Children’s Dental Treatment Under General Anaesthetic

This leaflet tells you about what you can expect when your child comes to hospital for dental treatment under general anaesthetic (whilst asleep).

What is general anaesthetic?

A general anaesthetic makes sure that your child is unconscious and free of pain during their operation. 

This is given by an Anaesthetist.   An Anaesthetist is a specialist doctor who gives the anaesthetic and looks after your child during surgery. 

They are also closely involved with your child’s pain relief after surgery.  They give the anaesthetic using drugs that are used to start and maintain anaesthesia.  These are called anaesthetic drugs. 

Some anaesthetics start with an injection into a vein and some start with breathing in gas.  There are advantages and disadvantages to both methods.

Why does my child need dental treatment under general anaesthetic?

Dental treatment such as fillings and tooth removal can often be carried out using injections to numb the mouth. 

It is also possible to add sedation to relax children who are anxious or afraid.

For some children however treatment under a general anaesthetic may be the only option.  The Dentist has decided that your child’s treatment needs to be done with a general anaesthetic.

Are there any risks or complications?

In modern anaesthesia, serious problems are uncommon.  Most children recover quickly and are soon back to normal after their operation and anaesthetic.

Some children may feel sick or have a sore throat.  These usually last a short time.  Medicines to treat sickness are available and are often given. 

For a child in good health having minor surgery:

• headache or a sore throat. This can happen to 1 child in every 10.^1,2

• sickness or dizziness. This can happen to 1 child in every 10.^1,2

• agitation on waking. This can happen to 1 child in every 5.^1,2

• serious allergic reaction to the anaesthetic. This can happen to 1 child in every 10,000.^1,2

• death from anaesthesia. This can happen to less than 1 healthy child in every 100,000 having minor or moderate non-emergency surgery.^1,2

Are there any extra risks with the anaesthetic if my child has learning disabilities or has special medical problems?

Yes, there may be a small increase in risk but this risk should be outweighed by the benefits of your child’s treatment.  Each child is different and will be carefully assessed (checked) before their procedure so their treatment can be tailored to their needs.

Sometimes children with serious medical problems who need a general anaesthetic for their dental treatment need to be admitted to hospital rather than go home the same day.  This allows full preparation for their operation and the anaesthetic and a longer recovery period afterwards.

How can I prepare my child for a general anaesthetic?

Unless your child is very young, you should try and explain that they are going into hospital. Explain why they need to have their teeth looked at by the Dentist.  Try to explain some basic information about what will happen to them when they are in hospital.

The best time to provide this information will differ between children. Pre-school children probably only need to know the day before. Older children may need more time.

We realise that the build-up to your child’s anaesthetic can be very stressful. Our hospital is using an award winning app, Little Journey, which is free from the App Store. You should select North Tees & Hartlepool Hospital from the list. 

If you have 3D glasses at home you can get an even better view of the hospital, but these are not essential. 

This is to try and reduce the worry that your child may feel. You can download it at home and let your child play with the characters on our ward, in our theatre and in the recovery area.   

The animal characters are for younger children and the people characters are for slightly older children. The app contains several types of children’s surgery in the hospital so some of the details in the story may not apply to your child. (It says ‘operation’ but your child will be having a dental procedure). 

Hopefully it will allow your child to become familiar with the process of their anaesthetic.

If you feel your child may benefit from a visit to the Children and Young Person’s Elective and Investigation Unit (CYPEIU), to see the surroundings and meet the staff before their procedure, this can be arranged by phoning the Children’s Ward 01642 382715 and asking to speak to the Nurse in charge.

The Children and Young Person’s Elective and Investigation Unit has a team of Hospital Play Specialists who will offer support and advice, if needed.  

Hospital Play Specialists will also be available on the day of your child’s treatment to help explain and prepare your child for theatre.

How should I prepare my child on the day of their treatment?

It is very important that your child has an empty stomach (tummy) when they have their anaesthetic.  If there is food or liquid in your child’s stomach during the anaesthetic this could come up into the back of their throat and then go into their lungs which can be very dangerous.

