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Thursday, August 17, 2017
Anesthesia-Child allergic to soy
My child is 4 and has 2 cavities. We tried to use to nitrous oxide on her but it didn`t relax her enough, so the dentist said that general anesthesia would be best. The problem is that she is allergic to soy (which is in the anesthesia). The anesthesiologist at the dental office says she could possibly have a reaction to the anesthesia and he refused to fill her cavity. He recommend we have her cavity filled at a Children`s hospital. Is that really necessary? Are there alternative ways to sedate her without using general anesthesia?
Thank you for your question. There are other options. With only two cavities (preferably your child would cooperate with x-rays of the teeth to confirm this is all that is needed), especially if at least one is in the upper jaw, oral sedation in conjunction with nitrous oxide maybe work well. Your dentist may not have a permit from the dental board to provide this service or may not have the experience to do so. Most specialist pediatric dentists do. So, that is one option.
If this is not an option when discussing this with your dentist, then general anesthesia is likely the only alternative. Fortunately, for a healthy 4-year-old, this is a very safe procedure with a trained dentist or physician anesthesiologist. Both dentists and physicians may specialize in anesthesiology.
The issue with soy is that the most common intravenous general anesthetic used has soybean oil in the base of the emulsion that contains the anesthetic agent. The oil used is highly purified and contains very minute trace quantities, if any, of soy protein, the component responsible for allergies. And the allergic reaction is very important as well to make sure it is a true allergy and not an intolerance.
Regardless, the agent can generally be used and there are alternatives as well. So, a safe office-based anesthetic can, in my opinion and barring a severe anaphylactic reaction to soy, be provided safely. In the hospital, inhalation (gas) anesthetics are used and therefore intravenous anesthetics can more or less be bypassed.
It is important to ensure your office-based anesthesiologist is fully trained as well. Discuss this with your dentist.
Steven I Ganzberg, SB, DMD, MS
Formerly, Clinical Professor of Dentistry
College of Dentistry
The Ohio State University