Questions and Answers for Parents

Using full anesthesia in a dental setting is done to avoid provoking a child’s overwhelming fear and also makes it faster and easier on the child when he or she must be treated for complicated dental conditions.

Full anesthesia also ensures your child can receive the highest level of dental care in the shortest amount of time. Most children who undergo dental anesthesia are sedated for a period ranging from as little as five minutes up to two hours for the most serious or invasive treatments.

Previously, the most likely alternative for children who needed anesthesia as part of their dental treatment required they be admitted to a hospital, with their dentist traveling there to perform needed procedures.

Unfortunately, being admitted to a hospital purely to receive anesthesiology services is expensive for parents and can be even more frightening to a nervous child who is thrust into an unfamiliar setting.

While many children can be successfully treated in a dental office using light sedation techniques such as laughing gas, your pediatric dentist may decide that this may not be effective or appropriate for your child’s situation.

Pediatric dentists are specialized practitioners who receive an extra two to three years of training in formal residencies after dental school to enable them to best care for infants, children and patients with special health care needs. During their additional education, pediatric dentists study advanced behavior management techniques—both pharmacological and non-pharmacological—to help them best gauge the right standard of treatment for your child.

If your pediatric dentist recommends you consider allowing anesthesia be used to fully sedate your child, he or she has determined that this is the best, most effective and pain-free way to properly treat him or her.

For instance, without full sedation through anesthesia, your child might otherwise need to be physically restrained in order to accomplish needed dental work. This can be traumatizing and also leads to poor quality dentistry because of the inherent treatment limitations. Without sedation, extensive dental work may also require multiple appointments. Extending complex treatments over several days can also cause your child unnecessary fear or upset.

Before a pediatric dentist suggests general anesthesia, he or she will first evaluate your child using the following factors:

• Developmental level of your child
• Cooperation level of your child
• Temperament of your child
• Anticipated dental treatment needs (both present and future)
• Risks of anesthesia
• Anticipated quality of dental care if provided using non-general anesthetic techniques
• Anticipated psychological distress if provided using non-general anesthetic techniques
• Caries (decay) risk

Dr. Lipon is dually board certified in both pediatric dentistry and dental anesthesiology, which makes him uniquely qualified to answer any questions you have about full sedation and pediatric dentistry. His experience and training also allow him to work seamlessly beside your pediatric dentist in order to achieve the highest level of care for your child.

Given his dual training as both a pediatric dentist and as a dentist anesthesiologist, Dr. Lipon understands both how and why anesthesia may be recommended in a dental setting. Because of that, he is able to provide the level of focused, attentive care your child needs while his or her pediatric dentist addresses the child’s dental situation.

After practicing for 13 years as a general dentist and completing his dentist anesthesiology training, which required two to three years of work in a full-time, hospital-based residency, Dr. Lipon also completed his pediatric dentistry residency.

Pediatric dentists receive several years of extra training in formal residencies to enable them to best care for infants, children and patients with special health care needs. Pediatric dentistry is recognized by the American Dental Association as a dentistry specialty.

During his resident anesthesiology training, Dr. Lipon provided IV sedation and general anesthesia for a full scope of medical procedures, including general surgery, orthopedic surgery, head and neck surgery, plastic surgery, neurosurgery and trauma surgery. Typical rotations during this specialized training included working in emergency medicine, internal medicine and pediatric medicine, as well as practicing outpatient dental anesthesia.

Dr. Lipon is on faculty at the Department of Pediatric Dentistry at the University of Minnesota and serves as an attending dentist for pediatric sedation cases at the Hennepin County Medical Center in Minneapolis.

And because Dr. Lipon and a minimum of one--and often two--registered nurses directly supervise every aspect of the anesthesia process in your child’s local dental office, they are able to provide the highest level of care for him or her in a safe, cost-efficient and familiar setting.

