At Union Pediatric Dentistry, we offer a variety of sedation options to help your child’s dental experience be as positive and comfortable as possible. Sedation is the use of medications to help your child’s behavior as he/she undergoes needed dental procedures. It will help increase his/her abilty to cope with the procedure and decrease anxiety and discomfort. Below are the the different sedation options that are provided at Union Pediatric Dentistry. Dr. Greenhill will help guide you as to what would be the best option for your child.

Nitrous Oxide
Some children are given nitrous oxide/oxygen, or what you may know as laughing gas, to relax them for their dental treatment. Nitrous oxide/oxygen is a blend of two gases, oxygen and nitrous oxide. Nitrous oxide/oxygen is given through a small breathing mask which is placed over your child’s nose, allowing them to relax, but without putting them to sleep. Your child will be able to pick from different flavors i.e. bubble gum, strawberry, grape, or orange. Another added benefit, is that once treatment is completed, they will be able to take the mask home with them. The American Academy of Pediatric Dentistry, recognizes this technique as a very safe, effective technique to use for treating children’s dental needs. The gas is mild, easily taken, then with normal breathing, it is quickly eliminated from the body. It is non-addictive. While inhaling nitrous oxide/oxygen, your child remains fully conscious and keeps all natural reflexes. It is important to remember that this is one tool in helping your child and is most effective in children that exhibit a mild degree of anxiety and have mild to moderate dental treatment needs.

Prior to your appointment:

• Please inform us of any change to your child’s health and/or medical condition.
• Tell us about any respiratory condition that makes breathing through the nose difficult for your child. It may limit the effectiveness of the nitrous oxide/oxygen.
• Let us know if your child is taking any medication on the day of the appointment.

I.V. Sedation
I.V. Sedation is recommended for very apprehensive children and some children with special needs and also have mild to moderate dental treatment needs. Dr. Greenhill will perform the dental treatment in the office with your child anesthetized under I.V. sedation, which is administered and monitored by an anesthesiologist, Dr.Vi Devany. IV sedation is best suited for those children who have a moderate to high level of anxiety and mild to moderate dental needs.

Dr. Viola Devany
We are very fortunate and proud to work with Dr. Viola Devany. Dr. Devany’s specialized expertise and calm demeanor make her a great asset to our practice. Thanks to her services we can now provide comprehensive restorative and surgical care to those anxious and/or young and cognitively immature patients that can not cooperate in the regular dental setting, in the comfort of our office!

Dr. Devany received her bachelor’s degree in Biology and Chemistry from Kent State University in 1977. She then went to Ohio State University-School of Medicine where she completed her doctorate in 1980. Dr. Devany is dual trained in Pediatrics and Anesthesiology. She completed her residency in Pediatrics at the Dallas Children’s Hospital in 1984. She then went to the University of North Carolina in Chapel Hill where she trained as a resident in Anesthesiology and completed her degree in 1986. Her passion for both specialties encouraged her to complete a post graduate fellowship in Pediatric Anesthesia at Emory University in 1987. Dr. Viola Devany specializes in In-Office Pediatric Intravenous Sedation and Anesthesia.

Dr. Devany lives in Tipp City, Ohio with her husband Glen. She has three sons; Sam, Greg and Henry, and three cats. In her spare time she enjoys her involvement in church, reading, playing euchre and visiting with friends.

Information Sheet for IV Sedation

If Dr. Greenhill has recommended dental treatment for your child to be performed using IV sedation/general anesthesia with Dr. Devany the following information will help you in your preparation for the appointment. Dr. Devany is Board Certified in both pediatrics and anesthesiology with 25 years experience in Pediatric Anesthesiology. She will provide anesthesia services for your child while Dr. Greenhill performs the dental procedures. This service is provided at Union Pediatric Dentistry in Union, KY.

In order to better care for your child and to maximize safety, Dr. Devany has arranged a protocol as follows:

Patient and Parent Check List for day of Surgery 2011

1. FOLLOW NPO (NOTHING BY MOUTH) INSTRUCTIONS
2. HAVE CLEAR LIQUIDS AND SOFT FOOD AT HOME FOR POST OP GINGERALE IS A GREAT ANTI-NAUSEA CHOICE Or gatoraide, koolaide, jello, popsicles
3. DO NOT MAKE ANY PROMISES FOR POST OP FOODS (LIKE STOPPING AT MCDONALD’S
4. BRING A CHANGE OF CLOTHS FOR THE CHILD AND A SECOND ADULT TO SIT BESIDE CHILD ON THE WAY HOME
5. BRING A COMFORT ARTICLE FOR CHILD (FAVORITE BLANKET OR STUFFED ANIMAL)
6. BRING A BOOK OR TOY TO USE IN THE WAITING ROOM
7. BRING BOOK ETC FOR PARENT TO HAVE DURING PROCEDURE
8. BRING THE RIGHT ATTITUDE, YOUR CHILD WILL SENSE FROM YOU HOW TO RESPPOND.; LEAVE HIGH ANXIETY AT HOME. HAVE A MATTER OF FACT ATTITUDE, LIKE THIS IS NOT A BIG DEAL,
9. WE STRIVE TO KEEP ALL APPOINTMENTS ON TIME, BUT PLEASE UNDERSTAND THAT SOMETIMES DELAYS CANNOT BE AVOIDED.

