Frequently Asked Questions

• If your child has any COUGH OR COLD SYMPTOMS now, or in the last couple weeks it is CRITICAL that you contact Dr. Seiden as this may affect your child’s safety for anesthesia in the dental office tomorrow.
  

• ***MOST IMPORTANT*** It is critical that your child **DOES NOT EAT** past the following times. They can have regular food until 9 hours before their arrival time and clear liquids until 3 hours before their arrival time. Clear liquids are ONLY water, apple juice, Gatorade, and Pedialyte. If you have another clear liquid you want your child to have, please check with first as drinking the wrong liquids may cause DELAY OR CANCELLATION . Things that are **NOT** clear liquids and that they **CAN NOT HAVE** are orange juice, milk or any dairy products, broths, or any other liquids. If you child eats or drinks at the wrong time, the procedure may be cancelled.
  

• If possible, do NOT take your child to school or daycare on the day of the procedure because they very often get food or snacks at school and daycare.
  

• Your child will receive a general anesthetic. They will typically go to sleep with an anesthesia mask, and shots can usually be avoided. After they go to sleep with a mask, an IV will be placed, followed by a breathing tube. General anesthesia is very safe, but there are risks. These are things such as allergic reactions, changes in heart rate, blood pressure, injury to lips, gums or teeth, and problems with breathing. More serious things are very uncommon. Common side effects from anesthesia include nausea, sore throat, nose bleeds, and waking up irritable.
  

• It is common for children to have an accident under anesthesia, so if they are recently out of diapers, a pull-up is helpful. Otherwise please bring a change of clothes just in case.
  

• Please BRING A BLANKET of your choosing to keep them snuggly warm during the procedure and any special lovey stuffed animals, etc that are a comfort to them!
  

• Sometimes the breathing tube is placed in the nose to give the dentist space to work in the mouth. A breathing tube placed in the nose has the risk of a nose bleed occurring, typically when the breathing tube is placed or removed. It is possible, but uncommon, for your child to have a nose bleed at home. If there is dripping blood that does not stop with direct pressure to the nose and tilting the head back, you should call 911 or go to an emergency room. This is very uncommon. However, it is common when your child sneezes or blows their nose to see small bloody boogers (clots). This is not a concern.

Patients having office based procedures need to be generally quite healthy. Ideally patients would have NO MEDICAL PROBLEMS, or only MILD medical problems that are very well controlled. Patients with any serious medical problems or medical problems not well controlled are not usually safe for office based anesthesia.

Some examples of medical conditions that are not good candidates for office anesthesia

• Poorly controlled asthma

• Cold symptoms (see above)

• Significant sleep apnea or snoring (s

• General anesthesia

General anesthesia means that you are completely unconscious and will not respond to painful stimulation. Many times you will have difficulty protecting your airway from secretions like your own saliva. Often times a breathing tube may be placed to help protect your airway or assist in breathing.

• Sedation

○Sedation exists on a continuum and ranges from mild, moderate to deep sedation. For some procedures, especially in teenagers or adults, sedation may be an appropriate options compared to general anesthesia. Generally sedation involves less medications and can result in a speedier recovery.

○Sedation in children

Young children are often not good candidates for sedation because they tend to get disinhibited (wiggly and move a lot) by being in a state that they don't understand. Teens and adults can have sedation, and as long as they are not feeling any pain (because of things like local anesthesia) they can usually hold still and be calm. In a young child in the same situation they often will panic and not hold still, and this is not safe.

It is very common for children to be nervous or anxious about going under anesthesia and having procedures. There are a variety of techniques that can be helpful to reduce anxiety.

• No shots! In most patients, the start of anesthesia can be accomplished without any shots or needles by using an anesthesia mask. This is called an inhalational induction of anesthesia.

• Tablet distraction. Dr. Seiden has pioneered the use of using tablets (iPad) video games as a distraction technique while going to sleep with anesthesia. His research demonstrated that the iPad is often times as effective or more effective than sedating medications.

• Medications. A variety of medications can be used to reduce anxiety. These can be administered as a liquid, injection (shot), or nose spray. If your child can hold still to have an IV placed, then medications can also be administered through the IV to reduce anxiety.

