Comfortable and Safe Dental Anesthesia for Children with Dr. Amanda Okundaye

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Welcome to the dentistry for kids podcast today we have our special guests. Dr. Amanda, how are you feeling today?

I feel great. Thank you for having me.

Yes, thank you so much. We're so honored to have you. So before we get started, I just want to introduce Dr. Amanda bid. Dr. Amanda is available to bring sedation and general anesthesia to dental offices. She's a board certified dentist anesthesiologist with over a decade of experience. She trained at UCLA and now practices in Las Vegas where she calls her home. So now let's get down to the questions. So what is a dental and the sociologist.

So, we are recognized by the ADEA as of 2019. And a dentist anesthesiologist is someone who went to dental school first and then has a love for anesthesia and chooses to go the dental route. So you have physician anesthesiologist and dentist anesthesiologist and Dennis gsecl. Just basically work with just dentist. It is different per state, right? So here in the state of Nevada, we can work on patients from basically head or shoulders up so head and neck, anything to do with the mouth, the jaw, nose, eyes, anything like that we can do anesthesia for them. Because we went to dental school, our residency is three years just like physician anesthesiologist. But again, we focused solely on dentistry, Oral Surgery, maxillofacial prosthetics, things like that.

Oh, okay. And I know. So why do children need to see you for their dental procedure?

Absolutely. So there's a lot of I mean, what there's almost 70 million children in the US, okay? Of them, statistically, about 70% of them are not cooperative for normal dental procedures, it's a very high number. Now, a lot of those are children zero to, let's say, 12. And then we also have a very large, special needs population of patients. And so a lot of them can't sit for a normal dental appointment. So that's one reason. And the other reason would be pre cooperative age. And we call pre cooperative age children between zero and five. And so when you're two years old, and you have a full mouth of decay, we don't expect that you're going to sit for hour and a half, even 45 minute procedure as a kid. And so a lot of times one, it's safe. So what we do at general anesthesia in the dental offices or in the hospital is very safe. Driving in our cars every day statistically, is actually worse than general anesthesia that we provide to our patients. And so it's very safe to have a young child or special needs patient or children in general, have anesthesia, because they're not moving around. Right? There's a lot of things. You know, they use hand pieces and sharp tools. And a kid who needs a lot of work. It's much safer for that child not to be moving around and all over the place and have general anesthesia and have a controlled setting, then bring them back for let's say four appointments, and let's with something like oral sedation, right where it's unpredictable. So anesthesia, general anesthesia for children is very safe. And it really is the most efficacious when it comes to making the child comfortable.

Ooh, that's very interesting. Jean. Oh, six for like all these young kids just to get some if they need it. Yeah. Yes. So I guess like, how many different kinds of dental anesthesia Do you usually provide on a child?

As far as how many patients we see or how much anesthesia we provide? What I just clarify that for me,

like, like, what are the different types, you know?

So there's different levels of anesthesia? Good question. So a child or an adult anyone can have four different types of anesthesia. So you can have minimal sedation, which is just let's say, like the nitrous nose, so maybe when you're younger, you go and you get laughing gas, right? Or they can have a pill or drink. So that's one so that's, that's minimal sedation where they just use a single drug. Then you have moderate sedation where they can use an oral sedatives and nitrous and that's moderate sedation. So you're set you're conscious, but you have diminished reflexes and stuff, so you're just really out of it and loopy and that's what they would call like a twilight, then you have deep sedation and general anesthesia and deep sedation general anesthesia, your unconscious totally asleep. And that could be with different things like a tube or not a tube. But there's many different ways to provide general anesthesia gas, no gas. So there's four levels of F sedation that we provide to our patients.

Ooh, that's very interesting. Do you typically use all four? Or is there like one you use more common than the other? App? Good, great,

great question. So for children, a lot of times for what we provide as dentists, anesthesiologist is going to be general anesthesia. And so to give a child a little bit of drug and then tell them to cooperate is kind of an oxymoron. So children are either totally awake or totally asleep, there's really no in between where they're cooperative. So I would say, general anesthesia is the most common with using a dentist's anesthesiologist in the dental office.

Oh, okay. Thank you. I know earlier, you said something about general anesthesia is really safe for children. So I'm wondering if there's any potential risks or side effects that might be associated with it?

Absolutely. So everything has side effects, nothing is 100%. And so I'm, I'm very honest with parents when I say that I'm a parent myself. And so you know, everything comes with, you know, some sort of risks always. Okay, so it could be something as small as a little bruise where your IV was, it could be, you know, they could potentially have an asthma attack, they could potentially have, you know, other sequelae. The worst, obviously, would be an unfortunate, you know, situation where there was a death, let's say, but in my hands, well, at least in my fifth 1516 years of practice, I've never had that, that really goes to case selection. But you have to tell parents everything, right? Full disclosure, when it comes to everything. Now, that is not very common. So if there is something on the worst end of general anesthesia, it's usually some underlying health issues. And something going on that, you know, it really could be avoided with the right operator.

