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Q. Does the removal of a supernumerary tooth require conscious sedation?

Answered by
Dr. Krishna Swaroop Achanta
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Nov 16, 2021

Hello doctor,

My 11-year-old son has a supernumerary tooth, and we need to extract that tooth. I was told that this procedure needs conscious sedation with periodic monitoring of vitals. But I am afraid of the medications that are used for sedation. Because some medicines will cause side effects like difficulty in breathing and a drop in blood pressure. I wanted to know if that procedure could be done under local anesthesia.

Thank you.

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#

Hi,

Welcome to icliniq.com.

Sedation is one of the options for the extraction of a supernumerary tooth. The other method is sedation along with general anesthesia. In extraction without sedation, the child should be cooperative, and the parents should console their child at the time of extraction. Your moral support will help get this extraction under local anesthesia. The child may cry or protest a bit, and the surgical procedure may be delayed for more than an hour because of the lack of cooperation. As you said, sedatives are commonly used in general anesthesia, which lasts around 40 to 60 minutes. But the recovery period for the child will be more because you need to wait a few hours for the sedative effect to entirely wears off. If the child is cooperative and you extend your full support to the child and the surgeon, it is possible to extract the tooth under local anesthesia. Nitrous oxide is a safe alternative along with local anesthesia. Is your child cooperative generally, or is it the first procedural visit to the dentist?

Thanks.

Hello doctor,

Thanks for the reply.

He is cooperative, but it is the first time he is getting an extraction.

In case of the doctor still wants to use conscious sedation, how good are the reversal medications?

Thanks.

#

Hello,

Welcome back to icliniq.com.

I think there is no need to use conscious sedation if nitrous oxide is used for extraction. But if the dentist still insists on sedation, it is safe to go with it. But do take it in writing about iv sedation before the procedure starts and discuss personally how long the effect of their sedative lasts.

It would help if you insisted first on local anesthesia and conscious sedation. If the child is cooperative with good moral support from the dentist and parent, the extraction can be done under potent LA (local anesthesia).

Only if the child is fussy, crying, or totally in pain, then sedative is needed. I think you should talk personally to your surgeon to do the procedure under LA.

Regards.

Hello doctor,

Thanks for the reply.

I have requested to see the doctor today to ask if he will extract the tooth with nitrous oxide and local anesthesia. I want to ask you about your experiences with reversal drugs.

Thanks.

#

Hello,

Welcome back to icliniq.com.

In my experience, nitrous oxide is enough to relax the children and keep them happy and calm during the extraction. If conscious sedation is used, there are drugs like Naloxone to reverse the child back to a fully conscious state. So, do not worry. Kindly go ahead with the extraction. Reversal drugs work well, but note the drugs they are using for sedation and reversal just as a backup in case the child is overly sedated.

Take care.

Hello doctor,

Thanks for the reply.

Because of COVID-19 protocols and as the child is 11 years old, I am not allowed to stay with him during the procedure. What should we do now?

Thanks.

#

Hello,

Welcome back to icliniq.com.

The parent has the right to stay with their child during a routine extraction procedure with the dental surgeon. It is better to visit another surgeon for a personal opinion.

If the extraction is under local anesthesia, it is acceptable to stay outside the procedure room.

Regards.

Hello doctor,

Thanks for the reply.

I just spoke to the surgeon's office, and they told me that the tooth is buried inside the gum. So they have to drill the bony socket to get the impacted tooth out. And so they suggested that sedation is best for him to avoid experiencing any trauma during the procedure.

Thanks.

#

Hello,

Welcome back to icliniq.com.

I think you can proceed ahead with the extraction. All the best. Kindly know the medications they are administering to give excellent postoperative care for the child.

Regards.

Hello, I have spoken to other surgeon and there advise is to wait and monitor, since the chances of this tooth causing problems are low they are saying to monitor it and like that if anything it’s easier to extract it once it gets bigger and it can even erupt, what are your experiences in India with these types of tooth.
# Hi Mrs. Joe,
See even if the chances of the tooth causing any problem is low,it cannot be left ignored for a long time. I am sure that especially if the supernumerary tooth is in between the central incisors , after its removal you might have to go for orthodontic treatment to close the gap as well . The ideal age for supernumerary tooth extraction is 7-10 years here in India as well as in most of the countries worldwide.
I suggest you go for the extraction as soon as possible and get the orthodontic treatment if necessary. Sometimes orthodontic treatment need not be necessary if the supernumerary tooth is not causing a gap and just placed in a wrong position.
The root completion would have been complete at 10 years only of this extra tooth so there is no point of waiting or monitoring .
You can discuss with the doctors about local anesthesia and nitrous oxide sedation or perhaps try speaking to a different maxillofacial surgeon. If they want to do under iv sedative only then do make a note of the reversal drugs and if possible be present physically with your child during the procedure. As I explained before , its not a risky procedure for sure if you have confidence in the clinic you are visiting .
do let me know what options you want to explore or what doubts you have after discussing with the surgeon .From my experience, I would suggest you to clear all your doubts first only before proceeding .

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