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For sedation to be safe, certain protocols are critical and many factors must be carefully weighed, according to the 2016 guidelines jointly written by the American Academy of Pediatric Dentistry and the American Academy of Pediatrics.

From left, Erica Regan, a dental assistant, and Dr. Sedation is a continuum from minimal to moderate to deep to general anesthesia, and “it is common for children to pass from the intended level of sedation to a deeper, unintended level of sedation,” the guidelines note.

Pediatric dentists train for an added two or three years to learn sedation. Moderate sedation, also known as “conscious” sedation, requires more vigilance than minimal sedation, such as laughing gas, because children could slip from moderate to deep sedation, which means they can’t necessarily maintain their own airway.

By contrast, a general dentist may have taken a weekend course in moderate sedation. For moderate sedation, dentists should have rescue drugs on hand and monitor oxygen levels and heart rate. Both deep sedation or general anesthesia using an IV should be administered only by qualified anesthesia providers, according to the anesthesiologists’ society.

Sedation may be needed, for example, if a 3-year-old requires root canals for badly decayed molars or has a throbbing abscess, said Dr.

Casamassimo, who sedates children at Nationwide Children’s Hospital in Columbus.

Jeremy Horst, a pediatric dentist at the University of California, San Francisco.

“The size difference is so enormous” between a 4-year-old and a 12-year-old.

Deborah Studen-Pavlovich, the director of the pediatric residency program at the University of Pittsburgh School of Dental Medicine.

A sedative “doesn’t get metabolized as quickly as the drug is stored in fat cells so they have a longer recovery time,” she said.

It’s unclear why but a 2009 study found that sedated children with developmental disabilities have three times the risk of having a decrease in blood oxygen levels that can lead to life-threatening complications.“Sedation is above and beyond routine dentistry,” so the first thing parents should ask is whether it’s necessary, said Dr.

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