Although the dental instruments and machines in the clinic can intimidate both parents and children, general anesthesia helps manage anxieties and ease young patients through the procedure. Dr. Kevin Smith, an anesthesiologist at Rodeo Dental & Orthodontics, explained the importance of using the medication to lower fears and keep a child comfortable during the treatment.
Why should general anesthesia be used in dentistry?
Dr. Smith: “Many of the patients seen are as young as 1 year old up to about 5 or 6 years old. And if they have a significant amount of dental decay … they just aren’t developed enough, psychologically, to handle some of the things that older kids or teens or grownups can experience during surgery. It’s a matter of how you manage their behavior … in a typical dental setting. We do that, obviously, by integrating general anesthesia techniques.”
How does Rodeo Dental’s use of general anesthesia different from other dentistry?
Dr. Smith: “It is a service that enables dentistry to be accessed or completed. So, in other words, if a child has, let’s say, a whole mouthful of decay that needs to be taken care of — abscesses, infections — anesthesia becomes the vehicle that helps the child arrive at a … successful treatment. So we’re just an adjunct that facilitates successful treatment to accomplish.”
How often do you use general anesthesia on a patient?
Dr. Smith: “What we do for Rodeo is we work with them every day, but it’s in many clinics throughout the state of Texas. We essentially bring all the hospital equipment into the dental clinic, and we turn it into a mini operation room for the day. So, every day, we could have anywhere from six to eight to 10 patients having treatment. Once we’re through with the operation for that day, or two days or so, or however many days we have for that particular clinic, we pack things up, and we move to another scheduled clinic.”
Please describe your approach to using general anesthesia on a patient.
Dr. Smith: “The child breathes Sevoflirane, an inhalation anesthetic with some oxygen and, within about 10 breaths, they are all the way asleep. We don’t do anything else on the child until they’re sleeping. We hook up the monitors and do all the things that could otherwise be looked at or interpreted as scary for a young child. After that, we prepare the child for surgery. We set up the American Society of Anesthesiology standard monitors to see their blood pressure, heart rate, and the pulse oximetry, a test used to measure the oxygen level of the blood. We put all those monitors on intravenous lines and a needle or tube inserted into a vein that transfers medicines or fluids are placed. We prepare the child by intubating them in the dental operation; that is, we place a breathing tube that allows that child’s airway to be safe and protected. Then, it’s about careful monitoring the whole time. The pediatric dentist then can come in and do full-mouth dental rehabilitation needed on the child. When the child is done, we wake the child up and, they end up waking up in a separate room, comfortable in a recovery position with the parents back in the room at that point. It works very smoothly for these patients.”
What is your goal for a patient when you’re using general anesthesia on them?
Dr. Smith: “We want families and, above all, patients to have a very positive experience. From the first moment they come into the room, we want to have a positive and uplifting environment. We talk with the patients, and we interact with them. We do all the things that we can to engage a young child’s mind in a world that, for them, can be otherwise quite scary. Clinical environments can be a little bit threatening, especially for some of these children that have had some bad experiences before they’ve seen us. Our goal is to have very safe, very predictable, and very dependable methods of anesthetic delivery, and, at the same time, build as much of a sincere relationship as we can with the family members and with these patients in the short time we have with them.”
What are some ways patients can prepare themselves to go under anesthesia?
Dr. Smith: “Giving strict adherence to the direction that we will give before that day, which means we want to make sure a child’s health is optimized. In preparation for the day, we want to assure that the child hasn’t had anything to eat or drink for safety reasons when a child goes unconscious under anesthesia. We want to make sure that there are no contents in the stomach that can come up and go into the lung or, in other words, aspirate. So, adherence to the preliminary instructions that we give parents, that’s the best way to prepare for that.”
What are some misconceptions regarding general anesthesia?
Dr. Smith: “Some of the misconceptions that people might have or at least questions they might have been ‘why can’t, my child, eat before the procedure,’ and we’ve touched on that a little bit. Other misconceptions or questions people might have are ‘will my child wake up during the procedure?’ The answer to that is no. This is the same kind of anesthesia that they would receive if having appendix surgery or tonsil removal. There’s a misconception about the difference between sedation and anesthesia. When giving a child sedation, they take medicines. Usually, it can be done by an anesthesiologist. Or it can be done by a trained pediatric dentist, a specialist in dentistry for that. If somebody has sedation, that’s like adding a drug to a semi-well-behaved child already. We always like to say that sedation in dentistry doesn’t turn bad behavior into good, and it doesn’t turn an uncooperative child into a cooperative child. It takes the edge off for the child during the appointment. Now, that’s in contrast to anesthesia, where somebody loses all their reflexes. Maybe one of the other misconceptions that parents might have is ‘can I be in the room when this happens?’ It is a different level of treatment. We want to put all of our focus on the safety and the treatment of the child. When we have any other person in the room, besides the personnel directly related to the treatment, it distracts from our goal. Which is giving complete undivided attention to the child, to their safety, to their comfort, and to a successful treatment.”
Have you ever been under general anesthesia? Please share your experiences.
Dr. Smith: “As far as my own experience with the couple of times that I have been under general anesthesia, I’m in the field, so receiving it isn’t quite so scary to me. I know what’s going on a little bit. But, I can understand, also, a lot of anxiety and fear and trepidation with these children or maybe more so with the parents.”
What have been others’ experiences under your type of general anesthesia?
Dr. Smith: “We typically have very positive experiences. It’s not an uncommon scenario to have a tearful parent before the procedure because of anxiety and concern. That’s not a bad thing. When a parent shows emotion, that means they love their child; we would like to see that. There’s some consolation involved, we talk them through things. As the child makes it through the procedure successfully, we’re pleased when we have a very predictable method that has their children … undergo the anesthesia, and wake up safely. We tend to see the same outcome with many of these patients with high levels of anxiety. They’re very thankful, and they’re very relieved. They didn’t realize it was going to be such a positive experience afterward. I think part of that is having the parent in the room while their child is going to sleep and then having them back in the room before the child is awake so they’re there when their child wakes up.”
Is there anything else you’d like to add or share with me about Rodeo Dental’s use for general anesthesia?
Dr. Smith: “Not only is our goal to have safe treatments that are effective for these patients, we want to do this in a way where we maintain a positive environment. Also, the question that might arise is ‘who might be an appropriate patient for anesthesia?’ We provide these services to patients of all ages and backgrounds. We focus primarily on younger children; our training is for them. Occasionally, we have older patients that … need various types of surgery. The question that comes up is ‘can adults have the same procedure done under anesthesia?’ The answer is yes. We review health histories and, … we are in contact with their doctors. If other doctors are involved, we make sure that we’re optimizing a patient’s health and that they are prepared for an out of hospital experience like this.”
For more information about Rodeo Dental & Orthodontics, call (888) 453-4129 or visit rodeodentaltexas.com.