Laurie A. Birsch, DDS
Portsmouth
(757) 398-1234
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Patient Info

  • Welcome
  • First Visit
  • Scheduling
  • Financial Policy
  • Insurance
  • Privacy Policy
  • Sedation
  • Pain Control
  • FAQ

Sedation

Sedation is most helpful for:

  • Infants
  • Children who require major treatment
  • A very anxious child
  • Children that have had traumatic dental experiences (sound and smell aversion)
  • Children with a strong gag reflex
  • Children who are medically compromised or have special needs

Reducing Fears

Dr. Birsch understands parents’ concerns about the fears their children possess concerning dental care treatment. Many fear going to the dentist themselves and want things to be different for their own children.Our team employs a variety of methods to accomplish this goal.

The office environment a child enters into plays a big part in either contributing to or reducing anxiety. When children are at ease with their surroundings they tend to adopt a more relaxed attitude. The office is designed especially for children. They feel right at home with the open atmosphere, cheerful colors and underwater theme.

Communicating with children on their level is one of the most important ways to reduce their fears. Dr. Birsch and her team are excellent communicators with children. They have a great deal of experience at it because it is what they do all day long. They constantly apply a technique known as Tell Show Do. They first “tell” the child what they are going to do in terms that the child can easily understand. Then they demonstrate or “show”it to the child. Then they” do” it together. The technique is very effective. It takes a little extra time but the children are not rushed.

If cavities develop and Dr. Birsch has to provide dental treatment, nitrous oxide, or “laughing gas”,can be used to relax the child. This mild, odorless gas is breathed through a small nosepiece while the child remains awake and able to communicate throughout the dental treatment. It is a very safe and effective technique.

Conscious sedation is an excellent way to provide dental treatment to very young children, fearful children and children with numerous dental needs. The child takes a combination of liquid medications or tablets about an hour before beginning dental treatment. The medications reduce fear and anxiety and may cause drowsiness or sleep but the child will remain conscious throughout the appointment. When used in combination with nitrous oxide, a much more effective result is reached in providing relaxation.

In certain situations general anesthesia offers the best method to deliver dental care in a relaxing atmosphere. It is most often recommended for young children with extensive dental needs that would otherwise require lengthy multiple conscious sedation appointments. It is also recommended for very young children with extreme fearfulness, anxiety, and apprehension,for children that are unable, by either age or maturity level, to cooperate during dental treatment, and for children with medical conditions or special needs. With the aid of general anesthesia the child is put to sleep by an anesthesiologist in a hospital or outpatient surgery center. Dr. Birsch then provides all the necessary dental treatment while the child is asleep. After a short recovery period, the child returns home the same day.

While all of these methods usually reduce fear and anxiety, some children may still exhibit apprehension regardless of the efforts made to put them at ease. Our team has lots of patience with children. When other options are ineffective, demonstrating patience to a child eventually wins out.We get enormous satisfaction when frightened children replace their fears with confidence and their frowns with smiles.

 
 
Nitrous Oxide
 
Nitrous oxide, commonly known as “happy gas” or “laughing gas”, is a combination of two gases: nitrous oxide and oxygen. It is used as an effective relaxation agent to calm a child’s fear of the dental visit and enhance effective communication. Additionally, it works well for children whose gag reflex interferes with dental treatment.
 
The American Academy of Pediatric Dentistry recognizes this technique as a very safe, effective technique to use for treating children’s dental needs.It is well tolerated, non-addictive, and non-allergic. The rapid onset is completely reversible and can be adjusted in various concentrations. Your child will inhale the gases through a flavored nosepiece. While breathing nitrous oxide, your child is fully conscious, is capable of communicating, and keeps all of his/her natural reflexes.Your child may feel like he/she is floating or tingling during its use. At the end of treatment, the deep feeling of relaxation is eliminated after a short period of breathing fresh oxygen. At this point, there are no residual effects of the laughing gas.
 
