Nitrous oxide/oxygen inhalation sedation is a safe and effective behavior management technique.
Use of nitrous oxide/oxygen is indicated in the following situations:
you are able to obtain written informed consent
the fearful or anxious patient
as an adjunct to local anesthesia
in a patient whose gag reflexes interfere with dental care
Use of nitrous oxide/oxygen may be contraindicated in children who have medical conditions such as:
upper respiratory infection, respiratory diseases, or asthma
severe emotional disturbances
You should consider the following factors prior to using nitrous oxide/oxygen inhalation sedation:
Precautions to reduce environmental exposure to the staff are required.
IHS guidelines require specific training and privileging.
Indications consent, flow rates, and duration must be documented
Facility requirements most often supersede IHS guidelines
Physical restraint includes partial or complete immobilization with staff, parent, or devices to protect the patient and staff from injury during dental treatment. The use of restraints may be offensive to uninformed parents.
Use of restraint may be indicated in the following situations:
The hand-over-mouth technique is a behavior management technique that is controversial and may be offensive to parents. A hand is placed over the child's mouth and behavioral expectations are explained. The hand is removed, or reapplied, depending on the behavior of the patient. Because this technique involves potential legal liabilities, its use is discouraged for other than senior clinicians and pediatric dental consultants.
Use of the hand-over-mouth technique is indicated for a healthy child who is able to understand and cooperate but who exhibits defiant or hysterical avoidance behavior.
Use of the hand-over-mouth technique is contraindicated in children if--
the technique causes occlusion of the nasal passages and restricts breathing
you are unable to obtain written informed parental consent.
You should consider the following factors prior to using general anesthesia:
Clinical privileging is required (usually involving postgraduate training with anesthesia rotation).
The indications for and informed consent for the use of general anesthesia must be documented.
General anesthesia should not be attempted without medical consultation, in an inadequate facility, or without provision for recovery.
Practical Tips in the Behavior Management of Children
The following tips may be helpful when working with children:
Spend time with the parents to address their concerns and gain their trust.
You may need to define the parent’s role for treatment done in their presence.
Use appropriate vocabulary with the child to explain the instrumentation, what you will be doing, and why he needs to help.
Give the child a few simple, clear, non-threatening expectations so the child understands his/her role in the appointment.
Do not ask a question if it is possible that you will not like the answer. Instead of asking "Will you help me?" say "I need your help!"
Use distraction frequently. Children's active imagination will allow you to distract them with stories about animals, cartoons, or current movies. When you stop talking, the child will focus on what you are doing in the mouth.
Dental Assistants may need additional training to treat children well.
Units should be fully stocked. The child should never be left alone in the unit. Delays should be minimized.
Praise good behavior and reward if possible. Praise in front of parents works well. Give the child expectations for the next visit.
Never belittle a child or compare his/her negative behavior to another child’s good behavior.
Know when to try another approach, including referral.
Learn to work quickly; children often have limits to their cooperative ability.