Before & After Dental Procedures for Children

Morning Appointment– NO solid food by mouth after midnight. CLEAR liquids (water, apple juice) may be consumed up to 2 hours prior to the appointment. NO MILK or other dairy drinks may be consumed! Breast feeding should be stopped 6 hours prior to appointment.

Afternoon Appointment– a LIGHT MEAL may be eaten up to 8 hours prior to the appointment. CLEAR liquids (water, apple juice) may also be consumed up to 2 hours prior to the appointment. NO MILK or other dairy drinks may be consumed! Breast feeding should be stopped 6 hours prior to appointment.

One of the most important safety parameters for anesthesia provision is following appropriate guidelines for eating and drinking. Failure to properly follow these guidelines can result in a catastrophe for the patient during anesthesia. The challenge with restricting eating and drinking is the time of the procedure. Everyone wants the early morning case as it is typically the most convenient for the patient and easiest to restrict food and fluids. Obviously, it is impossible to only see patients first thing in the morning so it becomes necessary to schedule patients at different times during the day. With the revision of guidelines for eating and drinking, this really does not become such a problem as it has in the past. If the patient has a feeding tube, it will be important to discuss with our office appropriate guidelines with respect to administering anything to the patient before the appointment. The current guidelines recommend the following;

1. Eating- no solid food, semi-solid food or any type of dairy product should not be consumed less than six (6) hours prior to an appointment
2. Drinking- clear liquids (water, juice, pedialyte, Gatorade, soda) can be consumed up to two (2) hours prior to the appointment
3. Examples-
   1. If you have an appointment at 11:00 AM- food would have to be consumed before 5:00 AM and fluids could continue until 9:00 AM. Now, it may be impractical to eat before 5:00 AM, but it would be fine to drink as much clear liquids up to 9:00 AM
   2. If you have an appointment at 2:00 PM- food would have to be consumed before 8:00 AM and clear fluids could continue until Noon. So, it would be fine to have breakfast before 8:00 AM and drink clear liquids until Noon.

The best clothing to wear is pajamas! Please have your child in comfortable, loose fitting clothes and please AVOID excessive jewelry as it can interfere with the procedure. With colder weather, layering is the best. The provision of anesthesia requires access of your arms and legs for monitors and the administration of medications. Wearing tight clothes, belts or other clothing extra (leggings/thermals under pants, extra shirts, and tight long sleeve shirts) make it more difficult to care for the patient. Accidents happen. For this reason, we do recommend that the patient bring an extra set of undergarments and clothes just in case!

For children under 6 years old, we recommend the parent to consider putting either a diaper or having the child wear a pull-up in case they have an accident during the procedure. Knowing that some children will be uncomfortable with this, it is only recommended as a consideration.

Though they make us look good, they are not helpful during an anesthesia procedure. Bracelets, rings, watches, artificial finger nails, and nail polish all make anesthesia provision difficult! One ring and one bracelet is OK, but multiple rings and bracelets often interfere with the procedure. By removing bracelets, rings, watches, nail polish and at least one artificial finger nail from each hand make it very helpful and easier to provide care for the patient.

Like accessories, a nice hairstyle makes us look good, but it can interfere with the anesthesia procedure particular with positioning of the patient’s head during the procedure. Removing all rubber bands, hair ties, scrunches other any other hair device removes the possibility of injuring a patient’s head during the procedure. Also, please don’t come in with wet hair! Patients with wet hair typically wake up shivering considerably because their wet hair allowed their body temperature to drop causing them to become very cold.

Take all regular medication as prescribed with a small sip of water. IF any medications require being taken with food, please inform our office. If your child has ASTHMA or other breathing problems, please inform our office to discuss our pre-treatment regimen as it applies to your child. If your child has DIABETES and is INSULIN dependent, please inform our office to discuss our pre-treatment regimen as it applies to your child.

It is always recommended to make sure you ask about your child’s medications if you are in any way unsure of what to do.