IV Sedation Pre/Post-op Instructions 2011

What to do and what to expect on the day of your appointment:

1. Your child may not have any food, milk, orange juice, gum or candy after midnight. He or she may have clear liquids up to 4 hours before the appointment.
2. Plan to arrive at the office 15 minutes before the appointment. This will allow time for any paper work to be completed.
3. For most children, the next step will be receiving the N2O (laughing gas) or “sleepy air”. Some toys are used to help distract from the start of the intravenous line (IV). Sedation is then started in the intravenous line. Parents can stay with their child until the sedation is started. Your child will not remember anything after this point including your leaving for the waiting room.
4. Some small children and children with special needs will receive a quick shot in the arm which will produce a rapid drowsiness. Again, parents can stay until the sedation is started and the child will no longer remember them leaving.
5. While your child is sedated, he/she will be monitored with the same equipment as used in a hospital setting (EKG, blood pressure, respiratory status, oxygen level). In addition, oxygen will be given. Dr. Greenhill will administer any local anesthetic that is necessary. Your child will take a “nap” while the dental work is being done.
6. At the end of the dental procedures, your child will wake up. He/she will still be drowsy and drunk-like. Most children wake up smoothly. However, it is normal for some children to be fussy. You will be able to hold your child during this time. Soon, you and your child will be able to go home. You will be discharged when your child can talk and stand up with help.
7. On the way home an adult should sit beside your child. Your child should be restained in an age appropriate car seat, booster seat or seat belt. If your child falls asleep in the car make sure the chin is lifted up and not in a chin to chest position. This will keep the airway open.
8. When you arrive home your child can sleep but not in the bedroom where they cannot be seen. He or she should be in a room like the living room where you can watch him/her.
9. At home, start with clear liquids, like gatorade, kool-aid, 7up or apple juice. Avoid dairy and plain water for a few hours. Ginger-ale has natural anti-nausea properties. Soft food can be added next. Later, your child can progress to a regular meal as tolerated.
10. For the remainder of the day, do not let your child do activities that require coordination like riding a bike, climbing, swimming, sledding etc.
11. If your child vomits, refrain from offering food and drinks for one hour. Start again with clear liquids. If it happens again, call Dr. Devany.
12. Also contact Dr. Devany if your child develops a temperature > 101˚F or if there is swelling of the mouth or airway, or if you have any other concerns.
13. Please ask any questions that you or your child have. We want this to be a safe and pleasant experience for both you and your child.

Outpatient General Anesthesia at
Cincinnati Children’s Hospital Medical Center

Outpatient General Anesthesia is recommended for apprehensive children, very young children, and children with special needs that would not work well under nitrous oxide or I.V. sedation. Those children with extensive dental needs may be best suited for this option. General anesthesia renders your child completely asleep. This would be the same as if he/she was having their tonsils removed, ear tubes, or hernia repaired. This is performed at Cincinnati Children’s Hospital Medical Center (Main Hospital or Liberty Campus) in an outpatient setting. For patients with more complex medical needs, an overnight stay may be required. While the assumed risks are greater than that of other treatment options, if this is suggested for your child, the benefits of treatment this way have been deemed to outweigh the risks. Most pediatric medical literature places the risk of a serious reaction in the range of 1 in 25,000 to 1 in 200,000, far better than the assumed risk of even driving a car daily. The inherent risks if this is not chosen are multiple appointments, potential for physical restraint to complete treatment and possible emotional and/or physical injury to your child in order to complete their dental treatment. The risks of NO treatment include tooth pain, infection, swelling, the spread of new decay, damage to their developing adult teeth and possible life threatening hospitalization from a dental infection.

Prior to your appointment:

• Please notify us of any change in your child’s health. Do not bring your child for treatment with a fever, ear infection or cold. Should your child become ill, contact us to see if it is necessary to postpone the appointment.
• You must tell the doctor of any drugs that your child is currently taking and any drug reactions and/or change in medical history.
• Please dress your child in loose fitting, comfortable clothing.
• You will receive information from Children’s Hospital on the appropriate time to show up for your appointment. They will also discuss with you regarding diet before surgery.
• The child’s parent or legal guardian must remain at the hospital or surgical site waiting room during the complete procedure.

Post treatment instructions:

Today your child has had dental treatment under general anesthesia. It is very important that you follow these instructions carefully.

What to expect:

• Bleeding from the mouth if teeth have been removed.
• Feeling sick to their stomach. Vomiting may occur up to 4 hours after surgery.
• Pain in the mouth, jaw, or neck.
• Slight rise in temperature for 24 hours. ( 99-100 F)
• Your child may be sleepy for several hours after returning home.

Activity and Care:

• Rest and quiet activities are important after surgery. Your child’s balance may be poor due to the medications given. Closely supervise any activity for the remainder of the day because your child may be sleepy. If your child wants to sleep, place them on their side with their chin up. Wake your child every hour and encourage them to have something to drink in order to prevent dehydration.
• If your child had teeth removed, avoid the use of a straw for 48 hours. You may want to place a towel over their pillow because of minor bleeding.

Diet:

• Begin your child’s diet with clear liquids such as apple juice, water, koolaide, Jell-O or Gatorade. You may increase their diet slowly to include milk and soft foods when tolerated. The first meal should be light and easily digestible.

Medications:

• If your child is able to take an acetaminophen product (Tylenol, etc) you may give it every 6 hours. In addition, you can also give children’s ibuprofen every 6 hours for pain as well.
• Avoid the use of Aspirin

Seek Advice:

1. If vomiting persists beyond four (4) hours.
2. If the temperature remains elevated beyond 24 hours above 101 F
3. If there is difficulty breathing.
4. If any other matter causes you concern.
5. Page Dr. Greenhill at 513-736-1812 if you need to talk with him. If you are unable to reach Dr. Greenhill, you can call 513-636-4200 and ask for the dental resident on call.