Children’s Dental Treatment Under General Anaesthetic

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

What is a general anaesthetic?

A general anaesthetic makes your child unconscious so they do not feel pain during their operation. This is given by an Anaesthetist.

Anaesthetists are specialist doctors who give the anaesthetic drugs and looks after your child during surgery. They are also closely involved with your child’s pain relief after surgery.

Some anaesthetics start with an injection into a vein and some start with breathing in gas.

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 decides whether your child’s treatment will need to be done with a general anaesthetic.

Are there any risks or complications?

Most children recover quickly and are soon back to normal after their operation under general 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. 

A child in good health, having minor surgery, may experience one of the following:

• Headache or a sore throat. This can happen to 1 child in every 10.

• Sickness or dizziness. This can happen to 1 child in every 10.

• Agitation on waking. This can happen to 1 child in every 5.

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

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

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

There may be a small increase in risk for children with learning disabilities or medical problems, but this risk is 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 for full preparation for their operation and the anaesthetic, and a longer recovery period afterwards. If your child needs this, they may need to be seen at a different hospital that has extra facilities.

How can I prepare my child for a general anaesthetic?

Unless your child is very young, it’s important that you try and explain that they are going into hospital. You need to explain why they need to have their teeth looked at by the Dentist.  Make sure to 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, while older children may need more time.

What is the Little Journey app, and how can it help?

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. 

To start using the app, you must select North Tees & Hartlepool Hospital from the list. 

The app covers many different types of children’s surgery in the hospital, some of the details in the story may not apply to your child. Some will say ‘operation’ but your child will be having a dental procedure. 

Hopefully, with this app, it will allow you and your child to become more familiar with the process of their anaesthetic.

What else can I do to help my child prepare?

On the day of their dental treatment, your child will come to the Children and Young Persons Elective and Investigations Unit for their care.

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

The Unit has a team of Hospital Play Specialists who will offer support and advice, if needed. 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. 

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

What will happen before my child’s hospital appointment?

Following your child’s assessment with the Community Dental Team, the Children’s Pre assessment Team will contact you by telephone to carry out their anaesthetic pre-assessment screening.

The screening is to identify any children who may need to be seen by the team for further medical assessment before the day of their treatment.

The team may ask you and your child to attend a face-to-face assessment appointment with one of the Consultant Anaesthetists to ensure that we will be able to safely look after your child on the day of their operation.

Once your child’s treatment date is set, you will have an appointment at one of the Community Dental Clinics to meet the Dentist who will be doing the treatment. At this appointment the team will check whether or not there have been any changes to your child’s medical or dental needs, they will confirm the treatment plan (if possible) and will go through the consent process.

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

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

For morning   appointments, all children are asked to arrive at the Children and Young Persons Elective and Investigations Unit at 7:15am.  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 members of staff will come and see your child before they go to theatre. They all have an important role in looking after your child. 

The Nurses will admit your child to the hospital and do some basic observations, such as taking their temperature and heart rate. They will also 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 your child and check that they 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 then 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 for any medication your child may be taking.  Occasionally, the Anaesthetist may learn something about your child that may result in delaying and/or postponing the procedure on the day. As an example, it could be if your child is unwell.

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

There are two ways anaesthetic can be given. These are by:

• Gas through a clear facemask – A clear facemask attached to the anaesthesia gas will be placed over your child’s face covering the nose and mouth. As they breathe this in, they will slowly fall asleep. This usually takes about 1 to 2 minutes to take effect.

OR

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

In some occasions, the Anaesthetist may prescribe pain medication before your child goes to theatre. This will help ensure that they are comfortable when they wake up and will reduce the pain they feel afterwards. You should try and encourage your child to take it.

Once you have seen the anaesthetic team, the Play Specialist will go through the anaesthetic plan again and they have cards and books to help your child understand what is going to happen.

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

Theatre

When it is your child’s turn to go to theatre, the Play Specialist or Nurse looking after them, will take you round to the operating theatre. The parent/carer can go to the operating theatre and be present when the child goes to sleep. 

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

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.

When your child is asleep in theatre, the team will take you back to the Unit. 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 Dentist will give you an approximate idea of the expected time, however, every child is different and this may change depending on their needs.

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

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 their treatment?

When your child is fully awake a Nurse 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.

Children have to remain on the Unit for a minimum of 1 hour after their operation before they can go home. Your child will be offered a drink and something to eat once they are fully awake.

The staff 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 result of your child’s treatment with you before they are discharged. Once the theatre list is finished, the Dentist will be available to discuss and answer any 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.

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.

References

• Common events and risks for children and young people having a general anaesthetic. Royal College of Anaesthetists. March 2022 Child-Infographics2022_0.pdf

• Information for Parents and Carers – Your Child’s General Anaesthetic. Royal College of Anaesthetists. October 2023 Your child’s general anaesthetic | The Royal College of Anaesthetists.

Contact Numbers

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

Children and Young Persons Elective and Investigations Unit
Telephone: 01642 383470                                               
Monday to Friday, 7:00am to 6:00pm                                                    

Community Dental Service (GA Office)
Telephone: 01642 944734
Monday to Friday, 8:30am to 4:30pm

Children’s Ward
Telephone: 01642 382715
24 hours a day, 7 days a week

Emergency Department
Telephone: 01642 382899
24 hours a day, 7 days a week

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.

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 at www.nhs.uk   

Further information is available from?

The Royal College of Anaesthetists
Churchill House                                                                                   
35 Red Lion Square
London. WC1 4SG
Telephone: 020 7092 150
Website: www.rcoa.ac.uk    

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, 2023”.

The Association of Anaesthetists of Great Britain and Ireland
21 Portland Place                                                                                
London. WC1 1PY.
Telephone: 020 7631 1650
Website: www.aagbi.org    

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

Patient Experience Team (PET)

North Tees and Hartlepool NHS Foundation Trust would like your feedback. If you would like to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Team who will help you to do this.

This service is based at the University Hospital of North Tees but also covers The University Hospital of Hartlepool, our community hospitals and community health services.

North Tees and Hartlepool NHS Foundation Trust
Telephone: 01642 624719
Freephone: 0800 092 0084
Email: [email protected]
Monday to Friday, 9:30 am to 4:00 pm

Out of Hours
If you wish to speak to a senior member of Trust staff, please contact the hospital switchboard (numbers below).