Sheila Banerjee vividly remembers the time her four-year-old, Jai, needed general anaesthesia for two fillings. “We had the appointment scheduled and Jai ate one leaf of spinach from our backyard that morning,” recalls the Toronto-based mom. After a lengthy drive to the dentist’s office, they were sent home and the procedure was postponed: The anaesthesiologist had decided that because Jai had eaten in the eight hours prior (which is known to be associated with a risk of vomiting and choking during anaesthesia) the procedure would have to be rescheduled.
Thankfully, the procedure happened two weeks later, and everything went smoothly. “Overall, it was a positive experience,” says Banerjee.
The real reason why cavities form Using general anaesthesia to treat dental issues in kids is common in Canada, and Jai’s procedure was just one of the 19,000 day surgeries involving anaesthesia performed on children under six to fill cavities, do root canals and extract teeth every year. Dentists use anaesthesia in situations where kids require a lot of dental work and the doctors don’t want to traumatize them with hours of drilling in the dental chair. Brett Saltzman, Toronto-based paediatric dentist at Forest Hill Children’s Dentistry, says these are low-risk, in-office procedures, but, as Jai’s cancelled appointment demonstrates, they aren’t without risks. That means that parents need to be informed and weigh their options carefully when dental anaesthesia is recommended for their child.
Why use sedation during kids’ dental procedures?
Often, general dental anaesthesia is used in cases when a child has numerous teeth with decay, says Diya Chadha, a paediatric dentist at Smile Town Dentistry in Burnaby, BC, who adds that it isn’t unusual to see eight to 10 teeth with cavities. Other times, it’s decay that has progressed to the nerve of the tooth—requiring a baby root canal—in which the nerve is removed, the hole is filled and a crown is placed on the tooth.
For kids with special needs, such as ADHD or autism, general anaesthesia or sedation can also make a procedure that would be very frightening more manageable, says Chadha. “You want to build on that positive experience, ensuring the child doesn’t associate the dentist with pain and anxiety,” she says. “And it allows the provider to do better dentistry.”
What are the risks of dental anaesthesia?
While general anaesthesia is considered safe, there still is risk involved. In Canada, the chance of a healthy person dying as a result of anaesthesia is between one in 200,000 and one in 400,000, according to the Canadian Anesthesiologists’ Society. Pre-existing medical conditions, such as asthma or diabetes, can raise the risk of complications, and in rare cases, patients may have allergic reactions to the drugs. Side effects of anaesthesia include nausea, vomiting and dizziness.
These risks have been highlighted by a few well-publicized cases. In 2016, a four-year-old Edmonton girl, Amber Athwal, suffered brain damage after she went into cardiac arrest while under general anaesthesia following a procedure to remove a tooth. Athwal had eaten breakfast that morning—something her father says he disclosed to the dentist—which may have played a part.
New standards have been put in place and dentists in Alberta can no longer both administer anaesthesia and perform a dental procedure on a patient. But the rules for dentists vary across provinces. In Ontario, for example, a dentist must have at least two trained assistants when administering anaesthesia.
While a situation like Athwal’s is rare, parents should still be vigilant. To ensure your child is a good candidate for general anaesthesia, make sure you report any health issues to your paediatric dentist. Jasdev Bhalla, a board-certified specialist in dental anaesthesiology who works at MM Family and Sleep Dentistry in Hamilton, Ont., says a child’s suitability for the procedure has to be assessed very carefully. Asthma, heart issues and sleep apnea could all affect sedation.
Tell your child’s dentist if your child has had adverse reactions to sedation in the past. You can also ask whether laughing gas or conscious sedation—which relaxes the patient but keeps them conscious—could work as an alternative, in addition to local freezing.
Once your child is deemed a good candidate for general sedation, you should ensure that the person administering general anaesthesic is a licensed dental anaesthesiologist or a dentist who has received authorization from their province’s dental authority to administer general anaesthesic. (Different provinces have different rules around this so check this on your province’s dental college website.) To receive this certification, a dentist has to complete emergency resuscitation and CPR courses, as well as specific anaesthesia training. The dental facility also has to have a permit from the college allowing anaesthesia to take place, and must have a certificate indicating it has been inspected by the college. You can ask your dentist to see these documents.
“You’re trusting someone to look after your child when they’re sedated,” says Bhalla. “It’s a good idea to determine how many procedures they have performed.”
How to prepare your child for dental anaesthesia
Before a child goes under, a paediatric dentist or anaesthesiologist is legally obligated to present all the details of the procedure, as well as the reasons for the general anaesthesia, says Saltzman. This is called informed consent, and the parent or caregiver must sign off before any anaesthesia can be performed.
In Banerjee’s case, she and Jai had a lengthy consultation with the dentist. “We were advised that, because of Jai’s age, doing the dental work without general anaesthesia would not be feasible,” says Banerjee. “It would be too scary.” But a child’s temperament should also play a role in the decision.
Bhalla suggests parents learn as much as possible about who will be doing their child’s sedation, where it will be happening and what emergency procedures are in place. Because many times parents will meet the anaesthiosiologist for the first time minutes before a procedure, he says parents should call the dentist/dental anaesthesiologist in advance of any surgery to find out the steps he or she will be taking to ensure the safety of the procedure. Will a monitor be attached to the child after the sedation to monitor vital signs? Will an assistant be in the recovery room with the child at all times? Is there a defibrillator—a device used to restart the heart during cardiac arrest—on site? And is there a wall and/or portable suction and supplementary oxygen in recovery? In Amber Athwal’s case, her monitor was turned off and failed to alert the dentist and his assistants that she was in cardiac arrest and deprived of oxygen. The assistant on duty also left the recovery room, and the staff had not received adequate resuscitation training.
Once you’ve signed off, find out what instructions you need to follow before your child’s procedure. Fasting for eight hours before a procedure is key to preventing vomiting and food from being inhaled into the lungs, leading to choking.
And prep for post-op cuddles. Many kids can wake up confused or upset after anaesthesia—which isn’t unusual. They may take a few hours to return to normal. Banerjee says that, after waking up from the dental anaesthesia, Jai was groggy and teary. Luckily, the episode was short-lived and lasted only 20 minutes, she says.
Ultimately, if your provider is well-trained, and equipped for emergencies—and you follow their directions carefully—all should go well. “Most parents say, ‘We are so glad we did that,’” says Chadha.
Banerjee is glad she chose anaesthesia for Jai. “After I did the research,” she says, “it didn’t seem alarming.”