General Anesthesia For
Pediatric Dental Patients
Children may receive dental treatment in conjunction with
general anesthesia. An anesthesiologist can provide general anesthesia, while a
pediatric dentist provides dental treatment. This may be done in either a
hospital or dental office.
Dentists were the first to demonstrate the usefulness of anesthesia. In
1844, a dentist named Horace Wells had a tooth extracted while breathing nitrous
oxide to control pain. Later, a dentist named William T. G. Morton used ether
vapor while performing a difficult extraction on a patient.
General anesthesia is defined as a controlled state of unconsciousness,
accompanied by a partial or complete loss of protective reflexes, including the
inability to independently maintain an open airway, and respond purposefully to
physical stimulation or verbal commands.
An adequate preoperative evaluation is the most important part of the
general anesthesia process.
Some of the major components of the evaluation include:
1. A thorough review of the child's medical history.
2. A complete physical examination.
3. A review of systems. This means evaluating each of the child's functional
systems, such as the: cardiopulmonary, airway, hematologic, central nervous,
renal, hepatic, gastrointestinal, endocrine, and metabolic systems.
4. Knowledge of the child's current medications and allergies.
5. Knowledge of the child's previous anesthetic experiences. 6. Diagnostic lab
tests and additional consultations.
Adequate monitoring during general anesthesia is essential to ensure that
the appropriate level of anesthesia is administered, as well to detect any
developing complications.
The anesthesiologist must be able to recognize and treat airway and other complications
quickly and appropriately. A thorough knowledge of the pharmacology of the drugs
being administered is vital. Emergency drugs and equipment must be available, on
site, at all times.
A recent article reviews the topic of general anesthesia:
Saxen M, Wilson S, Paravecchio R:
Anesthesia for Pediatric Dentistry.
Dental Clinics of North America. Vol 43, Number 2, 231-45, 1999
A recent journal article has found a causal link between the use of halothane
anesthesia and ventricular arrythmias during outpatient anesthesia:
Blayney MR, Malins AF, Cooper GM:
Cardiac arrythmias in children during outpatient general anesthesia for
dentistry: a prospective randomised trial.
Lancet. Vol 354, Number 9193, 27 Nov 1999
When Do Teeth Come In And
Fall Out?
Eruption and exfoliation schedules are not the same for
each child, and depend on prenatal, natal, and postnatal factors.
The following eruption and exfoliation tables are based on material presented
in:
Proffit WR, Fields HW: Contemporary Orthodontics.
St. Louis, 2000, Mosby,Inc.
Eruption of baby teeth
Upper
Lower
Central incisors
6-8 months
5-7 months
Lateral incisors
8-11 months
7-10 months
Cuspids
16-20 months
16-20 months
First molars
10-16 months
10-16 months
Second molars
20-30 months
20-30 months
Shedding of baby teeth
Upper
Lower
Central incisors
7-8 years
6-7 years
Lateral incisors
8-9 years
7-8 years
Cuspids
11-12 years
9-11 years
First molars
10-11 years
10-12 years
Second molars
10-12 years
11-13 years
Eruption of permanent teeth
Upper
Lower
Central incisors
7-8 years
6-7 years
Lateral incisors
8-9 years
7-8 years
Cuspids
11-12 years
9-11 years
First premolars
10-11 years
10-12-years
Second premolars
10-12 years
11-13 years
First molars
6-7 years
6-7 years
Second molars
12-13 years
12-13 years
Why Would A Young Child Need A Root
Canal?
A young child may need root canal treatment in order to
"maintain the vitality of the pulp of a tooth affected or infected by
caries, traumatic injury, or other causes," according to the American
Academy of Pediatric Dentistry.
Keeping baby teeth healthy is an important part of: preserving space in the
dental arch, preserving biting and chewing power, maintaining facial beauty,
preventing tongue habits, and helping with speech. Root canal treatment is also
called dental pulp therapy.
Two common forms of pulp therapy for young children are the pulpotomy, and the
pulpectomy.
The pulpotomy procedure preserves the vitality of the pulp within the root. The
dental pulp contains the nerve tissue, blood vessels, and reparative cells of
the root. Pulp therapy is usually performed "under a rubber dam,"
which isolates the tooth from the oral cavity during treatment. In a pulpotomy,
the diseased pulp tissue within the crown portion of the tooth is removed, while
the healthy tissue inside of the root is left alone. The space inside of the
treated crown is then filled with a healing agent, and a stainless steel cap is
usually placed over the tooth.
Another form of pulp therapy is the pulpectomy. A pulpectomy is needed when
inflammation, infection, or degenerative changes have progressed into the root
canal portion of a tooth. In this procedure, the diseased tissue is completely
removed from the inside of the crown and root. The root canals are cleansed,
enlarged, disinfected, and filled with a resorbable material. A stainless steel
cap is usually placed over the tooth.
Parents should know that neither dental radiographs nor the absence of pain will
always predict the need for pulp therapy. An x-ray does not provide a
three-dimensional representation of the "soft" pulp tissue. Rather, it
gives an imperfect, two-dimensional representation of the hard components of the
tooth, such as enamel, dentin, and cementum. The absence of pain cannot be used
to determine the health of a tooth, since disease may be present without any
history of pain.
A journal article provides additional information on pulp therapy techniques:
Primosch RE, Glomb TA, Terrell RG: Primary tooth pulp therapy as taught in
predoctoral pediatric dental programs in the United States.
Pediatric Dentistry 19:118-122, 1997.
