Anaesthetic for Child’s Dental Treatment

This information is aimed at parents who have decided their child is to have a general anaesthetic for their dental treatment.

This includes information on what an anaesthetic is, what other options are available (the dentist will have discussed the relevant options with you at the assessment appointment), the risks of general anaesthetics and what you should expect on the day of your child’s appointment.

There are important instructions that you should follow.

Anaesthesia

To have a tooth extracted or a filling you need an anaesthetic. Anaesthetics stop you feeling pain and other sensations.

There are different types of anaesthetics:

Local anaesthesia; involves numbing a localised part of the mouth, usually one tooth.
General anaesthetic; gives a state of controlled unconsciousness. Your child will be unconscious and feel nothing. Local anaesthesia is often used while the patient is unconscious to reduce pain when they recover.

Sedation with local anaesthesia

Your child will usually have the option of remaining awake and getting drugs to help them relax. There are two common options either breathing in a gas through a nose mask or administering through cannula or needle in their hand. Your dentist will discuss the options available to your child to help you decide how you would like your child to have their dental treatment. If you would like to discuss this further, please contact the dentist before your child’s appointment.

Anaesthetists are doctors with special training who:

Are responsible for giving your child their general anaesthetic, and for your child’s wellbeing and safety throughout their surgery.
Make your child experience as pleasant and pain free as possible.
Agree a treatment plan with you for your childs anaesthetic and pain control.
Discuss the risks of anaesthetics with you. Anaesthesia always carries a degree of risk with it. Please read the section on risks.

You will usually have an opportunity to speak to your child’s anaesthetist before their surgery; this will be your opportunity to discuss any issues so the anaesthetic can be tailored to any special needs.

General anaesthetics

There are two ways of starting a general anaesthetic. Anaesthetic drugs may be injected into a vein through a cannula or needle or your child can breathe anaesthetic gases and oxygen through a mask. Once your child is unconscious, an anaesthetist stays with your child at all times and continues to give them drugs to keep them anaesthetised. As soon as your child’s dental treatment is complete, the drugs will be stopped or reversed so that your child will regain consciousness.

Side effects of general anaesthetics

Most children recover quickly and are soon back to normal after their operation and anaesthetic. Some children may feel sick or have a sore throat for a short time. Medicines to treat sickness are available and often given. For a child in good health having minor surgery such as dental treatment:

1 child in 10 experiences a headache or a sore throat
1 child in 10 experiences sickness or dizziness
1 child in 5 becomes agitated on waking
Around 1 child in 10,000 develop a serious allergic reaction to the anaesthetic
The risk of death from anaesthesia for healthy children having minor or moderate non-emergency surgery is less than 1 in 100,000

Risks and complications

The likelihood of a serious risk or complication is higher if your child has a serious illness, or is under the age of one and having a major operation. The anaesthetist can discuss this with you in detail before the operation. Risk cannot be removed completely. Modern equipment, training and drugs have made having an anaesthetic much safer.

Preparing your child for their anaesthetic

We suggest that you explain to your child in simple terms what is going to happen. Keeping children in the dark is usually unhelpful.

Children must not eat after midnight before their appointment, so encourage them to have a supper before bed.

You should encourage your child to have half a glass (100ml) of water before 07.00 on the morning of their appointment, but ensure they have nothing to drink after this.

These fasting guidelines are intended to reduce the risk of your child being sick and choking during the anaesthetic and should therefore be strictly adhered to.

Children must be accompanied by a parent or legal guardian as they will be required to give consent for the anaesthetic and dental treatment.

No other children should be brought to the appointment.

It can be helpful to have a second adult attend the appointment to provide transport. Where this is not possible you must ensure you have arranged suitable transport for going home i.e. taxi.

Public transport is not acceptable after an anaesthetic.

Please dress you child in comfortable, loose fitting clothes. Please also bring a spare set of clothes, as there is usually bleeding after dental extractions and occasionally children may do the toilet while they are unconscious.

Please tell us if your child is unwell or has had vaccinations in the last two weeks, it may be best to postpone the treatment. Your child’s mouth is likely to be sore after their treatment, so ensure you have painkillers e.g. Liquid paracetamol or ibuprofen (if suitable) available at home for them.

At the hospital

Your child will be asked to attend the Paediatric Assessment Unit in the Women and Children’s Unit. You will be there for most of the morning so you may wish to bring something small or handheld to keep your child amused. Your child will be checked by one of the paediatric nurses. They will ask you medical questions about your child and they may also

Take their weight.
Take their blood pressure.
Measure their blood oxygen with a peg on their finger.
Place numbing cream on the backs of both hands.
Give them a painkiller such as paracetamol liquid.

The anaesthetist will visit you on the ward to discuss your child’s anaesthetic. The dentist will also speak to you about the dental treatment that is planned for your child.

A member of the dental team will bring your child from the ward to theatre where the treatment will be carried out; either you or another adult can accompany them. Your child will be encouraged to lie on a bed before being given the anaesthetic but very small children can sometimes sit on their parent’s knee.

Depending on how the anaesthetic is started, your child will either be given a mask to breathe into or have a cannula placed in their hand. Children will often wriggle as they become anaesthetised without realising it. We allow parents and staff to hold children’s hands to prevent movement that would be unsafe. You will then be taken to the theatre waiting room or back to the ward while the dental treatment is carried out.

Signed consent does not guarantee treatment when a child refuses to cooperate. We will try and encourage your child, but we will ask you to decide how you wish to proceed. The views of older children will usually be taken into account. Ensuring your child is prepared for their appointment will reduce the chances of them refusing to cooperate.

After the anaesthetic

Once the dental treatment is complete the anaesthetic drugs are stopped or reversed so your child can regain consciousness. They will be taken to the recovery room and the recovery staff will collect you when they start to wake up.

Children are often upset when they wake from the anaesthetic. Your child is likely to feel dizzy and their mouth may be numb if local anaesthetic was used. Tooth sockets usually bleed after extractions and your child will be encouraged to gently spit. Putting their tongue or fingers into the sockets causes more bleeding so this should be discouraged.

Once the recovery staff are happy your child has recovered from the anaesthetic, you will both be taken back to the ward. There the paediatric nurses will allow your child to rest and then carry out checks before allowing them to go home. Occasionally, children will need to stay in longer to be monitored before they can return home. Unfortunately, teeth that are extracted cannot be returned to you.

Your child will be given a tooth fairy envelope to take home.

Aftercare

You should leave the hospital by private car or taxi, public transport is not acceptable. You should have a second adult, allowing one person to drive while the other watches your child. Your child must be supervised for the rest of the day. Your child’s mouth may be sore after treatment so ensure you have painkillers available at home, both paracetamol and ibuprofen (if appropriate).

Most children who return home the same day are able to attend school the next day but you should let the school know they have had an anaesthetic. You may decide to keep them off another day depending on their recovery.

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