Dr. James Lipon, DDS

Education:

Bachelor of Science
University of Alberta
Edmonton, Alberta, Canada

Doctor of Dental Surgery
University of Alberta
Edmonton, Alberta, Canada

Residency in Dental Anesthesiology
Lutheran Medical Center
Brooklyn, New York

Residency in Pediatric Dentistry
University of Minnesota
Minneapolis, Minnesota

Board Certifications:
Diplomate – American Dental Board of Anesthesiology
Diplomate – American Board of Pediatric Dentistry

Licensure:
State of Minnesota Board of Dentistry
Dental License # D13930

Today anesthesiologists have the advantage of many modern delivery methods and monitoring techniques to make sure patients remain safe during anesthesia. Properly administered and monitored anesthesia is generally considered low-risk and is employed every day in many tens of thousands of medical procedures throughout the world.

The most common complications from anesthesia typically include nausea and vomiting, a sore throat after the anesthesia, mild fever or a bleeding nose.

And while there is always a small possibility that a patient may have some adverse reaction to anesthesia, both Dr. James Lipon and his nurse(s) are exceptionally trained to react to and handle unforeseen events. The team routinely conducts mock emergency drills, and Dr. Lipon also maintains certifications in CPR, ACLS and PALS. An emergency plan is also in place at each dental office to provide immediate transfer to a hospital in the case of any adverse event.

In addition, Minnesota Dental Anesthesia provides the same type of precautionary emergency equipment and medications on site that you would find in a hospital-level anesthesiology practice.

Minnesota Dental Anesthesia also requires a preoperative history and physical to be completed by your child's primary care physician in advance of the procedure in order to fully understand any underlying medical issues that may affect the anesthesia process.

This guidance from your child's primary care physician gives Dr. Lipon information from someone who knows your child’s medical history best. In some cases, Dr. Lipon may follow up with your primary care physician on medical issues such as asthma to ensure your child is in the best possible health prior to undergoing anesthesia.

In the case of very young children, one issue that is being increasingly recognized as a potential side effect of anesthesia on the developing brain is called neurotoxicity.

Initial animal and some small human studies have suggested that anesthetic and sedative drugs could affect normal brain development and result in cognitive deficits.

While the neurotoxicity issue is still being studied, leading authorities suggest anesthesiologists follow these recommendations to minimize this potential side effect:

1. Try to limit the number of anesthetics to one in children less than 3 years of age.
2. Make sure that the medical or dental procedure is necessary.
3. Try to only give anesthesia to ages 3 and above.
4. Try to limit procedural time to 3 hours or less.

You and your child benefit from the fact that Dr. Lipon takes steps to make sure your child is in the best possible position to receive anesthesia before he begins.

In a dental office setting, Dr. Lipon and his staff can generally administer anesthesia to children age 2 and older. (Anesthesiology is commonly used on children as young as newborns on up for a wide range of health issues when conditions mandate critical treatment.)

Children age 2 and up can be good candidates for dental anesthesia for a number of reasons: Your child may be experiencing significant pain because of a dental infection or may need complex or emergency dental work that cannot safely wait until the child is older. In other cases, your child may present complicating oral or maxillofacial issues of the hard and soft tissues of the mouth, including a type of tongue malformation known as ankylogossia, commonly known as “tongue tie.” Tongue tie hampers and restricts the tongue’s natural range of motion, making critical dental work in a conscious child patient very difficult, if not impossible.

Full sedation also can be a good option when a very young child is too frightened or uncooperative for your pediatric dentist to complete the dental procedures needed.

Because dental anesthesia is almost always a scheduled procedure, Dr. Lipon and his staff are able to fully prepare in advance to best treat your child in the safest way.

The goal on the day of treatment is for everyone involved to be as comfortable as possible moving forward with the dentistry, the anesthesia and the anesthesia plan.

Dr. Lipon will speak with you on the phone several days before your child’s scheduled appointment to review your child’s medical history, outline the risks and benefits of anesthesia, provide instructions for you and your child and answer any questions you may have. If any situation arises that makes it a better option to postpone anesthesia—such as if your child is sick or has not fasted completely — treatment can be delayed until employing full sedation is optimal.