Your child should not eat anything solid (this includes food / milk / yoghurt / fizzy drinks) for 6 hours before their anaesthetic.

Your child should drink water or very dilute juice up until 1 hour before your arrival time so that they do not become too thirsty.

Your child will be able to eat and drink after their dental treatment.  The hospital will provide them with food, but it may be worth packing their favourite healthy snack. 

Your child can also bring a toy to the hospital, which they may find comforting.

What will happen on the day?

On the ward

Please follow the instructions sent to you from the Community Dental Team.

For a morning appointment: All children are asked to arrive at the Children and Young Person’s Elective and Investigation Unit at 7.15am. You can get to the Unit through the Children’s Ward (Ward 15).

For an afternoon appointment: All children are asked to arrive at the Children and Young Person’s Elective and Investigation Unit at 12.30pm. You can get to the Unit through the Children’s Ward (Ward 15).

Space on the Unit is limited and a maximum of 2 adults per child are allowed on the Unit. We request that you do not bring any other children along to the hospital on the day of treatment as the Unit can get very busy.

Several people will come and see your child before they go to theatre.  They all have an important role in looking after your child.  The nurses on the Ward will admit your child to the hospital and do some basic observations, such as taking their temperature and heart rate.  

The nurses will try and put some local anaesthetic cream (numbing or magic cream) on the back of your child’s hands. This does not hurt, but if you think your child will not like this please let the nurses know. It is important to try and get the cream on as it gives your child more options for the anaesthetic. 

The Dentist will come and see you and check that you are still happy to have the treatment that has been discussed and to answer any last minute questions you or your child might have. 

The Anaesthetist will come and see you too. They will ask you some general questions about your child’s health, if they have ever had an anaesthetic and any allergies or any medicines your child may be taking. 

Occasionally the Anaesthetist may learn something about your child that means it would be safer not to do the procedure on that day.

This could be if your child is unwell and it may mean that your procedure is postponed. 

The Anaesthetist may decide that your child needs premedication (pre-med). This is the name for a drug given before the anaesthetic starts. It may make your child feel more relaxed but in some children can have an opposite effect. The Anaesthetist will talk to you about this. 

The Anaesthetist will discuss with you the best option for your child and will give you time to ask questions so that you can decide together on the best plan for your child’s anaesthetic.

The anaesthetic will be given by:

• gas through a clear facemask. The anaesthetist will need to hold the clear facemask quite tightly over your child’s face and they may become very restless. It may be quite distressing for you.   If the anaesthetist uses gas it takes about 1to 2 minutes for your child to go to sleep.

or

• inserted into a cannula (a fine tube inserted into a vein in the back of your hand or arm using a small fine needle). If a cannula is used your child will go to sleep very quickly and can be easier for yourself and your child. 

The Anaesthetist will prescribe pain medication to be given before your child goes to theatre. You should try and encourage your child to take it, as it will help them wake up more comfortably. 

You will also meet the Play Specialist and they will go through the anaesthetic plan again, they have cards and books to help your child understand what is going to happen.

They also provide a range of toys, games and activities on the Unit, which your child can play with while waiting for their treatment. This helps to make your child feel less anxious. 

A parent or guardian must stay with their child during the day.  

Going to theatre

When it is your child’s turn to go to theatre, the Play Specialist will take you; 1 parent/carer can go to the operating theatre and be present when your child goes to sleep. 

Your child will go off to sleep in theatre either on the trolley or sitting on your lap if they are small. The Anaesthetist will use the plan that you have discussed earlier. 

The Play Specialist will try and help to make your child feel less anxious.  It is quite normal for you to feel quite distressed even if everything goes very smoothly. 

When your child is asleep in theatre the Play Specialist will take you back to the Ward to wait. You will be asked to wait back on the Unit while your child’s treatment is carried out, in case the Dentist needs to speak to you.

Your child’s treatment time may vary from 30 minutes (simple extractions) up to over 2 hours (several fillings and extractions). 

The Community Dentist will give you an approximate idea of the expectedtime at your pre-admission appointment, however every child is different.

Do not be concerned if your child’s treatment takes longer than expected.

