Referral for sedation and GA

Referral for sedation and general anaesthesia

Taking the time to use behavioural management techniques, together with good clinical judgement regarding selection of appropriate treatment options, will enable most children to complete a planned course of care. However, some children will have difficulty accepting dental treatment without sedation (for young children usually inhalation sedation; for older children/young people inhalation sedation or intravenous sedation) or general anaesthesia (GA). 

Inhalation sedation is a safe and effective form of sedation. It is useful for children aged 5 years or older but is of limited effectiveness for pre-school children. Intravenous sedation may be useful for teenagers (young people). All forms of sedation can only be provided by clinicians who have undertaken appropriate postgraduate training.¹⁰⁵ In Scotland, sedation services for children are usually only available in the Public Dental Services or Hospital Dental Service, while elsewhere in the UK, sedation may be provided in general dental practice or the Community Dental Service.¹⁰⁶ The various types of care available locally for children often stems from different historical commissioning patterns.

Compared with inhalation sedation, GA is generally believed to be associated with greater morbidity and mortality (risk of death from GA for healthy children having minor or moderate non-emergency surgery is less than <1:100,000, i.e. very rare¹⁰⁷). In view of this, it is generally recommended that GA is only used after less invasive management options, such as inhalation sedation, have at least been properly considered, if not tried. For very young children (under 5 years of age) who may be unable to comprehend the required behaviour for treatment, young school children who need extensive treatment, or for other potentially traumatic procedures GA may be the preferred management option. A meeting of GA providers in Scotland in 2003 agreed that the use of GA was a reasonable first option for 9 or 10 year-old children requiring extraction of all first permanent molars (unpublished).

The final decision about whether sedation or GA is justified for dental care, and the planning of the dental care to be provided in this way, must be made by an appropriately experienced clinician. 

The Management options when considering referral for sedation/GA flowchart may be helpful in deciding whether or not to refer a child for treatment under sedation or GA.

Referral for sedation or GA is not a management option for acute dental pain. It is the referring dentist’s responsibility to relieve the child of dental pain (see Pain or infection).