During anesthesia, a child may be sedated by breathing a gas, receiving medicine in their shoulder or thigh (similar to an immunization) or even by drinking a syrup that contains medication. Minnesota Dental Anesthesia encourages parents to be directly involved with your child falling to sleep under the team’s care. Once your child starts to fall asleep, a staff member will take you to the waiting room until your child is in the post-anesthesia recovery period.

In most cases, after your child is asleep, an intravenous catheter will be inserted as a precaution, should your child require additional medicines at any point during the anesthesia. In addition, in most instances after your child is fully asleep, a breathing tube will be put in place through the nose to deliver oxygen. This tube will stay in place for the duration of the dental procedure.

During the recovery period post-anesthesia, the Minnesota Dental Anesthesia team will reunite you with your child at the earliest possible time that it is safe to do so.

Dr. Lipon will provide you with a full set of instructions for post-anesthesia care for your child. (These forms are also available for download in the tab marked “Forms” on this page.)

There are two common scenarios when Dr. Lipon will postpone anesthesia — when your child has not fasted completely or if your child is showing certain signs of illness.

Minnesota Dental Anesthesia and Dr. Lipon strictly follow the American Society of Anesthesiology fasting guidelines. This includes no solids for 6 hours prior to a procedure (cereal, toast, jam, etc.) and no clear liquids for 2 hours prior to a procedure (water, apple juice, ginger ale, etc.).

Any person who will undergo anesthesia must strictly observe all fasting orders because the risk of vomiting increases with full sedation. If the contents of the stomach end up in the lungs, it can be life-threatening.

Dr. Lipon allows no exceptions to the fasting rules because of his absolute commitment to your child’s safety. Even if your child only had a single bite of toast or a sip of orange juice before the procedure, Dr. Lipon will postpone anesthesia.

If Dr. Lipon has any question about your child’s being appropriately fasted prior to a procedure, he will either rebook to later in the day or reschedule for another day.

Dr. Lipon may also decide to postpone anesthesia if your child is showing certain signs of illness. He may, however, make an exception if he believes your child feels sick or is running a fever because of the dental problem that needs to be addressed.

Children often experience viral upper respiratory tract infections throughout the year. If your child is outwardly sick or has a fever because of such an infection, Dr. Lipon may decide to cancel the elective general anesthetic. He will weigh the signs and symptoms of your child’s upper respiratory infection against the possibility that if the procedure is rescheduled, your child may also have similar infection on that day.

In every case, Dr. Lipon will use his best judgement about postponing anesthesia to ensure your child receives the safest possible care. If he does decide to postpone anesthesia, any fees you have paid will be applied toward your child’s next appointment.

It depends. Not every child is an appropriate candidate for dental office-based anesthesia.

Minnesota Dental Anesthesia and Dr. Lipon will weigh the merits of administering anesthesia in a dental office setting with the individual child’s specific challenges. In some cases, he will be able to safely and effectively anesthetize your child without any concerns. In other cases, he may decide your child would be more effectively treated in a hospital setting.

In every case, Dr. Lipon’s decision to treat any child centers exclusively around their health and wellness.

Typically, your pediatric dentist office can give you the costs associated with anesthesia, based on their anticipated treatment time for your child.

Minnesota Dental Anesthesia does not accept insurance but will accept all major credit cards.

From a medical provider’s standpoint, working with insurance companies can be very costly and time-consuming, and providers often must charge much higher rates to account for the time spent interacting with a wide range of insurance carriers.

Because Minnesota Dental Anesthesia does not accept insurance, we are able to offer you the most cost-effective and highest-quality anesthesia services available.

Minnesota Dental Anesthesia will be happy to give you an estimate which you can submit to your insurance carrier for consideration of reimbursement.

Payment for anesthesia is due when booking is completed for your anticipated procedure. This way, on the day of the procedure Dr. Lipon and his staff can concentrate solely on the care of your child.

• Consent for Anesthesia
  
• Pre-operative History and Physical Form
• Pre and Post-operative Instructions