A new advanced system of dental treatment for children - sedation - has become available at the Marina Kurchaninova Smile Dentistry Center. A system that has long been used by specialists from Europe and the USA.
The discoverer of nitrous oxide was the English scientist Joseph Priestley, who first synthesized this substance in 1772. However, the pain-relieving properties of nitrous oxide were discovered by another researcher, Humphry Davy. He also gave the name to the new substance – “laughing gas”. This name is completely true - when inhaling this gas, a person falls into a slight euphoria, a very pleasant state. In addition, his pain sensations (if any) disappear, as well as the ability to experience them for some time.
ZAKS began to be used in dental practice in 1948, and to date, about 80% of cases of treatment of children cannot be done without the use of this drug.
Basically, all pediatric dentistry technologies that are now widespread in Russia are aimed not at treatment, but at healing teeth. The current situation is quite understandable - this is all that can be done during the time until the child agrees to open his mouth.
Now dentists have a tool that helps them provide full treatment to young patients - sedation.
What is sedation, in short?
Sedation is a superficial sleep in which the patient can be awakened at any time. This method is aimed at calming the patient so that the specialist can carry out all the necessary dental procedures. Sedation is an excellent addition to traditional anesthesia and is carried out using special sedatives.
Each physician may have individual sedative preferences. However, throughout the world, the greatest respect has been earned by such a drug as nitrous oxide - oxygen sedation (NAS). It is a mixture of inert gas and oxygen, which has an indistinct sweetish odor. The use of the mixture ensures the most harmless and safe sedation.
The sedation procedure is simple: the patient puts on a mask and inhales ZAC. After which he has a feeling of calm and relaxation. Nitrous oxide is supplied using special equipment. Exhaled gases are immediately collected by high-speed suction.
The resulting state is reminiscent of the sensations that we experience on a summer day after rain, when an increased nitrogen content appears in the air. We experience a feeling of joy, pleasure and pleasant relaxation.
The effect of laughing gas is short-lived. Within just a few minutes it is completely cleared from the lungs. Laughing gas is completely safe - when taken, heart rate and blood pressure remain normal, and there is no addiction to it.
Treatment of children after sedation is quick, effective and, importantly, leaves pleasant memories for the children. The child is in a state of light anesthesia, but at the same time he is conscious and able to communicate normally with the doctor. The use of nitrous oxide greatly facilitates the process of dental treatment for both participants in the process - both the doctor and his little patient. In addition, children develop a positive attitude towards visiting the dentist, and this also makes life easier for their parents.
Children willingly put on bright masks and inhale the sweet aroma. Their use makes the procedure even more enjoyable for the child.
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Many children are afraid to have their teeth treated. And besides, sometimes you have to treat several teeth at once. The process may not be quick and it will be physically difficult for the child to sit quietly in a chair for more than 15 minutes. Therefore, treatment under sedation is ideal for children. The latest equipment and the professionalism of our doctors - pediatric dentist Tatyana Vladimirovna Ermakova and anesthesiologist Oleg Stanislavovich Markov - allow us to perform all the necessary procedures quickly and without pain, as well as provide the psychological comfort that is so necessary for young patients.
Benefits of using sedation in children
Therefore, we can say with confidence that the use of sedation has undeniable advantages. Among the advantages of the method are the following:
- The use of ZAX (nitrous oxide - oxygen sedation) makes dental treatment painless;
- The child does not experience psychological discomfort in the doctor’s office: in a state of sedative anesthesia, he does not smell unpleasant odors, does not hear the frightening sound of a drill, and does not distinguish between medical instruments;
- The use of ZAX removes tactile sensitivity, so the baby will not be frightened by vibrations, pressure, compression, etc., made by the doctor;
- The doctor is able to provide full treatment, because his access to the patient is no longer hampered. Now the dentist has enough time to apply the most effective modern treatment methods. He can also use any preparations, even those that harden for a long time;
- The risk of complications after dental treatment is reduced.
