Sedation Dentistry – Before and After the Dental Procedure

Eating and drinking instructions- 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! You are encouraged to wear loose, comfortable clothing. 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!

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.

Unless specifically advised, it is recommended to take all medications as prescribed. If medication is required before an appointment, it is recommended to take the pill/tablet with a very small amount of water. If medication must be taken with food, it is recommended to take the pill/tablet with a very small amount of applesauce. It is not typically necessary to stop taking any medications before an anesthesia procedure. It is important to make sure to report all medications that you take including medication prescribed by a doctor or that you purchased on your own from the drug store. It is also recommended to make sure you ask about your 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

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 the patient 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 the patient 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.

No patient who receives sedation or anesthesia can operate a vehicle following discharge from the dental office! Additionally, patients will require at least one adult to provide observation and supervision for a period of three to four hours after leaving the dental office. Sometimes it can take longer for a patient to fully recover and it is advised to make arrangements to stay as long as necessary with the patient. The main concern is balance and coordination. If a patient attempts to move on their own without assistance, they could suffer an injury. It is our best recommendation for any patient to have a responsible adult stay with them until they are fully recovered.

1. The medications administered during the procedure affect memory and this effect lasts after the procedure is completed. It is important to have someone with the patient to ensure that the patient doesn’t do something and then forget about it with the possibility of a resultant accident. For example, the patient lights the stovetop to cook something and then forgets about it and a fire results. It is also advised not to make any type of important decisions or buy something due to the potential of not remembering what was done by the patient.
2. Adult Patients with Special Needs. Depending on size of the patient or their ability to ambulate, it may be required to have more than one adult available to assist with the safe and appropriate transfer of the patient to the vehicle at the completion of the procedure. It is also recommended to consider bringing a wheelchair (if available) to the appointment to facilitate transfer.

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. The patient can typically drink when they are ready. It may even be advised to drink something before leaving the dental office.
      2. Adult Patients with Special Needs. The patent will be assessed based on their level of incapacity. Typically, it will be advised to not allow the patient to receive any fluids for at least one hour following discharge from the dental office.

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.

1. Adults. It is advised to not consume any alcoholic beverages eight hours before and after the procedure. If you smoke, it is advised to discontinue smoking at least 2 days before the procedure. Realizing for many patients this may be difficult, any reduction in smoking before the procedure is beneficial.
2. Adult Patients with Special Needs. If the patient is taking any medications, it is important to understand that the patient should not have any medications administered before the patient is drinking clear fluids without any problems regardless of when the patient is scheduled to take their medications. Taking medications before being able to tolerate clear fluids can potentially be problematic for the patient.
3. It’s advised not to stay up late the night before the procedure. This can actually cause the patient to take longer to recover after the procedure! Maintain your regular schedule the night before the procedure including when you eat your last meal and when you 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.
4. 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.
5. 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.

Adults: When you come to the treatment room, you will meet your anesthesiologist who will discuss with you your preferences concerning anesthesia. We typically find that our adult patients do not request deep sedation for the procedure and are happy to receive only moderate sedation. Ultimately, your comfort and desired experience is our goal, but your safety is our priority. If there is any concern regarding your ability to safely undergo anesthesia during the procedure, it will be discussed with you.

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 Post Dental Anesthesia Care Instructions are to provide you with information and guidelines to follow after the procedure you have just completed. You have received medications that can alter your perception, memory and coordination. Though full recovery is expected within the day of the procedure, you can continue to have effects of these medications for up to 24 hours. By following the instructions, it is expected that you will have an uneventful recovery.

The MOST important thing that you can do is go home and REST. Giving your body a chance to recover post anesthesia is best achieved through resting and no planning any activities. If you live alone, it is recommended that you arrange to have someone stay with you for at least 3 hours after you leave the office.

The following categories will address specific issues pertaining to your recovery:

AVOID:

Any operation of mechanical or electrical machinery/devices. Driving for the remainder of the day. Allow at least 12 hours if not longer. Making any important decisions or signing important documents. Consuming alcoholic beverages and/or smoking for at least 24 hours. Any unaccompanied activity.

ACTIVITY:

Take your time when moving, use help or assistance as much as possible. As you move from lying to sitting or sitting to standing- move slowly. If you experience any dizziness, lie or sit back down and rest. When climbing stairs, have someone help and assist you.

MEDICATIONS:

Resume taking any prescribed medications once you are drinking fluids. If you receive prescriptions for the procedure, take those as directed. Over the counter pain relievers- Tylenol, Motrin, are very helpful to take.

EATING AND DRINKING:

Liquids may be consumed as soon as possible. Begin with frequent small quantities of clear fluids- water, juice, soda. NO dairy products at first. Progress slowly from liquids to soups to solid foods. Increase your diet as desired depending on how you feel. Taking your time increasing your diet help to avoid nausea and possible vomiting.

If you experience any problems not discussed above or you are continuing to have any problems or difficulties, please call the office at 520-571-7951.

Here are Dental Anesthesia Instructions for Special Needs Adults scheduled to receive dental treatment under Deep Sedation/General Anesthesia. The medications that will be administered will allow you to undergo this treatment in a safe and comfortable manner. The following instructions will help you prepare for this procedure. FAILURE to follow these instructions could put you at unnecessary risk and result in cancellation of the appointment.

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.

Clothing

Please wear comfortable, loose fitting clothes. Do not wear any jewelry, make-up or fingernail polish. Consider a blanket and/or pillow for the ride home.

Medications

Take all regular medication(s) as prescribed with a small sip of water. If you are DIABETIC and INSULIN dependant, please inform our office to discuss the pre-treatment regimen as it applies to you.

Sickness

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

Escort

At the completion of the appointment, at least one adult is required to bring you home. Please plan to have someone stay with you for at least 4 hours upon your arrival home.

Depending on size of the patient or their ability to ambulate, it may be required to have more than one adult available to assist with the safe and appropriate transfer of the patient to the vehicle at the completion of the procedure. It is also recommended to consider bringing a wheelchair (if available) to the appointment to facilitate transfer.

Day of the Procedure

Typically, the anesthesiologist will come out to meet the patient and those who came with the patient to the appointment (family, caregivers) and assess the patient’s ability to undergo the procedure comfortably. Another reason is to determine the ability to start an IV. We have been very successful starting IVs because we take the time to carefully and compassionately approach the patient. We request that the family or caregivers give full consideration to the behavior issues with the patient as well as an understanding of their size (weight) and ability to ambulate. If a patient has behavior issues that do not allow them to be cooperative, it must be arranged for a family member/caregiver to assist with the administration of anesthesia medications. If we are unable to administer medications to a patient because of ineffective behavior management and assistance, the procedure will be cancelled. If the patient is large, especially if they are overweight, consideration must be made for more than one adult to be present to assist with treating the patient. If the patient is large and/or does not ambulate or walk on their own well, we may require assistance from others to transfer the patient into the dental chair.

After Procedure

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.

For Recovery, the patent will be assessed based on their level of incapacity. Typically, it will be advised to not allow the patient to receive any fluids for at least one hour following discharge from the dental office.

Extras

Do not consume any alcoholic beverages for at least 24 hours before and after your appointment. If you smoke, please try to discontinue any smoking at least 48 hours prior to your appointment. Do not change your daily routine before the appointment, plan on a good night’s sleep. Arrange to take the day off from work and possibly the following day.

If you have any questions or concerns about these instructions, please contact our office.

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.