Prior to your appointment:
 
Some children can feel nauseated with its use. For this reason, please give your child little or NO food prior to the dental visit using nitrous oxide/oxygen. A piece of dry toast or small amount of dry cereal is all that is recommended. Please avoid all dairy and egg product prior to dental treatment.
  • Please inform us of any change to your child’s health and/or medical condition.
  • Tell us about any respiratory condition that makes breathing through the nose difficult for your child. It may limit the effectiveness of the nitrous oxide/oxygen.
  • Let us know if your child is taking any medication on the day of the appointment
 
Conscious Sedation
 
Conscious Sedation is recommended for apprehensive children, very young children, and children with special needs. It is used to calm your child and to reduce the anxiety or discomfort associated with dental treatments. Your child may be quite drowsy, and may even fall asleep, but they will not become unconscious.
 
There are varieties of different medications, which can be used for conscious sedation. The doctor will prescribe the medication best suited for your child’s overall health and dental treatment recommendations. We will be happy to answer any questions you might have concerning the specific drugs we plan to give to your child.
 

Prior to your appointment:
  • Please notify us of any change in your child’s health and/or medical condition: any new and/or current medications, and any drug reactions and/or change in medical history.
  • We must know if your child has taken any medications for 2 days prior to the sedation visit. If your child is sick (cough, cold, ear ache, congestion, fever, nausea, rash, etc.) the day before the appointment, please call our office since we may need to postpone and reschedule the appointment.
  • Your child must have NOTHING TO EAT OR DRINK AFTER MIDNIGHT.We will check with your pediatrician if your child must take daily medications.
  • Please dress your child in loose fitting, comfortable clothing. Two-piece pajamas without a bootie attached to the leg are excellent. Please bring an extra set of clothing with you to the appointment.
  • Please make sure that your child goes to the bathroom immediately prior to arriving atour office.
  • Be prepared to remain in the office up to 3 hours. Do not plan to leave the office during that time.
Dental treatment will not begin until 45-60 minutes after the medication is given orally. Please watch your child closely while the medication is taking effect.Your child will act drowsy and may become slightly excited at first. Hold them in your lap or keep close to you. Do not let them “run around.”
 
Your child will require your close attention during the visit and while recouperating at home. Do not bring other children to the office that day or plan to complete errands during or after the visit.We recommend that you bring extra person to assist you.
 
After the sedation appointment:
 
The sedation medication your child was given can taken 4-6 hours to wear off. Your child will probably go home and sleep for 1-4 hours and should NOT be left unattended, even while sleeping. Check on your child every 15 minutes or so while sleeping. Occasionally the sedation will cause a child to become very hyperactive or irritable. Your child may experience dizziness, agitation, or excitement in response to the medication. This lasts 30-60 minutes and will go away.
 
You must carry or support your child during transport in a car seat. It is recommended that you bring another person to drive while you monitor your child closely. Keep your child away from areas of potential harm. Restrict his/her activity (playing, climbing, running, etc.) since the effects of the medication may linger on for several hours. It is extremely important for you to:
  • Keep your child under observation; if you are unable to do so, have another responsible adult supervise your child. Do NOT leave your child unattended!
  • If your child wants to sleep, place them on their side with their chin up. Do not allow your child to obstruct his/her breathing with a pillow, clothing, etc.
  • Wake your child every hour and encourage them to have something to drink in order to prevent dehydration. At first it is best to give your child sips of clear liquids, such as apple juice, ginger ale, etc., to prevent nausea.
  • If your child vomits, help them bend over and turn their head to the side to insure that they do not inhale the vomit.
  • Do not force solid food until your child is alert and ready. You may prefer to wait until any numbness wears off if your child received local anesthetics so that he/she does not bite his/her lips, cheeks, or tongue. The first meal should be light and easily digestible.
  • Because we use local anesthetic to numb your child’s mouth during the procedure, your child may have the tendency to bite or chew their lips, cheeks, and/or tongue and/or rub and scratch their face after treatment. Please observe your child carefully to prevent any injury to these areas.
  • If needed for discomfort, give Children’s Motrin or Tylenol as directed on the package label.
Please call our office for any questions or concerns that you might have, 757-398-1234.
 
