Drs. Gep and Werb are trained to provide several levels of conscious sedation. Based on her initial assessment of your child and their treatment needs, she may recommend one of the following sedations.

1) Nitrous oxide/oxygen (“laughing gas”)
2) Oral sedation
3) Combination of oral plus nitrous oxide sedation

Conscious sedation is an extra procedure. Please check with your insurance if this is a covered expense.


Nitrous Oxide (“Laughing Gas”) Sedation

After the consultation appointment, the dentist will assess your child and may recommend your child have dental treatment done with “laughing gas”. This is a mixture of nitrous oxide and oxygen. The ratio of the gases can be adjusted to reach a suitable level to reduce your child’s anxiety and nervousness. It will ease their fears so that they may relax and receive treatment comfortably and safely.

Nitrous oxide sedation is generally not recommended for children under the age of four since they do not have the maturity level to appreciate the sedative effects of this type of sedation.

The gases are inhaled with a small mask that fits over the nose. Your child is conscious and responsive throughout the appointment. As the gas begins to work, your child will become calm and are still awake and can talk with the dentist. When treatment is complete, your child will breathe 100% oxygen that will blow off the effects of the nitrous oxide sedation usually within 5 minutes.

How to prepare and what to expect for your child’s sedation appointment:

1. The most significant side effect is nausea that may lead to vomiting. To reduce this risk, your child should have a light meal but nothing to eat or drink for 2 hours prior to the scheduled appointment.

2. The use of nitrous oxide/oxygen sedation is greatly influenced by whether your child is able to breathe through his/her nose since this partially regulates how much “gas” your child receives and this ultimately influences the sedation level achieved. It is necessary, therefore that some degree of co-operation and willingness to help be obtained by your child. For this reason, we often separate introduction to the nitrous oxide appointment from the consultation appointment to enable your child to enjoy the effects of the “laughing gas” and for the dentist to evaluate your child’s ability to respond to the sedation.

3. If your child develops a cold and cannot breathe through their nose, please contact our office and we will be happy to reschedule the appointment. If your child cannot breathe through their nose, nitrous oxide sedation will be ineffective and your child will have difficulty tolerating the procedure since they will feel claustrophobic and panic.

4. Different children have different experiences. Most children will feel light headed, floating, tingling in the fingertips and for the majority of children it is an enjoyable experience. The equivalent feeling in an adult would be having a couple of glasses of wine. The benefit of nitrous oxide is that there is no hangover effect.

5. Nitrous oxide sedation also provides minor pain control for simple fillings and/or eliminate the discomfort of the local anaesthetic injection.

6. After dental treatment is completed, your child will be administered 100% oxygen for approximately 5 minutes to clear his/her system of all nitrous oxide and to return him/her to their original state.

7. Your child should be able to walk out of the dental operatory on his/her own however, some children will experience a sensation of “rubber knees”.

8. Not all children will react the same way to sedation. As a result, there may not be a significant sedation effect for your child, or in some cases, your child may become hyperactive. Most of the time, the medication creates the desired and planned effect.

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Oral Sedation

After the consultation appointment, the dentist will assess your child and may recommend your child have dental treatment done with oral sedation. It will ease their fears so that they may relax and receive treatment comfortably and safely.

Drs. Gep and Werb routinely use two types of oral sedatives that are both benzodiazepines.

How to prepare and what to expect for your child’s sedation appointment:

1. Based on your child’s age and weight, the dentist will recommend one type of oral sedative (either Midazolam or Triazolam).

2. The medication works best on an empty stomach. Your child must not have anything to eat 6 hours prior to the appointment. Sedation appointments are booked in the morning therefore, we recommend that your child not have any breakfast. Your child may have CLEAR LIQUIDS UP TO 2 HOURS BEFORE THE APPOINTMENT, that is, water or apple juice. NOT MILK OR ORANGE JUICE.

3. On the day of the appointment, we recommend if possible two adults to accompany the patient home. One adult should monitor the child in the car seat. Most children return to normal state within 2 to 3 hours but some children may take 6 to 8 hours for the effects to wear off. The day of the appointment, your child should not be left at daycare or go back to school. Please be prepared to have a responsible adult stay at home with your child.

4. You are required to arrive at the office 30 minutes prior to your dental appointment. Dr. Nguyen will administer the medication that is combined with either Tylenol or Motrin to mask the bitter taste of the sedative and to provide some pain relief. Your child will be given a choice of “flavours” to pick. The medication will produce effects in most children in 10 to 20 minutes.

5. After administration, your child will be allowed to play while supervised in the children’s waiting room, until the effects are noticed. Please sit close to your child because they may become uncoordinated suddenly and hurt themselves.

6. When the sedative effect begins, your child will appear “drunk”. There are different types of drunks: happy, silly, sleepy, and in some rare instances, angry drunks. It is difficult to predict what type of drunk your child will be.

7. When your child appears sufficiently sedated, we will ask you to carry your child to the treatment room. The oral sedatives used do not necessarily induce sleep but instead promotes a state of relaxation that allows the child to learn from the procedures and cooperate with the paediatric dentist by interacting positively.

8. Some children become very lethargic and their gait becomes erratic and need support to walk. This effect may continue for approximately two to three hours and the child should be watched during this time as he may accidentally fall and hurt himself. Some children experience some mild amnesia and have a foggy recollection of the visit.

9. Not all children will react the same way to sedation. As a result, there may not be a significant sedation effect for your child. Most of the time, the medication creates the desired and planned effect.

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Combination Oral + Nitrous Oxide Sedation

After the consultation appointment, the dentist will assess your child and may recommend your child have dental treatment done with combination sedation. Your child will be given an oral sedative along with nitrous oxide (“laughing gas”) sedation.

The procedure follows the oral sedation protocol and then the nitrous oxide sedation protocol. Multi-drug sedations carry a slightly higher risk than single drug sedation. There are respiratory concerns and nausea and vomiting side effects. This type of sedation is safe with advanced training and appropriate monitoring.

How to prepare and what to expect for your child’s sedation appointment:

1. Your child must not have anything to eat 8 hours before their appointment. They can have CLEAR LIQUIDS UP TO 2 HOURS PRIOR TO THE APPOINTMENT. That is, water or apple juice, NOT MILK OR ORANGE JUICE. If your child was given something they were not supposed to have, the paediatric dentist will have to use single drug sedation that will not be as effective or she will cancel the appointment.

2. Your child must arrive 30 minutes prior to the appointment. The paediatric dentist or nurse will take pre-operative vitals (pulse, oxygen saturation and blood pressure).

3. The dentist will administer the oral medication (in some instances the older patients, the medication may be administered at home).

4. Once your child becomes sedated (see oral sedation), we will ask you to carry or escort your child to the treatment room.

5. Once your child is settled into the dental chair, we will place a pulse oximeter on your child’s finger in order to continue to monitor your child’s pulse and oxygen saturation levels).

6. Your child will then be introduced to the nitrous mask and nitrous oxide sedation will commence. (see nitrous oxide sedation).

7. Your child will be continuously monitored throughout the dental procedure. When treatment is complete, your child will receive 100% oxygen for 5-10 minutes to dissipate the effects of the nitrous oxide. Your child will still have the effects from the oral sedation therefore he/she must still be monitored closely (usually for 2-3 hours).

8. Your child should stay home with a responsible adult and should not return to daycare or school.

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