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Dental Anesthesia

Versed or not Versed

01/20/2011

Question:

Our son is 8 yr old, and is on the autism spectrum. He has a lot of reservation regarding the dentist,as his last one a (Pediatric Dentist) pulled out two of his teeth that were loose, but on the their way out on their own. And he was strapped to a papoose board to do 1 filling. Our current dentist, wants to call in a Versed Rx for him to get two fillings done. I am very nervous about this, as I have read the adverse affects of it. What are your thoughts of using Versed on children, given the side effects? Thank you

Answer:

Thank you for your question. Midazolam (Versed) is a very safe drug when administered at recommended dosages. Serious adverse effects are indeed very rare. When used alone in typical doses, respiratory (breathing) depression is generally minimal and similar to sleep. If your son is a loud snorer, has very large tonsils, or sleep apnea, this risk increases. For a short procedure, midazolam may be fine. Usually, the dentist will have adequate procedural sedation time of around 15 - 20 minutes. This sounds about right for two fillings. 

The most bothersome adverse effect is "disinhibition", meaning that instead of relaxing your son, he may become agitated. Of course, as you can suspect, patients with autism spectrum are somewhat unpredictable. Still, this is a good safe alternative. The dentist may also add nitrous oxide (laughing gas) which is fine. 

The other option is to have a dentist anesthesiologist come to your pediatric dentist's office and provide deep sedation or general anesthesia. Dentist anesthesiologists are dentists who have completed a full, accredited residency in anesthesia for dentistry. Many times, the autistic patient can only be treated in this way. Alternatively, you may have the dentist take your son to the operating room but the costs are very high. To find a dentist anesthesiologist, go to asdahq.org I hope this helps.

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Response by:

Steven I Ganzberg, SB, DMD, MS Steven I Ganzberg, SB, DMD, MS
Formerly, Clinical Professor of Dentistry
College of Dentistry
The Ohio State University