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Pediatric  Dental   Health

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Sedation Of Children For Dental Procedures
Most children are cooperative during dental treatment, despite occasional moments of anxiety. Nevertheless, some children, especially the very young and fearful, may have difficulty cooperating for treatment at the dental office, and may benefit from behavior management techniques. One pharmacologic behavior management technique is conscious sedation. During interactive conscious sedation, a child can respond to verbal requests from the dentist, and keep the eyes open while being sedated. Conscious sedation is often provided because it may be the only way to provide dental care for children whose insurance companies refuse to pay for dental treatment under general anesthesia. It is unfortunate that less than half of all states reimburse dentists for general anesthesia if the child has no underlying medical conditions.

Conscious sedation can be provided using specific drugs and delivery techniques. Some of the drugs used in pediatric conscious sedation include meperidine, chloral hydrate, midazolam, and ketamine. Certain drugs should only be administered via specific routes, such as the oral, I.V., rectal, or intramuscular routes.

The oral route is the oldest of all routes of drug administration, and still the most commonly used. It is a useful method for managing uncooperative or fearful children who need dental treatment. The oral route offers some advantages over other routes, including decreased incidence of adverse reactions, lower cost, and ease of administration. The disadvantages of the oral route include prolonged onset time, prolonged duration of action, and erratic absorption from the GI tract. Most orally administered drugs demonstrate the highest blood levels at approximately 60 minutes after ingestion. The absorption of a drug from the GI tract is affected by its lipid solubility, the pH of the gastric juice, slow gastric emptying time, inactivation of the drug by the liver, and drug bioavailability.

An adequate preoperative evaluation is an important part of the conscious sedation process.
Some of the major components of the evaluation include: