General Anesthesia

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Dental Treatment Under General Anesthesia In-office

Southern Smiles Pediatric Dentistry is proud to be Cameron, Sanford, and Fort Bragg’s only pediatric dentistry specialty practice offering in-office general anesthesia services. As a parent, Dr. Ray knows the difficult decision you may face if your child needs to have treatment under general anesthesia.

Our office and team members are here to walk you through all aspects of the process to make sure that everyone understands what to expect. Southern Smiles Pediatric Dentistry is dedicated to providing your child with the best experience possible, so that they will have a positive and enjoyable experience with dentistry for years to come. You probably have questions, so let’s get started.

Why is general anesthesia (GA) recommended for certain children?

For some children, dental treatment under general anesthesia is necessary to provide the best possible experience while still completing all necessary treatment. GA is recommended for several different reasons including:

  • Children with high anxiety or fear of the dentist;
  • Children who have had a traumatic experience with a previous dentist;
  • Very young children (3 and over) with moderate treatment needs;
  • Children with extensive treatment needs;
  • Children with special healthcare needs that would otherwise not be able to sit for dental treatment in other settings.
At Southern Smiles Pediatric Dentistry, the most common reason that we recommend GA is usually for a child that is having their first dental experience, and has a LOT of treatment needs that would be too overwhelming for them to handle, or a child that has had a bad/traumatic experience previously with a dentist, that is now in our office and needs some teeth repaired.

Kids are amazing- but sometimes the number of appointments needed is just too much for them. GA allows us to fix everything in 1 visit (usually around 2 hours), so that we can focus on fun, positive, and easy experiences during dental cleanings and exams. In this way, children get the treatment they need to prevent pain, while still allowing them to naturally grow their comfort with the dentists through subsequent positive appointments.

As stated above, GA is recommended for apprehensive children, very young children, children with extensive treatment needs, or children with special needs that would not work well in other settings. If we’ve recommended GA as an option for your child, we have already considered all the other possible options, and have presented other options as alternatives to GA, along with the pros and cons of each choice.

I’m scared of the risks of General Anesthesia. Can you tell me more?

Sure. Your child’s safety is our number one priority. For that reason, in-office treatment is reserved for children who are 3 or older, and must weigh at least 30 pounds. Our anesthesiologist, Dr. Charles Cangemi, is an experienced clinician who consults for the State Dental Board. At Southern Smiles Pediatric Dentistry, we do not “cut corners” and Dr. Cangemi is no exception to this rule. Strict guidelines for anesthesia are followed, so that your child’s risk is the lowest achievable.

Parents (Dr. Ray included) may worry that their child may suffer harm during general anesthesia, or even worse, that they may not wake up from GA. But GA is quite safe for virtually all of our patients, as long as they don’t suffer from chronic diseases like cancer or heart disease, and they don’t have problems with their heart, lungs, brain, or blood. For patients that have any chronic or questionable health issues, Dr. Ray will take these patients to Cape Fear Valley Highsmith Rainey Hospital in Fayetteville, NC. To put the risk of death during general anesthesia in perspective – the pediatric medical literature suggests the risk of death is far less than that the risk of death from an accident while driving with your child in the car. That risk is so small, that we do not even think about it as we put our child into their carseat. Remember, the risk for a problem during GA is far smaller – about 1 in 300,000. In all of Dr. Ray’s time in treating children under general anesthesia, there has never been a child with an adverse event. Other risks are that a short-term low grade fever, sore throat, and general malaise for the day of surgery.

I have never heard of putting a child to sleep for dental work – why would parents choose that for their children?

Did you know that Cape Fear Valley Highsmith Rainey Hospital in Fayetteville, NC has one room dedicated to dental surgeries, and that this room is used 5 days per week, every week during the year by Dr. Ray and other pediatric dentists in Wake County?

