___________ Dental Clinic
Pre-Sedation Instructions
Dear Parent:
In our recent discussion about your child’s up-coming dental treatment, we have agreed that it will be
necessary to pre-medicate your child. This pre-medication will help us to provide the best possible dental
treatment in a well-controlled setting. In order to accomplish this safely with the best chance for success,
there are certain procedures we ask that you follow before and after the appointment. These are as
follows:
1. A child is much influenced by his/her parents’ behavior. If you are anxious upset, and worried about
going to the dentist, your child will be also. Please relax, and both of you should have a good night’s
rest before the appointment.
2. The child must be accompanied by a parent or legal guardian for all appointments, who shall be
required to remain
at the dental clinic for the entire treatment period.
3. Depending on the type of sedation your child may be required to have a physical exam performed
prior to the sedation. Date:__________________ Time:_____________________.
4. Any change in the child’s health, especially the development of a cold or fever, within seven (7) days
prior to the day of treatment, it is very important to let Dr.___________________ know. For the
child’s safety, a new appointment may be made for another day.
5. Dietary precautions, to avoid vomiting and complication during treatment with sedation are as
follows:
(a) The meal prior to the sedation should be light and easily digestible.
(b) No milk or solid food after midnight prior to the scheduled sedation.
(c) Children ages 0-3 years clear liquids up to 4 hours before the sedation, then nothing not even
water.
(d) Children ages 3-6 years, clear liquids up to 6 hours before the sedation, then nothing not even
water.
(e) Children ages 7 or greater, clear liquids up to 8 hours before the sedation then nothing, not even
water.
6. Give your child only those medications which he/she takes routinely, such as seizure medications or
prophylactic antibiotics, and those prescribed by your child’s doctor or dentist. DO NOT give your
child any other medication, before or after treatment without checking with your doctor or dentist.
7. Your child will be given a medicine that in most cases will calm them down, so they will feel drowsy.
Some patients might become more excited for a period, during the 15 to 60 minutes it takes for the
medication to take its effect. During this time we will have you sit in a quiet place (bring a favorite
story book) where you and the dental staff can carefully watch your child until they are placed in the
dental chair. Your child may cry when being placed in the dental chair and during treatment due to
the stimulation, but they will be given a local anesthetic to block out pain. It is therefore important
after the appointment not to allow your child to bite his/her lip, tongue, or cheek before the numbness
wears off (several hours). Remember your child will not be put to sleep, only relaxed.
8. Your child maybe wrapped in a papoose board so they will feel secure (as if you were holding the
child in your arms) and so if they move during treatment the chance for injury is reduced.
9. Please be on time for the appointment. We are setting aside extra time for your child’s treatment
needs, and this time may be wasted if you show up too late to sedate your child or if you fail to show
up.
10. Because of the tendency towards drowsiness and clumsiness for several hours, your child should
remain indoors and be closely watched for several hours after the appointment. It is normal for a
child to sleep after the appointment.
11. In case you have any questions once you are home, call _________ and ask for Dr. ____________
during office hours ___________.