Kalamazoo Pediatric Dentistry
1900 Whites Rd.
Kalamazoo, MI 49008
(269) 343-5386

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Sedation

Children often have carious lesions and need dental restorations for their primary, mixed, or permanent dentitions.  The ability of children to accept and cope with dental procedures varies along a continuum of cooperativeness and depends on a host of prominent factors including age, cognitive and emotional attributes, personality and temperament characteristics, parental, sibling, or peer influences, social skills, degree of pain tolerance, and past experiences in medical, dental, or other settings.
Most children are relatively easy to treat in the dental operatory and respond well to guidance and information given them by the dental team.  Usually, these children are 3 years of age or older and are attentive and compliant with directives of the dental staff in leading them through procedures.  Characteristically, most of these children are comfortable with or without the presence of a parent and do not display stressful or anxiety related posturing and facial expressions or emote crying, whimpering, or responses that delay treatment.
A minority of children are not cooperative.  They may have normal cognitive functioning, but have poor coping skills for handling the situational anxieties and fears associated with dentistry.  Others may have emotional, physical, or cognitive problems that with attending poor coping skills cause them to respond in disruptive, uncontrolled hysterical ways.
The children who fall into this minority will require more assertive behavioral management techniques such as immobilization or pharmacological management (i.e., monitored anesthesia or general anesthesia). The choice of technique considered most appropriate for managing an uncooperative child will be dependent on interactions among and salient beliefs and values held by the parent, dental professional, and to some degree the child.  Ideally, the match among the three constituents in this setting is favorable; however and on occasion, a mismatch occurs and the outcome of the procedure is placed in jeopardy from the perspective of at least one of the participants.  Needless to say, it is a complex, multidimensional, and interactive process. 

Nitrous Oxide

Nitrous oxide, more commonly known as “laughing gas,” is often used as a conscious sedative during your child's dental visit. Nitrous oxide inhalation is a safe and effective technique to reduce anxiety and enhance effective communication.  Its onset is rapid, the effects easily are titrated and reversible, and recovery is rapid and complete.  Additionally, nitrous oxide mediates a variable degree of analgesia, amnesia, and gag reflex reduction.  The patient will place the hood "scooby doo nose" over their nose.  The patient will get a choice of flavor to smell during the visit.   The gas is administered with a mixture of oxygen. Because it is a mild sedative, patients are still conscious and can talk to their dentist during their visit. After treatment, the nitrous is turned off and oxygen is administered for approximately 5minutes to help flush any remaining gas.  Most patients tolerate this very well and it is very helpful when local anesthesia or extractions are necessary.

Office-Based Anesthesia

Due to the growing needs of our practice and the increased requests of our patients, we offer office-based anesthesia. Office-based anesthesia is provided in an office setting.  It is a safe and convenient alternative to hospitals and ambulatory surgical centers (ASCs).    We coordinate our services with a mobile anesthesia company who provide highly trained, credentialed staff including a registered nurse for post-anesthesia care.

There are many reasons why more and more parents are choosing the office setting: access to care, lower costs to the family, efficiency, confidentiality, and increased comfort with their surroundings.

Due to improvements in drugs, technology, anesthesia techniques, and provider education, anesthesia care is safer than it has ever been. In fact, the Institute of Medicine reported in 1999 that anesthesia is nearly 50 times safer today than it was in the early 1980s.

The same standard of anesthesia care for hospitals and ASCs also applies to our office, regardless of whether the anesthesia professional is a CRNA or an anesthesiologist.  The mobile anesthesia company adheres to the same guidelines and standards set forth by the American Association of Nurse Anesthetists and the American Society of Anesthesiologists. 

General Anesthesia

Dr. Basler and Dr. van Hofwegen take children to Bronson Methodist Hospital for outpatient dental surgery if necessary.  General anesthesia is a controlled state of unconsciousness accompanied by a loss of protective reflexes, including the ability to maintain an airway independently and respond purposefully to physical stimulation or verbal command.  The use of general anesthesia sometimes is necessary to provide quality dental care for the child.  The age, behavior and amount of treatment to be completed is taken into consideration. 

The goals of general anesthesia are to:

  • provide safe, efficient, and effective dental care
  • eliminate anxiety
  • reduce untoward movement and reaction to dental treatment
  • aid in treatment of the mentally, physically, or medically compromised patient
  • eliminate the patient's pain response
  • completing all procedures in one visit

Pre-Operative instructions for office-based anesthesia

  1. Arrive to our office 15 minutes before your scheduled appointment. 
  2. MOST IMPORTANT!!!  DO NOT GIVE YOUR CHILD ANYTHING TO EAT OR DRINK AFTER MIDNIGHT.  The anesthesia group will call you to give you more detailed pre-operative instructions prior to your child's appointment.
  3. Be honest with your child if they ask you questions about the dental appointment.  If you do not know the answers to their questions, simply say, “I do not know”...”we will ask the dentist”.