In the recovery room

Your child will wake up in the recovery room.  A Specialist Nurse will look after them until they are fully awake and the Anaesthetist will be close by.  You will be called as soon as your child is awake and comfortable. 

Many children show signs of confusion or distress when they wake up, especially smaller children. 

A few children become very agitated and they may cry and move about.  This usually settles after about 30 minutes when they are fully awake.  The nurses will advise you, as they are experienced in looking after children at this time. 

What happens after my child has had the treatment?

When your child is fully awake, a nurse from the Children and Young Person’s Elective and Investigation Unit will collect them from the recovery area with 1 parent / carer and return to the Unit.   

When your child first wakes up they are likely to be a bit confused and may cry for a short time.

Your child may have local anaesthetic given once they are asleep to make their mouth numb.  This numb / tingly feeling will last for

3 to 4 hours after their operation and may feel strange but it will return to normal later in the day.

Your child will be offered a drink and something to eat.  

Children have to remain on the Unit for a minimum of 1 hour after their operation before they can go home.

The nursing staff on the ward will let you know when your child is ready to go home and will explain how to look after your child following their treatment.

When will I be told the result of my child’s treatment?

The nurse will discuss the treatment your child has had with you before they are discharged. Once the whole theatre list is finished, the Dentist will be available to discuss and answer questions, which you may have.

You will be given a copy of your child’s discharge letter which tells you what treatment has been carried out. A copy of this letter is sent to your child’s Dentist and also your child’s GP to add to their medical records.

How will my child feel when they get home?

It is common for children to:

• feel dizzy and a bit sickly for a few hours.
• be sick occasionally, especially if they have swallowed a little blood during treatment.
• have some discomfort for a few hours.

Make sure you have age appropriate pain relief medication at home as you can help by giving your child this regularly after you leave hospital.

When your child is ready to go home the nursing staff will let you know what time they can have more pain medicine.

Your child may feel tired due to the effect of the anaesthetic. Do not worry; they should just relax quietly at home.

Children should be fully supervised and stay off school for the remainder of the day.   Children should not take part in any vigorous exercise for at least 24 hours – no running, playing outside, swimming or cycling.

All children should see their Dentist for a check up no more than 3 months after their treatment.

Contact numbers

If you have any worries or concerns following your child’s treatment, please feel contact the team:

Children and Young Person’s Elective and Investigation Unit

Telephone: 01642 383470

Opening hours: 7:00am to 6:00pm (Monday to Friday)

Community Dental Service (GA Office)

Telephone: 01642 944734

Opening hours: 8:30am to 4:30pm (Monday to Friday)

Children’s Ward

24 hours a day, 7 days a week.

Telephone: 01642 382715

Emergency Department

24 hours a day, 7 days a week.

Telephone: 01642 382899

If you have any worries or concerns, you should contact your Dentist during normal surgery hours. Outside surgery hours, you should contact your Dentist’s surgery for the Out of Hours Service number.

Further information is available from:

The Royal College of Anaesthetists

Churchill House                                          

35 Red Lion Square

London

WC1 4SG

Telephone: 020 7092 150

This organisation is responsible for standards in anaesthesia, critical care and pain management throughout the UK.

This publication includes text taken from The Royal College of Anaesthetists’ (RCoA) leaflet “Your Child’s General Anaesthetic: information for parents and guardians of children, 2017”.

The Association of Anaesthetists of Great Britain and Ireland

21 Portland Place                                       

London

WC1 1PY

Telephone: 020 7631 1650

This organisation works to promote the development of anaesthesia and the welfare of anaesthetists and their patients in Great Britain and Ireland.

NHS Choices

Telephone: 111 (when it is less urgent than 999).

Calls to this number are free from landlines and mobile phones or via the website.

References

1. Your Child’s General Anaesthetic for Dental Treatment: information for parents and guardians of children.  The Royal College of Anaesthetists’ (RCoA), 2008.
2. Your Child’s General Anaesthetic: information for parents and guardians of children.  The Royal College of Anaesthetists‘, 2020.

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

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Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

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Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]