The use of sedation has ushered in a new era in pediatric dentistry. After all, doctors now have the opportunity to use modern composite materials for treatment. And they are more durable, hygienic and aesthetically pleasing compared to those previously used. Until recently, composite materials were not used for the reason that their placement requires careful drying of the tooth. The doctor must also wait a long time for the material and fixing glue to harden. Now he has the necessary time reserve.
Coming out of a sedative state
At the end of treatment, the anesthesiologist turns off the nitrous oxide supply and increases the oxygen supply through the mask, which ensures faster removal of nitrous oxide from the patient's lungs. 5 minutes after the end of the treatment procedures, not even a trace of the sedative remains in the child’s body. Local anesthesia wears off after 1.5-2 hours. The child does not experience any consequences (such as dizziness or nausea, familiar to many from the effects of surgical anesthesia) after sedation. In rare cases, after sedation, a child may remain in an unusually calm state until the end of the day.
How to prepare for the sedation procedure?
It is necessary to strictly adhere to the recommendations given by the doctor, namely:
Before performing drug sedation, it is necessary to do a general blood test, coagulogram, ECG, biochemical blood test, tests for HIV, HCV, HbsAg, Rw. These studies are required for the safety of the patient himself. General preparation for the procedure is usually carried out directly in the dental clinic itself. Patients are advised to refrain from eating and drinking 4 hours before the procedure.
The doctor should be aware of whether the child has respiratory problems, in particular whether he has difficulty breathing through his nose. In the case of such diseases, the sedation procedure loses its effectiveness to some extent. Be sure to tell the dentist what medications your child took on the day of the clinic visit.
Sedation scheme
The patient puts on a mask, and 100% oxygen first enters his lungs. The oxygen mass is supplied at a speed of 4-6 liters per minute. Nitrogen is gradually mixed with oxygen. Its content is increased to 30%. When the proportions of nitrogen and oxygen are brought to a ratio of 30 to 70, respectively, the moment comes favorable for starting treatment. However, it should be noted that the concentration of nitrous oxide may vary depending on the individual patient. It is important to achieve the desired effect, and it, in turn, can occur with a different ratio of nitrogen and oxygen. Individual indicators are recorded in the patient's record.
The blood is saturated with gas in about 5-7 minutes. Nitrous oxide is completely dissolved in blood serum and is not biotransformed in any way. As soon as the supply of ZAX stops, the process of removing gas from the lungs begins. The gas is removed completely unchanged.
ZAX differs from other sedatives in that the sedative effect occurs very quickly, and the trace effect is completely absent. This is caused by nonspecific depression of the central nervous system.
Sedation manifests itself as follows: a comfortable and relaxed state; good, elevated mood; movements are inhibited; deep breathing; motor activity of the eyes is reduced; sound perception is dull; resistance is reduced.
If you plan to undergo a particularly painful procedure, you can temporarily increase the concentration of nitrous oxide to 50% (acceptable limit is 70%). Nitrous oxide has an analgesic effect, and also enhances the effect of local anesthetics. If the child is suddenly frightened and painful sensations begin to “reach” him, manipulation with nitrous oxide will quickly calm the baby down and treatment can be continued.
Thus, the use of ZAX makes it possible to carry out treatment of any complexity in just one visit.
As for removing the patient from the state of sedation, it occurs smoothly and consists of supplying 100% oxygen for 5-10 minutes. At this time, the doctor communicates with the child, trying to reinforce his positive impressions of visiting the dental office.
In general, the successful use of ZAX is impossible without the competent use of behavior management techniques. Trying on a mask by a child should be done in a playful way so that the child has time to relax before the onset of sedation. The doctor calms the child by telling him about the condition he will soon find himself in. You cannot force a mask on, as this may cast doubt on the success of the procedure.
Preparation and stages of the procedure
Children do not require any special preparation for treatment under sedation. If you are very worried and in doubt, you can take a general blood test, give your child a cardiogram, show the doctor a medical card that notes previous and chronic diseases, and tell about your doubts.