Oh, okay. So would you recommend kids to kind of see and check out their health conditions before getting anesthesia?

Absolutely. And that's why I said case selection, because there are some patients that are not good candidates for in the office, for instance, those who are morbidly obese, right? So someone who is morbidly obese, unfortunately, with a high BMI does put them at increased risk. We're having anesthesia in the dental office. There's other patients with underlying cardiac issues, right. So if they were born with something like tetralogy of flow, where there's not the right flow of their heart, right, and they need to be monitored afterwards and need to be in recovery for a while, or even admitted into the hospital, they may not be a good candidate for in office, general anesthesia.

Hmm. I see. Okay, thank you for that. So I guess during the procedure, how long does it typically last?

Most, pediatric dentist as far as a kid, right? So we're working on 20 teeth only. And so for a child, it's anywhere from 45 minutes to an hour and a half is very average.

Okay? That's not that long. I thought it'd be like three hours from

now, not for child, not most pediatric dentists, that are really well trained board certified, you know, quick, they can get work done, and it'd be really good. You know, and in that amount of time, and they can work on all the quadrants of the mouth and get everything done within that timeframe.

Oh, okay. That's really cool. Thank you.

So they only one procedure then Right? So a parent who opts to have their child under general anesthesia. It's a one appointment where everything is done. They don't have to come back for another crown or anything like that. Everything's done at that appointment. Oh, so

if they do not undergo it, then they have to go back several times, will times

and that's where we lose kids, right? So a lot of times, children are not phobic of the office. But if there was somebody who's a little more gruff, or the office is, you know, or the procedure is tough for them, or they're using local anesthesia and numbing up the area multiple times. Well, kids are very smart, they're not going to want to go back. And that's why we have phobic adults now, right? So now we have adults who I treat, who didn't have the best procedures or the best experience when they were a kid. And now they're fearful of the dentist and don't want to go unless they have some sort of sedation. And so I do see it on both ends where we literally can ruin a kid if they come back from multiple appointments, and don't just have general anesthesia one time to get it all done.

Oh, so for what I'm hearing, it's better for the kid in general

100%. From a psychological standpoint, it's better for the child, be smart, right? Every time you go for a vaccination shot, you know what's coming, when you go back to your primary doctor, you know, you're gonna get a shot, right? So it makes you more phobic to go. And that's what happens with kids when you're 245. If you've gone multiple times, as you get older, it makes it to where you can develop some kind of anxiety and phobia of the dentist. Oh, okay.

Thank you. So since we're on the topic of phobia, I was wondering, What measures do you take to ensure that the children remain comfortable and safe while they're under anesthesia?

Great question. So I follow obviously, the law. So we do have our ADA guidelines, the American Dental Association of American Dental Association has their own guidelines. And then you have to follow state guidelines. So when a child is asleep, or adult is asleep, they're fully monitored with the full scope monitor. So we monitor their heart, their breathing, their pulse oximetry, we monitor their end tidal co2, we look at their pupil size, we look at their lip color, we look at everything, and I literally never leave the room. And that's part of our standards of monitoring, you cannot leave the room when a child is asleep. And so I'm literally sitting right next to them the whole time, my practitioners working so that I know what's going on with the child, minute by minute.

Okay, so you can monitor everything that goes on

circulation, ventilation, oxygenation, they're all monitored.

Oh, yeah, that definitely ensures the safe. So I was wondering like before the appointment, what can the Barons do to prepare for their general anesthesia for their children?

Great question. So most importantly, they should have maybe some sort of rapport with their office, right? And talk to them, you know, ask them do you trust your your anesthesia provider, right, you're there my kids about to go to sleep, but I want to make sure that whoever's treating them, you trust as well, right. So that's one thing, make sure that their office, they're going to they trust their practitioner to trust their anesthesia provider, that's a big one, too, they're going to prepare by making sure that their kid has nothing to eat and drink. That's really important because you have to be on an empty belly for general anesthesia doesn't matter. It's in the dental office or in a in the hospital, right? You cannot have food on your belly, because you're at risk for vomiting and aspiration. So not eating and drinking is a big deal. From a mental standpoint, or psychological standpoint, I'm not a huge firm believer in telling zero to whatever your old, everything that's going to happen, because it does make them more scared. So if you say, Okay, tomorrow, you're getting a shot or tomorrow, they're gonna put a mask on your face and hold you down kind of thing. Kids, you know, do better when the parents not telling them what's going to happen, in my opinion, if they show up, and then I'm the bad guy, it makes it better. So they're not looking at their parent, like, Why would you let her do that? Right. So preparing them from a psychological standpoint, it's just telling them that they're just going to be okay, you know, telling them that they're in a good place. And these are people that care about them, and helping them understand that that that they're going to be loved on and nothing's going to happen to them kind of thing. So that's what parents can do.