As a pediatric dentist, Dr. Ray is responsible for making sure that a child gets to adulthood with all of their permanent teeth. Along the way, we sometimes have to face difficult decisions about how to fix baby teeth that may not fall out until 13 years of age! For children that need these teeth to be fixed, it may be too emotionally difficult to insure that the child will have experiences that they can conquer. Thus for these children, the benefits of GA definitely outweigh the risks. In suggesting general anesthesia for your child, Dr. Ray has already considered the risks of treating your child using other methods which may include:

  • An overwhelming negative experience (or multiple awful experiences) previously with a dentist;
  • Significant dental treatment that requires an impossible amount of cooperation from your child;
  • Possible emotional and/or physical injury to your child in order to complete their dental treatment;
  • Negative thoughts/memories of dentistry resulting in dental fear into adulthood.
The risks of NO treatment at all includes:

  • Tooth pain;
  • Infection or swelling;
  • Spread of new decay;
  • Damage to their developing adult teeth;
  • Possible life-threatening hospitalization from a dental infection.
Asking why parents would choose this is also a question we’ve thought about before. We know why we recommend it, but sometimes it’s useful for parents to hear from other parents who have been through this with us. We’ve got you covered! When we polled parents who experienced GA for their children at Southern Smiles Pediatric Dentistry, these points were cited as reasons why they chose to have treatment under GA for their children:

  • All treatment is completed at one visit, usually around 2 hours, with full cooperation of the child;
  • Upfront and accurate pricing- unlike the hospital, where [we] were unsure of what we would owe later;
  • In-network dental treatment lets us take full advantage of our dental insurance with the advantages of general anesthesia;
  • A more personal experience, and we can be there when our child is waking up- rather than in the hospital when we have to wait to go back to recovery;
  • A concierge dental assistant there to help from check-in all the way to check-out and beyond.

Will my child remember anything after surgery?

Your child’s experience is designed to be as positive as possible. On the morning of surgery, your child will drink a little medicine, which will cause them to relax, and potentially may make them more tired. An important feature of this medication is that there is a slight amnesic effect, which will make your child more forgetful temporarily. The last thing your child will remember is breathing some nitrous oxide through a mask, and then drifting off to sleep. The next thing they will remember is waking up as if they’ve been asleep, in our recovery area with their parents. Post-op instructions are given to the parents, but the experience for children is similar to just falling asleep.

Southern Smiles Pediatric Dentistry offers 24h call services for our young patients who undergo dental treatment under general anesthesia, so answers to your questions are just a phone call away.


Who is the anesthesiologist that will administer the general anesthesia?

Photo of Cameron NC dental anesthesiologistCharles Cangemi, DDS, MS
Pediatric Dental Anesthesiologist

Meet Dr. Charles Cangemi! Dr Cangemi has held a lifelong interest in both dentistry and anesthesiology. He completed dental school at the University of North Carolina School of Dentistry, where he received the Grover C. Hunter Jr. Award for academic and clinical excellence in Periodontics. He then completed a residency in Advanced Education in General Dentistry, also at the University of North Carolina. While in private practice he completed his certification in intravenous sedation. Desiring more extensive knowledge in anesthesiology, he sold his practice and entered into an anesthesiology residency and also a Masters Program in Anesthesiology at Ohio State University. This comprehensive hospital based program provided training in all areas of medical anesthesiology.

After obtaining a Certificate of Residency in Anesthesiology as well as a Masters Degree in Anesthesiology from Ohio State University, he has provided anesthesiology services for Dentists, Pediatric Dentists, Oral and Maxillofacial surgeons and other dental Specialists for a wide variety of dental, maxillofacial surgeons and other Dental Specialists for a wide variety of dental, maxillofacial and facial cosmetic surgical procedures.

Dr. Cangemi is a National Dental Board of Anesthesiology Fellow, an American Dental Society of Anesthesiology Member, on the Anesthesia Advisory Committee, the North Carolina Board of Dental Examiners, an Anesthesia Examiner, on the North Carolina State Board of Dental Examiners, Author of Publications in Dental and Anesthesiology Journals, Certified in Pediatric Advanced Life Support, Advanced Cardiac Life Support and Basic Life Support.

Dr. Cangemi has worked with Southern Smiles Pediatric Dentistry for several years, and shares the same values and respect for your child as Dr. Ray.

General Anesthesia services are available in-office for healthy children over the age of 3 and over 30 lbs. For children with special healthcare needs, for those that are very young, or who have very extensive treatment plans, General Anesthesia services are also available at Cape Fear Valley Highsmith Rainey Hospital in Fayetteville, NC. Regardless of which option you choose, Dr. Ray and his professional and experienced staff will be at your child’s side the whole time to make sure that Southern Smiles Pediatric Dentistry’s high standards of care are met, for both the child and parents’ experience.

Come and talk to us today about dental treatment under general anesthesia.