If you have any type of medical issue, it must be reported on your health history questionnaire! There is no more important thing to do as a patient undergoing an anesthesia procedure than to accurately and thoroughly report all of your medical conditions. When identified, each medical problem will be reviewed with you to ensure that it is fully understood and if any additional intervention is required. If additional information is needed, a medical request will be sent to your physician and/or specialist. Based on the information received, it will be determined if you require any necessary intervention in preparation for the procedure. Though there are many potential interventions that can be presented, the following are the most common situations we address;

1. Sub-acute Bacterial Endocarditis (SBE) Prophylaxis. The recommendations for administering antibiotic have drastically changed over the years and the current recommendations apply to much fewer cardiac or orthopedic conditions. If it is identified that SBE Prophylaxis is required, it will be discussed and confirmed how the antibiotic will be administered.
2. Diabetes. There are many medications administered for the control of diabetes including injected insulin and oral medications. Also impacted by patients with diabetes are the guidelines for eating and drinking. The most important considerations regarding diabetes are a patient’s blood sugar and a1C level. Each patient is individually prepared with regards to the control of their diabetes. Intervention typically involves adjusting the administration of insulin and oral medications with respect to eating and drinking guidelines. It is also required to check your blood sugar before the procedure.
3. Asthma. One of the most challenging aspects of anesthesia provision involves the lungs. Breathing effectively during anesthesia is paramount to the success of the procedure and the safety of the patient. Patients with asthma have impaired lungs and depending on the severity of a patient’s asthma intervention with breathing/nebulizer treatments may be required. The importance of administering breathing/nebulizer treatments prior to the anesthesia procedure is directly related to the safety of the patient during the procedure. Our office guidelines require that if a patient has had any use of their nebulizer within six (6) months of the dental appointment, a breathing/nebulizer treatment must be administered before bedtime the evening before the appointment and the day of the appointment within one hour of the appointment.
   1. Examples-
      1. If the dental appointment is scheduled at 10:00 AM, the first breathing/nebulizer treatment would have been given the evening before and the second would be given at 9:00 AM.
      2. If the dental appointment is scheduled at 3:00 PM, the first breathing/nebulizer treatment would have been given the evening before and the second would be given at 2:00 PM

Please contact our office as soon as possible to report any changes in general health- persistent fever, productive cough, illness, etc.

It is very important to ensure optimal health for an upcoming dental appointment when anesthesia will be administered. The most important issue to address is communication. If a procedure is scheduled and your child is sick or ill prior to the date of the appointment, it is recommended to contact our office to discuss the situation and determine the best course of action. Sickness alone is not necessarily a reason to cancel an appointment. Depending on what symptoms your child has will determine whether the procedure should be rescheduled or not. The following are general guidelines to follow;

1. Temperature. Elevated temperature is not a reason to cancel an appointment. The best recommendation is to use a thermometer to accurately obtain the patient’s temperature. If the temperature is significantly elevated, then the procedure should be rescheduled.
2. Congestion. This is one of the more challenging areas to assess and evaluate. If a patient is congested, the condition needs to be examined. The color and thickness of the discharge will help determine how ill the patient is currently and what to discuss with our office.
   1. Examples-
      1. Clear, ‘runny’ discharge
      2. Yellow, thick discharge
      3. Green, very thick discharge
3. Coughing. The important issue with coughing is whether the cough is productive or not. A dry cough though possibly uncomfortable may not be as significant as a cough where the patient is able to produce discharge. Though not necessarily a reason to reschedule an appointment, a productive cough should be evaluated and assessed similar to congestion.

You are requested to arrange for two adults to be with your child for discharge NO other children should be brought to the appointment. NO ONE is allowed to remain in the treatment area after your child has responded to the administration of the medications. At least ONE adult/parent must remain at the office during the procedure.

We request that two adults are with the child, especially for the ride home. This allows one adult to drive the car and not be distracted while the other adult sit next to the child to observe them and make sure they are safe in the car. We also recommend that no other children are brought to the appointment particularly younger children or infants who will require an adult to watch them. The more distractions that are present can potentially result in the sedated child not being properly observed.