Okay, that's definitely different from what you do to adult. So I know you mentioned nope, eating or drinking prior. So I was wondering, is it just for dinner? Or is it like during breakfast the day of?

Absolutely. So we follow the American Society of anesthesiology guidelines on not eating and drinking. And so the guidelines say nothing to eat a fatty meal, eight hours, six hours for a light meal, and then two hours for clear liquids. So what I tell my patients is depending on their appointment time, so most kids we see in the mornings to make it easy for parents not to keep them without eating all day. But I tell them absolutely no food eight hours, and so whatever their eight hours before their appointment time and then they can have water, apple juice Gatorade up until two hours before so that they're hydrated.

Oh, okay. So eight and two.

Yes. Eight no food, two hours clear liquids. Okay,

thank you. So how long does it take for a child to recover? Great question.

And so most kids it depends on the child right? There's some kids that are really good sleepers. So it could be anywhere from 15 minutes to an hour for them to be recovered enough to go home so they have to be able to sit up open up their eyes give us high five before I let them go home. I do not let them go home. super sleepy.

Oh, do you You monitor them while they're recovering. Yeah, so

they'll have a monitor on usually a pulse oximeter, just to tell us what their breathing is, right? But I allowed them to be with their parent, once they have some movement. Once I see a little movement, I see that they're moving around, we remove, let's say, their IV, and all their monitors, so they don't wake up with a bunch of stuff on right. One little monitor usually in their parents arms. And that's what I do.

Oh, okay. Okay, thank you. Yeah, that definitely makes it more simpler. So they yell at them much.

Well look at the kids, you know, wake up in a weird environment, and they go to sleep. I really think as a parent, you should go to sleep in your parents arm and wake up and your parents arms. I don't think you should feel like you don't know what's going on. Because that doesn't make the experience smooth.

Yeah, I agree. Like, waking up with a bunch of devices feels very scary.

I mean, even if they do get a shot before whatever we take the band aids off the gauze off, there's literally no evidence of what we did that day, you know, so it doesn't give the kid anything to talk about later. You know, you don't want to be like, Wait, why do I have this band aid here? Nope, none of that? Oh. They just think they took a nap. And that's the best part. Right? So when they leave as a parent, you're like, You did such a good job, little Johnny. Now we go back to the dentist, you can just do it all by yourself. Because most times they don't even remember what happened.

Oh, my that's so funny. After their appointment, what are some of the steps and procedures they should do?

Yeah, most importantly, it's to hydrate. You ask them, you know, to start with soft bland food, right. So they don't give them run out and get them a huge burger kind of thing. Because we rarely see nausea, vomiting after general anesthesia. But a lot of times, it's what they eat first, we asked parents not to put them off in a room by themselves so that they can just, you know, be monitored with their parents at home for the first couple hours. Most of the drugs that we use in anesthesia are redistributed in about four to six hours. And so you know, they may not be sleeping for that long, but they still have medication on board that they're going to redistribute and pee out right. And so really want to make sure a responsible adult is with them for that duration of time, because it's kind of like drunk driving, right? Kids don't know how sleepy they're and they might think they can jump on their bed or go to the restroom by themself or something. So you really want to make sure parents are vigilant when they get home. So the child doesn't fall or something. So those are some of the post operative instructions that we get to parents.

Oh, okay. How long do they typically lasts for? Or like, how many hours should you keep an eye on your children?

Like I said, I mean, for the duration of the medications. For me, I tell a parent for the duration of the day, because I don't break down redistribution of medications and all that. But I say the duration of the day. But you know, truly, if a parent, let's say had to go to work, they should probably give the kid a good four to six hours of them with them or responsible adult before they leave them, you know, on their own.

Okay, see. Thank you. So, that concludes all the questions I have today. So before we go, is there anything else you would like to talk about?

I mean, there's so much I mean, dental anesthesia is pretty awesome. I think I have the best job in the world. It is hard. Depending on my patient population, you know, we do get a lot of combat of special needs patients and stuff and really sick patients. But dental anesthesia is amazing. I say that whoever it is, as a parent, they use in the office, look them up, make sure they have good, you know, reviews make, see if they're board certified, see if they teach, you know, there's a lot that parents can do to ensure that their child's in the right hands. And if there's anything they're not comfortable with. It's elective, its teeth, but don't do it. You know what I mean? If you if you're just not comfortable, it's fine. I prefer to punt and not do a case then force it and be cavalier. So I think that's really important from the parents perspective, that they feel like they still have control and they could say I'm not comfortable in this situation, you know. So I think it's great, but that's because it's my job.