Do not say anything that will scare your child such as “the dentist is going to give you a shot.” You may have good intentions of preparing your child, but the effect may backfire”  It is best to let us talk with your child during the visit.  We will tell them everything that will occur, but use language best suited for your child's age and understanding.  For example we refer to the shot as “sleepy juice.”

  1. We recommend that you bring another adult with you to the appointment.  We feel it is important for you to take care of your child when he/she is in the child's car seat and the other adult can concentrate on safely driving you home.
  2. Please feel free to let your child bring a favorite blanket or stuffed animal to the appointment if he or she is strongly attached to it.
  3. Dress your child in comfortable clothing, preferably a T-shirt or sweatshirt and pants. 
  4. If your child develops a cold, fever, congestion or the flu for a week or within 24 hours of the scheduled appointment, please call the office.  We will make a decision after talking to you whether to postpone and reschedule the appointment or refer you to your child's physician.
  5. If your child's health changes, such as being diagnosed with a condition, problem, or disease within a week of the appointment, please call the office.  Also call us immediately if your child has had an injury to his/her head causing loss of consciousness, vomiting, or dizziness.
  6. Please let us know if your child has taken any over-the counter medications within the last 24 hours.  This is very important to us and to your child's safety.
  7. Make sure your child uses the bathroom before the appointment.
  8. If you have any further questions, do not hesitate to call us at the office.  We are here to help you and your child.  Thank you!
Our emergency numbers are office:  269-343-5386  Dr. Ryan Basler's cell 616-292-2333   Dr. van Hoffwegen's cell 505-503-0829

 

Post-Operative Instructions for Office-Based Anesthesia

Nausea & Vomiting:  Any nausea and/or vomiting that may occur will last a short time. If your child does vomit, wait about 30 minutes before giving them liquids such as water or carbonated soft drinks. If nausea does not occur, progress slowly to a regular diet.

Diet: For the first 24 hours, soft foods and plenty of fluids are recommended.  Your child will tell you when they feel up to more of a solid diet.  Please refrain from any STICKY and/or CHEWY foods and candies, as they may pull off the caps your child received (taffy, tootsie rolls, starburst, etc.).

Bleeding & Pain: Children will respond to pain or discomfort differently, therefore their mouth may or may not feel sore after surgery. Pain may last up to 2 weeks after surgery.  This is normal. Their gums may be sensitive from the caps or fillings that have been placed, and a little bleeding is normal after dental surgery. If your child’s mouth starts bleeding excessively, and cannot be stopped with the use of pressure, please call Dr. Basler or Dr. Nathan van Hofwegen.

Fever: After any surgical procedure, a low-grade fever (99-100 F) is normal.  You may give your child Children’s Tylenol or Motrin*. If the fever continues over 101.5 F for 24 hours please call Dr. Basler, or your child’s pediatrician.

Extractions: If teeth were extracted there may be some discomfort and bleeding. You may give your child Children’s Tylenol or Motrin* to help make them more comfortable.  If your child’s mouth starts bleeding excessively, and cannot be stopped with the use of pressure, please call Dr. Basler or Dr. Nathan van Hofwegen.

The numbness should last about 2 - 3 hours. Do not chew, rub, scratch or play with the numb lip, tongue or cheek. Your child should be watched closely until the numb feeling wears off. Remind your child to keep his/her teeth still to prevent injury to the numb areas.

Bleeding is expected but will be well controlled before leaving the office. If sustained bleeding occurs, your child should bite firmly on gauze for 15 minute intervals.

Maintain a soft diet for the remainder of the day.  Please avoid carbonated drinks and straws for the remainder of the day.  Sports activity is usually restricted for the remainder of the day.

Activity: Your child may feel sleepy for the next few hours due to the medication they have received. Please do not leave the child alone, and have them refrain from strenuous activities for the next 24 hours. Regular activity is encouraged the day after surgery.

Post-Operative: After the surgery your child will need to come back to see the dentist in three months for an exam.  If your child requires a spacer cemented in, you will need to schedule an appointment three weeks after the surgery.  Please call our office, following your child’s surgery, to schedule a follow up visit. If you have any further questions or concerns please call Dr. Basler's office at (269) 343-5386.