All patients are recovered until the point that the anesthesiologist determines it is safe to go home. The usual time from completion of the procedure until discharge from the office is 30-45 minutes. If the patient requires more or less time, it will be provided as determined by the anesthesiologist. Upon determination that the patient may leave the dental office, it will typically take 3-4 hours for complete recovery from the anesthesia medications administered to the patient. During the recovery period at home the following is advised;

1. 1. Go home! Do not plan to take the patient anywhere else- store, restaurant, other appointment, errand or any place else. The best place for the patient to be is home. This will allow them to recover comfortably and safely.
   2. Balance and Coordination. Patients take time to regain their balance and coordination and will need help and assistance when attempting any movement initially. Someone should be there to facilitate and assist the patient when moving from one position to another (lying to sitting, sitting to standing) as well as help them if they are trying to walk. The patient should not be left alone or unobserved until they are fully recovered.
   3. Drinking and Eating. The most important issue to determine is how awake the patient is before giving something to drink. Drinking anything should not be done until the patient is fully awake! If a patient receives something before they are fully awake they risk vomiting or aspiration. If a patient vomits following drinking something too soon, it is our experience that it can take 20-24 hours for the vomiting to stop, even with medications. Our best recommendation is to wait until the patient if fully awake before giving them anything to drink. Always start with small amounts and slowly increase until the patient can drink a full glass of clear fluid without having any issues with nausea or vomiting. When clear fluids are able to be consumed without any problems, then slow progression to more solid food is allowed. This is also the time to administer medications (prescribed by the dentist, regular medications or other recommended medications). If a narcotic medication was prescribed, we recommend that the patient is able to eat something of substance without nausea or vomiting before taking the narcotic medication. Good choices following clear fluids include yogurt, milk or soup. A slow progression to more solid food is permitted as long as the patient is not showing any signs of nausea or vomiting.
      1. We strongly encourage parents to not attempt to give any fluids to their child before they are fully awake. Doing this will almost certainly guarantee the child will get sick. Please wait at least one hour after leaving the office before attempting to give your child any fluids.

Bring a pillow and blanket for the ride home. Do not change your child’s daily routine prior to the appointment- Please DO NOT have them stay up late the night before the appointment or have them eat too late. Please make arrangements to have appropriate supervision after the appointment. If you have any questions or concerns about these instructions, please contact our office.

1. Do not have your child stay up late the night before the procedure. This can actually cause the patient to take longer to recover after the procedure! Maintain your child’s regular schedule the night before the procedure including when they eat their last meal and when they go to sleep. It is also advised to not wake up your child early to give them something to eat or drink before the procedure. Changes in their regular schedule in any way do not help with the planned procedure.
2. Safety. It is important that all patients have appropriate safety restraints for the ride home. Adults should wear seat belts, patients in wheelchairs should have proper safety systems in the vehicle and children of appropriate age should be in car seats or booster seats. If the patient can recline in the vehicle safely or a pillow and blanket can provide comfort for the ride home, these are fine as long as appropriate safety restraints are utilized. This is also why it is important to have a responsible adult sit with the patient for the ride home.
3. After Hours Contact. It is recommended to contact our office if there are any issues or concerns after leaving the dental office. In the event that we cannot be reached and the patient is experiencing a serious problem (difficulty breathing, not responding to physical stimulus, not drinking or eating several hours after leaving the office), call 911. If there is any question or concern, please contact our office first to assist in the evaluation and assessment of the patient.

Ultimately the patient’s health, safety and well-being are our utmost concerns when providing anesthesia for the dental procedure. Following the instructions as well as asking any questions about the instructions or discussing concerns about the procedure will allow our office to provide the highest level of anesthesia care for the dental procedure. Never hesitate to contact us regarding any questions, issues or concerns about the anesthesia that will be provided. It is always better to ask questions and address concerns before the procedure instead of the day of the procedure.

The child will comes to the treatment area with one or both parents. We encourage family to come with their child to provide comfort and support, but due to space challenges we typically only allow up to two adult family members. We ask a parent/family member to sit with the child in their lap. An injection is given (usually in the arm) that consists of anesthesia medications. The child stays with the parent/family member until the desired effect of the medications is achieved. Once this occurs, the child is taken to the treatment area. As difficult as it may be, parents or other family are not allowed to remain for the procedure. We make every effort to ensure that children are unconscious when they are separated from their parents, and will not know that they ever left their family. Please understand that no parent, family member or other person will be able to stay with the child once the medications take effect. This is done for the safety and well-being of the child. If you have any concerns about staying with your child, please discuss this with our office.

1. Medications and fluid are given through an IV. Monitors are placed including EKG (heart monitor); blood pressure; pulse and oxygen saturation. The patient is positioned comfortably for the dental procedure. All patients are monitored continuously throughout the procedure by the anesthesiologist until all dental treatment is completed.
2. Following the completion of the dental treatment, the patient continues to be monitored until the anesthesiologist determines that the patient is stable and able to go into recovery. Patients are either brought into a separate recovery area (usually children and adults with special needs) or they recover in the same location where the procedure is performed (adults). During the recovery period, anesthesia instructions will be reviewed and any questions about the procedure will be answered. All patients are given written instructions which include contact information if there is any need to call after leaving the dental office.

