Why We Use General Anaesthesia For Children With Special Needs, and When We Don’t

Brisbane Paediatric Dentists may use general anaesthesia for children with special needs when the treatment cannot be done in the dental chair. We may also use it when there is so much work that staying awake would mean eight or ten appointments that your child would not cope with. Sometimes, special needs children may not be able to lie back, manage the noise or the light in the dental room, hold still long enough for us to take an X-ray, or have decay that will worsen if not addressed on time. Most of the children we see this way are autistic, or have ADHD, cerebral palsy or a developmental delay. Knowing a child is autistic tells us almost nothing about how the appointment will go. We may have two patients with the same diagnosis, and one needs theatre while the other manages fine in the chair. What we are actually looking at is whether your child can manage the visit while they are awake. While some children with special needs can only receive dental care while asleep, we have seen some children with autism or a developmental disability who managed to get through it awake.

What We Try in the Chair Before Anything Else

The First Appointment

We don't insist on an examination at the first appointment, says Dr Ellie Nadian. Sometimes the first visit is no more than a conversation with you. If we get a few seconds with a mirror, good, we'll use it, and if we don't, that's okay too. Either way, we monitor how your child is in the room and plan the next appointments based on what we see.

A Quieter Visit

Our team can book a quieter time of day. If waiting in the car until we're ready is easier, say so, and we'll put it in the file. Headphones, sunglasses, or a comfort item, none of that is unusual at Pure Dentistry.

Tell-Show-Do

Our paediatric dentists use tell-show-do with most children who come in. It's what gets us through most appointments. We tell your child what's about to happen, show them the instrument on a finger or a mirror, then do it. It usually works pretty well. One fourteen-year-old we see copes so well with it that when he needed a CBCT scan, we wrote the instruction into the referral so the radiology clinic would do the same. He had the scan awake.

Photos From Home

When we can't get a look at all, we sometimes ask parents to take photos at home on a phone. Not as good as an exam. It still may give us something to work from.

Happy Gas

Some children don't need to be asleep; they just need to be calmer, and happy gas does the trick. But please bear in mind that nitrous oxide only works if your child can stay in the chair while we do the work.

When the Chair Doesn’t Work, and How We Know

His dad had already taken him to three or four other practices before us, and none of them could get anywhere with him. The boy was six years old and did not speak. He wouldn't get into the chair, so his dad sat him on his lap and held him there while we had a look. What we got was about forty seconds, which was enough to count decay in six teeth. However, it wasn't enough for an X-ray of any kind, including the panoramic one, where the machine goes around the outside of the head, and nothing has to go in the mouth. We can't see between the teeth or under the gum without an X-ray, so we don't know how deep the decay has gone or whether it has reached a nerve. What we could count by eye in forty seconds was only six teeth. That number usually goes up once we get proper images.

His dad mentioned in the same conversation that he'd been waking up at dinnertime with sore teeth. Trying another few visits to see whether he'd settle into the chair would have left him in pain. And even if he had settled, forty seconds at a time was never going to get six teeth fixed. We booked him for treatment in the hospital under general anaesthesia, and we wrote into the plan that any X-rays would be taken on the day, once he was asleep. We wouldn't normally decide on the hospital this early. A first visit is usually spent finding out what a child can handle. With this boy, it was already obvious.

One Anaesthetic Instead of Ten Appointments

His mum wrote to us before we had met him. There was no way he would sit in the chair, she said, and she turned out to be right about that. He was seven, autistic, and had ADHD as well. He needed about nine treatments. He had decay in most of his back teeth, a baby tooth that had broken and gone septic, and a silver crown from an earlier visit that had cracked because he grinds his teeth at night. Awake, that would have been eight or ten separate appointments, each one asking him to get back into the same room and let someone he doesn't know work in his mouth. All of it is booked for one session instead, so he only has to get through the day once.

What the Child Asks for Still Counts

He told us it was his body and his rules. He was autistic, he did not want the treatment, and he did not want silver crowns on his back teeth. We gave him white ones. White crowns take longer to place than silver, so we booked extra time in the theatre, and we matched him with an anaesthetist who is good with children who are frightened. Before we book anything, our team reviews each child's medical history to ensure an anaesthetic is safe for them.

Sometimes the Anaesthetic Is Needed Just to Look

We saw a five-year-old who needed his teeth checked but could only manage to let us take a look for a few seconds at a time. While the time we got was enough to see he had decay, it was not enough to know how much. So we left the X-rays until he was asleep in theatre, and we wrote to his parents beforehand to say we might find more once we could see properly. We can only quote on what we have seen, and what we see depends on how long your child will hold still.

When We Don’t Use General Anaesthesia

One of our patients was fourteen, autistic, had ADHD, and needed a 3D x-ray of his jaw. He did not need to be asleep for it. He could cope when someone told him what was about to happen, showed him, then did it, so we wrote that into the referral, and the radiology clinic did the same. He had the scan awake, in an ordinary imaging room. We have also seen a child arrive with a general anaesthetic already recommended by another provider, and told the family we did not agree it was needed.

A diagnosis of autism, ADHD or a developmental disability is not on its own a reason to book theatre. What we focus on is how your child copes in the chair, and plenty of them cope.

Medical Disclaimer

This page is general information, not advice about your child. Every child is different, and the cases here are decisions we made for particular children with their own medical histories. We can't say what your child needs without assessing them.

Book A Visit With Our Special Needs Paediatric Dentist

If your special needs child has been turned away somewhere else, or you have not been able to get anyone to look properly, call us and tell us what happened. We will work out what is possible from there. You can reach out to us by calling (07) 3343 4880.