Information for the parent/guardian of a child with special care requirements needing dental treatment under general anaesthesia

Why has my child been referred for a general anaesthetic?

Your child has been referred because, after consultation with you, your dentist feels that your child will be unable to cope with treatment in the dental chair. Your dentist will have discussed all other appropriate options with you, including sedation if suitable for your child.

Your child’s name will be placed on a waiting list

When your child’s name reaches the top of the waiting list, you will receive an appointment letter along with more instructions.

Your child will need to be seen at a separate pre-surgery appointment. You will receive an appointment for the pre-surgery assessment by post, e-mail or telephone.

You will also be contacted, usually by telephone, a few days before your child’s appointment for a pre-op anaesthetic assessment.

How many teeth will my child have treated?

The dentist will have discussed your child’s treatment needs with you.

At the assessment appointment it was decided that on or more of the following treatments should be carried out:

• Extractions
• Fillings
• Scale and polish
• Dental examination and treatment planning

Please note that although the treatment above is proposed, this may change following the pre-surgery assessment and more teeth may require extraction.

If the dentist has been unable to examine your child properly in the dental chair, your child will have a dental examination while under general anaesthesia and treatment as necessary which may include fillings, extractions and a scale and polish.

Will my child’s adult teeth be affected by losing these baby teeth?

One of the reasons that we have baby teeth is to provide space for the adult teeth to grow into. Extracting baby teeth may lead to crowding of the adult teeth.

What should I tell my child about the anaesthetic?

This will depend on the age of your child and how much you feel they will understand.

It may be enough to explain that some of their teeth are poorly and need to be removed before they cause any pain. You can explain that a doctor (anaesthetist) will give them some medicine which will make them go to sleep while the teeth are treated, and afterwards they will wake up then go home.

Older children may want to know more. Encourage your child to talk about the procedure and going to sleep. Books, games and stories can help.

What should I do if my child has toothache before their appointment?

Give your child the recommended dose of their usual pain relief. If they are still in pain then please contact your own dentist for advice.

What should I do if my child is unwell on the day of the appointment?

If your child has a cough, cold, runny nose or temperature, or is otherwise unwell it may not be possible to go ahead with the general anaesthetic and treatment. Please contact the Paediatric Day Unit at Gloucestershire Royal Hospital on 0300 422 8452 or 0300 422 8453 for advice before attending for the appointment.

What will happen on the day the teeth are treated or extracted?

• Your child will have been given a time to arrive at the Paediatric Day Unit in the Children’s Centre, Gloucestershire Royal Hospital in the appointment letter.

• Please let the dentist know if your child has lost any teeth since their last visit to the dental clinic.
• You will be seen by the team who will be treating your child. This will include the dentist, nurses and anaesthetist. The dentist will discuss the proposed treatment and ask you to sign a consent form. The consent form must be signed at the hospital before the treatment can be carried out.
• The consent form must be signed by an adult (over 18) who has parental responsibility (PR) for the child. Your child will therefore need to be accompanied by a parent or legal guardian. The individuals who have parental responsibility for a child are as follows:
  • Biological mother
  • Biological father (if married to the mother at the time of the birth, or if after 1 December 2003, not married to mother but named on the birth certificate, or if ordered by the Court)
  • Any other person granted PR by the Court (this could be Social Services, adoptive parents, any other guardian or carer)

The anaesthetist will meet you and your child and make an assessment of any medical problems that they may have. The anaesthetist will discuss with you the best and most appropriate type of anaesthetic for your child, taking into account their special needs and any medical problems.

The anaesthetist will also need to know about any known allergies your child has, any medication your child is currently taking and if they have ever had a problem with any previous general anaesthetics.

You will usually be with your child while they go to sleep. The general anaesthetic will be as short as possible to remove or treat the teeth. During the anaesthetic some pain relief will be given if necessary. Once the treatment is completed your child will be taken to the recovery room.

A trained recovery nurse will look after your child and once he or she is responding to the nurse’s voice, you will be able to be with your child again. You will be able to take your child home later that afternoon.

Children are generally seen in order of age, with the youngest first, however, the order will be determined on the day based on patient need.

Please note that due to unforeseen circumstances, your child’s dental treatment under general anaesthesia may be cancelled on the day. If this happens you will be informed. You will also be contacted at a later date offering you another appointment.

How will my child feel afterwards?

When your child first wakes up, he or she is likely to be a little sleepy/confused and may cry for a short time. They may still feel a little sore, so they may be given some pain-relieving medicine while in the recovery room or when they are back on the ward.

Should I keep my child away from school?

You will have to be guided by how your child feels. Some children will feel a little off-colour the following day and may need to stay off school.

Possible risks of a general anaesthetic

With modern anaesthesia, serious problems are uncommon, however, risks cannot be removed completely. Common side effects (1 in every 10 cases) include feeling sick, dizzy or having a sore throat. Uncommon but treatable complications (about 1 in every 1000 cases) include a serious chest infection, existing medical problems getting worse or having breathing problems during or immediately after the anaesthetic.

The risk of a life-threatening problem such as a serious allergy is about 1 in every 10,000 and the risk of death is very rare (about 1 in 100,000).

Further information

If you have any questions which have not been answered on this page, please telephone the clinic where your child was assessed.

If you require further information about your child’s general anaesthesia, please visit the Royal College of Anaesthetists website at www.rcoa.ac.uk