What Criteria Does a Dentist Use to Decide Whether to Treat a Child in the Office or Under General Anesthesia?

Many factors enter into this decision and include the age of patient, treatment requirements (extraction, crowns, rehabilitation), behavior, and additional medical history.

Younger patients tend to have less cognitive and emotional ability to cooperate for an exam, radiographs, local anesthetic administration, and dental procedures in the office. Their attention span and ability to open their mouths for a prolonged amount of time are still being developed. Such children have often failed attempts at “conscious” sedation in the dentist’s office.

Depending on the amount and extent of treatment necessary, the patient’s ability to tolerate the treatment will vary. The average pediatric patient will have 20 primary teeth and, depending on the location of their cavities, may require multiple areas of local anesthetic. Therefore, a child who has a cavity on the lower right and also lower left quadrants of the mouth may need two separate injections. A patient who has anywhere from 8 to 12 cavities may require multiple dental procedures. Cooperation from a child often decreases with increased number of procedures. This can be consolidated into a single operating room visit under general anesthesia.

The presence of oral or perioral pathology, anatomical anomalies, or trauma that requires surgical intervention and requires stabilization and splinting will be facilitated by the use of general anesthesia.

Infections or abscesses that cause swelling or dysphagia will predispose to airway obstruction during sedation, and should instead be referred for general anesthesia.

Patients with comorbidities that require medical management, or unique management of sedation, should be referred for pediatric anesthesia consultation. These include congenital heart disease, bleeding disorders, craniofacial abnormalities with a compromised airway, severely developmentally delayed and combative patients, to name a few.