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Medications Used to Help Children in the Dental Office
Nitrous Oxide
Nitrous Oxide, commonly referred to as laughing gas, is the most common medication used in dentistry to relieve anxiety. It is a gas that is administered through a mask that fits on the patient's nose. It is given to the patient as a percentage of oxygen usually between 25% and 50%. It can not be given in concentrations above 70%. Because Nitrous Oxide is given as a percentage, the age or weight of the patient does not have any bearing on the proper dose. Since it is a gas that is inhaled, Nitrous Oxide is only effective while it is administered and does not have any lasting effects after administration is discontinued. The most common adverse reaction to Nitrous Oxide is nausea and vomiting and this is more frequent with higher doses although some patients cannot even tolerate a small dose. In order for Nitrous Oxide to be effective, the patient must be willing (cooperative) and able to breathe through his/her nose. For this reason Nitrous Oxide may not be useful for a very young patient or very uncooperative one. Nitrous Oxide will not be effective if the nasal passages are blocked due to a cold or allergy. In addition to providing anxiety relief, Nitrous Oxide is an excellent pain medication. While a person is breathing it some procedures that would normally hurt will not be felt at all. Nitrous Oxide will not make a child go to sleep but may make them relaxed enough to take a nap during treatment. Because Nitrous Oxide is so safe, relieves anxiety, calms and takes away pain it is an excellent medication to use to help most child patients with dental treatment.
Diazepam
Diazepam, commonly known as Valium, is one of the older and most used anti-anxiety medications and can be given by mouth in the form of a small tablet. Valium is usually used in dentistry to help a nervous patient be more relaxed. Although Valium can make a person who takes it more tired and sleepy, it is used here strictly as an anti-anxiety medication and not for the purpose of sedation. At the doses given here many parents don't recognize any change in behavior but this does not mean it is not working and effective. Even if there is no outward sign such as the patient being sleepy, Valium can make an experience not as scary as it would be if the medication was not given. The maximum effect of Valium is about 1 hour after it is taken by mouth but can last several hours after taking it. Children taking Valium should be monitored the rest of the day. The most common adverse reactions are being tired and sleepy for a period of time. Some children actually will get more excited after taking Valium. Valium cannot make a child be cooperative but can really help the moderately anxious patient feel more comfortable. Valium is available in liquid form but due to a bitter taste it is not generally accepted. The small tablet can be soaked in milk or juice for about 10 minutes and then crushed, mixed and taken as a drink.
Promethazine
Promethazine is in the same class of medications as Benadryl, the common allergy medication. Promethazine, also known as Phenergan, is given because it is an anti-nausea medication and it also reduces the amount of saliva that is produced. Promethazine has some calming effects and can make a person tired and sleepy just like Benadryl does. Promethazine is usually given in combination with Nitrous Oxide and/or Valium for added effect. Promethazine can't make an uncooperative patient cooperative but can help, usually with other medications, make the dental procedure more comfortable. Promethazine is available as a tablet or liquid but the liquid form is much more common.
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