*Note: With all medications, follow manufacturer’s instructions for administering drugs, found on the package. Aspirin is contraindicated for children.

In case of emergency call 911.  Also call us immediately at the following numbers:  office:  269-343-5386, Dr. Ryan Basler's cell 616-292-2333, Dr. van Hoffwegen's cell 505-503-0829.

Click on the following link for more information:  AAPD Patient Management Guidelines

Post-Operative Instructions for Anesthesia (at hospital)

Nausea and Vomiting: Any nausea and/or vomiting that may occur will last a short time.  If your child does vomit, wait about 30 minutes before giving them liquids such as water or carbonated soft drinks.  If nausea does not occur, progress slowly to a regular diet.  They may also have a sore throat for 24-48 hours from the gases and gauze used in surgery.

Diet: For the first 24 hours, soft foods and plenty of fluids are recommended.  Your child will tell you when they feel up to more of a solid diet.  Please refrain from any STICKY and/or CHEWY foods and candies, as they may pull off the caps your child received (taffy, tootsie rolls, starburst, etc.)

Bleeding and Pain: Children will respond to pain or discomfort differently, therefore their mouth may or may not feel sore after surgery.  Pain may last up to 2 weeks after surgery.  This is not unusual.  Their gums may be sensitive and bleed along the gum line where the caps or fillings have been placed.  If teeth were extracted there may be some discomfort and bleeding.  You may give your child Children's Tylenol or Motrin * to help make them more comfortable.  If your child's mouth starts bleeding excessively and cannot be stopped with the use of pressure, please call Dr. Basler or Dr. van Hofwegen.

Fever: After any surgical procedure, a low-grade fever (99-100 F) is normal.  You may give your child Children's Tylenol or Motrin *.  If the fever continues over 101.5 F for 24 hours, please call our office or your child's pediatrician.

Activity: Your child may feel sleepy for the next 24 hours due to the medication they have received.  Please do not leave your child alone.  Have them refrain from strenuous activities for the next 24 hours.  Regular activity is encouraged after 24 hours.

Post-Operative: After the surgery your child will need to come back to see Dr. Basler or Dr. van Hofwegen in three months.  This appointment has already been scheduled for you.  If your child requires a space maintainer, the dentist will inform you of this and you will need to call our office to set up an appointment in three weeks.

In case of emergency call 911.  Also call us immediately at the following numbers:  office:  269-343-5386, Dr. Ryan Basler's cell 616-292-2333, Dr. van Hoffwegen's cell 505-503-0829.

* Note: With all medications, follow manufacturer's instructions for administering drugs, found on the package.  (Aspirin is not usually prescribed for children.)

Behavior management

Behavior guidance is based on scientific principles.  The proper implementation of behavior guidance requires an understanding of these principles.  Behavior guidance, however, is more than pure science and requires skills in communication, empathy, coaching, and listening.  As such, behavior guidance is a clinical are form and a skill built on a foundation of science.  The goals of behavior guidance are to establish communication, alleviate fear and anxiety, deliver quality dental care, build a trusting relationship between dentist and child, and promote the child's positive attitude toward oral/dental health and oral health care.

Tell-Show-Do

Tell-show-do is a technique behavior shaping used by many pediatric professionals.  The technique involves verbal explanations of procedures in phrases appropriate to the developmental level of the patient (tell); demonstrations for the patient of the visual, auditory, olfactory, and tactile aspects of the procedure in a carefully defined, non-threatening setting (show); and then, without deviating from the explanation and demonstration, completion of the procedure (do).  The tell-show-do technique is used with communication skills (verbal and nonverbal) and positive reinforcement.

Voice Control

Voice control is a controlled alteration of voice volume, tone, or pace to influence and direct the patient's behavior

Positive Reinforcement

In the process of establishing desirable patient behavior, it is essential to give appropriate feedback.  Positive reinforcement is an effective technique to reward desired behaviors and, thus, strengthen the recurrence of those behaviors.  Social reinforces include positive voice modulation, facial expression, verbal praise, and appropriate physical demonstrations of affection by all members of the dental team.  Nonsocial reinforces include toys and stickers.

Parental Presence/Absence

The presence or absence of the parent sometimes can be used to gain cooperation for treatment.  A wide diversity exists in practitioner philosophy and parental attitude regarding parents' presence or absence during pediatric dental treatment.  Dr. Basler does allow parents in the operation room for non-sedated patients.  He does discuss situations with parents prior to treatment, discussing that sometimes the child's behavior will be better without the parent in the operation room.