injection: For children 18months – 3 years of age, who have dental needs, for children who are extremely scared or “phobic” of the dentist, or for children who have special needs so that they are unable to cooperate at all initially, but who have some work that needs to be done, Ketamine, an injectable medicine, can be used. This option is stronger than oral medicine. It will cause the child to be in a trance-like state, where they do note feel or remember the procedure. They are completely still, but are still breathing on their own and have all of their protective reflexes, such as breathing and swallowing. This is often used in hospitals when children break bones and the doctor does not want to use general anesthesia or even IV sedation, but just need a shorter acting medicine, 20-40 minutes, so that they can quickly reset the bone and cast a young child. In the same way, if the child cannot cooperate for any reason, and needs a treatment that Dr. Luedemann-Lazar or Associates can complete in 20-40 minutes, Ketamine is a good option.
- IV sedation: For children who have extensive amount of dental treatment needed, more than 1-2 visits, more than 20-40 minute in an asleep state, IV sedation is available. Dr. Luedemann-Lazar has an MD-Anesthesiologist come once per month to help with these children. Dr. Magill, the anesthesiologist has been practicing for more than 20 years, and has extensive experience in treating children in this manner. With this type of sedation, the child receives Ketamine first, so they do not remember the IV going in, and then Dr. Magill keeps the patient “asleep” while all of their work is completed in one visit. This is not general anesthesia, where the child is so deep that they have a tube in their airway, and need the anesthesiologist to “breath” for them, as happens when they are “put to sleep” in a hospital for ear tubes or other OR procedures. This is similar to when adults have an IV to have their wisdom teeth removed but do not want to be aware or remember the procedure.
- Hospital or Surgery Center: Because providing only the safest care possible is our top priority, for any child who needs dental work but cannot cope on their own, and they are assessed to have a medical condition, airway issues, or any other concern that would make their procedure with any of the above options more risky in a dental office, there is the option of being transferred to a surgery center or hospital. At this time, Texas Children’s Hospital only sees children with a medical diagnosis that would qualify them to be a patient. The only surgery center in the greater Houston area who accepts dental patients is 1 hour away in North Houston. (Dr. Luedemann-Lazar used to work there, and is on staff as a senior-staff dentist, though she no longer travels there to work.) The surgery center’s protocol is only to see healthy children (ie, no significant heart, lung, liver, kidney, seizure disorders). There is the option of Hermann Hospital through being a patient of the Pediatric Dentistry Residency program. If Dr. Luedemann-Lazar and or Dr. Magill complete the health evaluations on your child and assess they are not safe to be treated with nitrous oxide, Oral Conscious Sedation, Ketamine, or IV sedation in our office, we will need to send you to one of the above places for treatment in an OR setting.