Otherwise, it is better to try to avoid strong emotions on the eve of the procedure and do not feed the child too much. If your child is quite sociable, then you don’t have to tell him about the procedure - the doctor himself will explain everything to him. If the baby does not trust anyone except his parents, then you can prepare him in advance by telling him in general terms what the doctor will do.
In the office, before the procedure begins, the doctor will explain to the little patient what sensations await him, and during the game he will help him climb into a chair and put a “space” mask on his nose. After just a few breaths, treatment can begin. The baby will watch cartoons or listen to what the doctor is saying, while the dentist performs the required therapeutic actions.
Is sedation with ZAX safe?
Yes, it's safe. ZAX is completely harmless for children. Moreover, today it can be called the safest sedative. It is easy to use, is eliminated from the body without a trace, does not have a heavy or overly strong effect, and is not addictive. The child remains conscious, his breathing is not difficult, all reflexes are preserved. The use of ZACS ensures maximum safety, complete controllability and early activation of the patient.
You may have doubts about how well this technology has been tested. Despite the fact that it represents an innovation for Russia, ZAX sedation has long been used throughout the world (more than 30 years). The vast majority of pediatric dental clinics in the USA, Israel and the UK use ZAX as the main sedative. Thus, this technology can only be called new conditionally - it has long been tested and approved by professionals.
Indications for treatment under ZAX
One of the main advantages of nitrous oxide is its safety: the gas is eliminated from the body in the shortest possible time and in an unchanged state. To recover from the state of sedation, no special antidotes are required, which is very important when treating children’s teeth. After 10–15 minutes, the little patient returns to his normal life and does not feel any side effects. Dental treatment with nitrous oxide for children is carried out very often and has a number of indications.
- Fear of the dentist. Any treatment under sedation can reduce fear of the doctor. Few children are not nervous before the appointment, so sedation is an ideal procedure for relieving stress.
- Preschool age. At a very young age, the use of potent drugs and tranquilizers is prohibited or not recommended. In this regard, nitrous oxide is a better solution.
- Pronounced gag reflex. Laughing gas not only does not provoke, but even suppresses the gag reflex.
Experts recommend using nitrous oxide in dentistry for children for no more than 1 hour. During this time, a fairly large number of manipulations can be performed, including treating pulpitis or periodontitis. If longer or complex treatment is required, then it is better to split it into several stages.
Differences between sedation and general anesthesia
1) The occurrence of coughing, swallowing and other reflexes is excluded, which in turn allows for complete dental safety.
2) The dentist can fully control the patient’s condition, since he is conscious throughout the entire procedure. Another advantage of the action of sedatives is the fact that a person under its influence can be taken out of a state of superficial sleep at any time.
3) The patient is in a relaxed state and can communicate with the doctor.
Very often, due to anxiety, a person cannot clearly formulate his problem, and the patient’s internal tension can complicate treatment. Sedation makes it possible to relieve emotional stress without causing harm to the body. Also, when a person experiences psychological stress, hemodynamic changes occur. High blood pressure and rapid heartbeat force the attending physician to make certain changes to the given treatment regimen.
Recommendations for using sedation
In dentistry, this method is used if the patient wishes, when he wants to receive the most comfortable and safe treatment. Dental specialists recommend resorting to drug sedation in cases that require the patient to remain in the dental chair for a long time. This may include surgical manipulation of the maxillary sinuses and other long-term operations.
Sedation is very convenient during orthopedic procedures, which can last up to 12 hours and involve putting the patient into a sleep state. In case of diseases of the cardiovascular system, psychiatric and allergic reactions, the possibility of using sedatives is discussed individually in order to avoid undesirable manifestations.
Modern specialists are actively finding the use of drug sedation in the field of prosthetics, implantology and surgical dentistry. Sedatives are widely used because they are absolutely safe and do not have a narcotic effect on the body and are not addictive. The great advantage of using sedation in dentistry is the parallel use of the necessary equipment and a special cardiac monitor, with which it is possible to monitor the patient’s condition, which almost completely eliminates any complication.