 
Outpatient General Anesthesia
 
Outpatient General Anesthesia is recommended for apprehensive children, very young children, and children with special needs that would not work well under conscious sedation. General anesthesia renders your child completely asleep. This would be the same as if he/she was having their tonsils removed, ear tubes, or hernia repaired. This is performed in a hospital or outpatient setting only.
 
While the assumed risks are greater than that of other treatment options, if this is recommended for your child, the benefits have been deemed to far outweigh the risks. Most pediatric medical literature places the risk of a serious reaction to general anesthesia in the range of 1 in 25,000 to 1 in 200,000, far better than the assumed risk of even driving a car daily. The inherent risks if this is not chosen are multiple appointments, potential for physical restraint to complete treatment and possible emotional and/or physical injury to your child in order to complete their dental treatment. The risks of NO treatment include tooth pain, infection, swelling, the spread of new decay, damage to their developing adult teeth and possible life threatening hospitalization from a dental infection.
 
Dr. Birsch utilizes the facilities at Children’s Hospital of the King’s Daughters in Norfolk, VA. to ensure the optimum beneficial outcome.
 
Prior to your appointment:
 
The child’s parent or legal guardian must remain at the hospital or surgical site waiting room during the complete procedure.
 
After the appointment:
 
Your child has just undergone dental surgery with a general anesthesic. Your child will be drowsy and will need to be monitored very closely. Keep your child away from areas of potential harm. Prior to leaving the hospital/outpatient center, you will be given a detailed list of “Post-Op Instructions” and an emergency contact number if needed.

 
  • Nausea and Vomiting: Any nausea and/or vomiting that may occur will last a short time. If your child does vomit, wait about 30 minutes before attempting clear liquids such as water or Ginger Ale. If nausea does not occur, progress slowly to a regular diet, beginning with easily digestibles (soup, crackers) first then solid foods.
  • Bleeding and Pain: Children will respond to pain or discomfort differently, therefore their mouth may or may not feel sore after surgery. You may give Children’s Tylenol or Motrin* to help make them comfortable, if necessary. There may be also a small amount of bleeding around the gums. The gums are pushed on and cleaned around during surgery therefore a little bleeding is normal after dental surgery and should stop within a few days. If teeth were extracted there may be some discomfort and bleeding. If your child’s mouth starts bleeding excessively, please call our office immediately and/or proceed to the emergency room.
  • Fever: After any surgical procedure a low-grade fever (99-100 F) is normal. You may give your child Children’s tylenol or Motrin*. If the fever continues over 101.5 F for 24 hours, please call us immediately.
  • Activity: Your child may feel sleepy for the next 24 hours. This is due to the medicine your child received. Please doNOT leave your child alone. Children should rest at home but may be up and about. Please have your child refrain from exercise that requires quick reflexes for 24 hours. regular activity is encouraged the day after surgery. Keep children propped up with a pillow while sleeping. Check your child every 20-30 minutes to make sure they respond.
  • Sore Throat: Your child may have a sore throat due to the drying effects of the anesthetic gases and the breathing tube placed during surgery for up to 48 hours.
  • Post Operative: Your child will need to come back to see Dr. Birsch 1-2 weeks after the surgery. Please schedule a post-operative visit at the time of surgery.
If you have any further questions or concerns, please call our office at 757-398-1234.

*Note: with all medications, follow manufacturer’s instructions for administering drugs, found on the package. Aspirin is contraindicated for children

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Laurie A. Birsch, DDS • Address: 3413 South Street Portsmouth VA 23707 • Phone: Laurie A. Birsch, DDS Phone Number (757) 398-1234 • Fax: (757) 393-6353

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