Nausea is one of the more common risk factors from anesthesia and sedation. Patients receive anti-nausea medication during their procedure, but it is still possible to have nausea even with this medication.

○ Patients having office based procedures need to be generally quite healthy. Ideally patients would have NO MEDICAL PROBLEMS, or only MILD medical problems that are very well controlled. Patients with any serious medical problems or medical problems not well controlled are not usually safe for office based anesthesia.

○ Some examples of medical conditions that are not good candidates for office anesthesia

• Poorly controlled asthma

• Cold symptoms (see above)

• Significantly overweight (a body mass index above 30) LINK BMI CALCULATOR https://www.cdc.gov/healthyweight/bmi/calculator.html

• Sleep apnea or snoring

○ Snoring can suggest sleep apnea which can cause airway obstruction during anesthesia and when recovering from anesthesia

We are still learning about the effects of anesthesia on the developing brain of young children (children under 3). Current recommendations are to avoid general anesthesia in children under 3 unless the risk of not having the procedure is also significant. Current evidence has demonstrated that for short procedures (less than 1 hour) there is not a detectable difference in neurodevelopment between children who have had anesthesia and those who have not. Visit SmartTots for more information.

An IV is necessary to be able to deliver medications as part of general anesthesia and sedation as well as any emergency drugs that might be needed. The IV will be in place after the procedure, but will be removed once the patient is awake and safe. It does not hurt to have an IV removed more than having a band-aid taken off. For young children and those scared of needles, the IV can usually be placed once under anesthesia. This is done by going to sleep with an anesthesia mask.

For many procedures with general anesthesia a breathing tube is necessary. A breathing tube helps prevent anything inappropriate from entering the lungs during the procedure. A breathing tube also allows a way to deliver anesthesia gases that keep you asleep. When possible, a breathing tube is placed in the nose because then the dentist has more space to work in the mouth.

For dental procedures, a nasally placed breathing tube allows the dentist to work in the mouth without the breathing tube getting in the way of your mouth opening and closing. This gives the dentist more space to work.

Yes. When a nasal breathing tube is placed it is very common to have some nose bleeding. Usually this just happens when the tube is placed. It however can also happen when the tube is removed. When you go home you may notice some small amounts of blood from the nose, especially if sneezing or blowing your nose (bloody boogers). This is ok. But if you see fresh dripping blood that does not stop with pressure to the nose you should seek medical attention at the nearest emergency room or all 911.

Yes. In many circumstances, especially with young children, anesthesia can be started by breathing anesthesia gas through a mask. This is called a "mask induction of anesthesia." Dr. Seiden will review with you if this is an appropriate technique and other options to make the start of anesthesia as calm as possible.

○Clear liquids: 2 hours before scheduled arrival time

• Clear liquids are, for example, water, apple juice, Gatorade, Pedialyte, black coffee.

• Clear liquids are NOT: orange juice, milk, anything with dairy, any kind of broths or soups.

○ Breast milk: 4 hours before schedule arrival time

○ Formula: 6 hours before schedule arrival time

○ Solid foods: 8 hours before scheduled arrival time

When receiving anesthesia or sedation, the stomach must be empty. There is a risk of vomiting during anesthesia, and if there are food or liquids in the stomach there is a risk those contents could end up in the lungs. This is called an aspiration and can result in a life threatening pneumonia. Unless it is an emergency procedure, these fasting times are required for safety. If not followed your procedure may be postponed or cancelled

○ It is not ideal to have a cough or cold symptoms before anesthesia, and often times if you have such symptoms your procedure may be postponed until you are healthy.

○ Cold symptoms that are concerning include:

• Fever above 101 degrees

• Wet sounding cough or cough where you cough stuff up (also known as a productive cough)

• Wheezing like asthma patients have

• Runny nose with thick or greenish color

• Currently testing positive for COVID-19

General anesthesia is very safe, but there are risks with any medical procedure. Common side effects from anesthesia include nausea and vomiting, sore throat, and waking up irritable. Other possible reactions include allergic reactions, changes in heart rate, blood pressure, or problems with breathing. More serious reactions are very uncommon. While exceedingly uncommon, it is possible to have more serious reactions from anesthesia that could result in death, stroke, heart attack, or other injury.