The purpose of these instructions are to provide parents or guardians with information and guidelines regarding Post-Anesthesia Care Instructions for Children. Your child has received medications that can alter her/his perception, memory and coordination. Though full recovery is expected within the day of the procedure, effects of these medications can continue for up to 24 hours. By following these instructions, an uneventful recovery is expected. The following categories will address specific issues pertaining to recovery:

ACTIVITY:

Provide help and assistance when moving- move slowly. Allow your child to move on their own- do not force them or move them excessively- rocking, swaying can cause nausea and vomiting. Close supervision is important to ensure the safety of your child.

MEDICATIONS:

Resume taking any prescribed medications once fluids are being tolerated. If prescriptions were given for the procedure, take as directed. Over the counter pain relievers like Tylenol or Motrin are very helpful to take, especially if your child develops a temperature.

EATING AND DRINKING:

Liquids may be consumed as soon as possible. Begin with frequent small quantities of clear fluids- water, pedialyte, gatorade. NO dairy products at first. Progress slowly from liquids to soups to solid foods. Increase the diet as tolerated depending on the response of the your child. Taking your time increasing your child’s diet will help to avoid nausea and vomiting.

EXTRAS:

On occasion, it is possible to see one or more of the following:

• Nausea and Vomiting – this is best avoided by minimizing or avoiding external movement (rocking, swaying) and slowly introducing your child to fluids as well as slowly progressing their intake from liquids to solids.
• Elevated Temperature – may be noticed during recovery, though this will resolve with time, it is OK to give a medication like Tylenol or Motrin once your child is tolerating fluids.
• Fast Heart Rate – this is the result of medication given and will go away with time. If it persists more than 2 hours, please call the office.
• Red areas on the face and/or body – this is also a result of medication given and will go away with time. If it persist more than 2 hours, please call the office.

The purpose of these instructions are to provide parents and caregivers with guidelines and instructions for those with Special Needs.

We request that two adults are with the child, especially for the ride home. This allows one adult to drive the car and not be distracted while the other adult sit next to the child to observe them and make sure they are safe in the car. We also recommend that no other children are brought to the appointment particularly younger children or infants who will require an adult to watch them. The more distractions that are present can potentially result in the sedated child not being properly observed.

Eating and Drinking

Any solid food intake must stop 8 hours prior to the appointment. CLEAR liquids (water, apple juice) may be consumed up to 2 hours prior to the appointment. NO MILK or other dairy drinks are to be consumed.

**IF your child has a feeding tube, please follow the same instructions above for eating and drinking. If you have questions, please contact our office.

After the procedure

The patient has received medications that can alter her/his perception, memory and coordination. Though full recovery is expected within the day of the procedure, effects of these medications can continue for up to 24 hours. By following these instructions, an uneventful recovery is expected.

Ambulatory – provide help and assistance when moving- move slowly. Non-ambulatory – ensure that normal response to stimulus is occurring, any movement that can be tolerated should be done to aid in recovery. Close supervision is important to ensure the safety of the patient.

1. On our Forms and Instructions web page you will find all of the instructions, information, and required forms you need in preparation for the procedure. Prior to the appointment, you will complete a medical history specific for the provision of anesthesia as part of the dental procedure. One of the most daunting forms to complete is the consent for anesthesia. Though extremely unlikely, it is important to discuss the possibility of death in relation to the procedure. This is done to provide full disclosure as well as to emphasize the serious nature of anesthesia provision. Anesthesia is administered to carefully selected patients so that the patient can successfully undergo treatment, and the dentist is able to provide quality and complete dental treatment, BUT safety of the patient during anesthesia is our number one priority! For this reason, the full and complete understanding of necessary preparations for the procedure is of utmost importance.
2. Please carefully complete all required forms. Also make sure to ask any and all questions that you may have about the procedure. Your confidence in us is important and we want to ensure that you are comfortable and that all your concerns have been addressed. Following the completion of the anesthesia forms, you will be contacted by a member of our office to review your medical history and provide any additional information requested.