Intro to Pain and Anxiety Control Flashcards
who regulates and defines dental sedation in UK
GDC
irrespective or location, sedationist, technique
highly regulated
concious sedation definition
A technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation. The drugs and techniques used to provide conscious sedation for dental treatment should carry a margin of safety wide enough to render unintended loss of consciousness unlikely.
- The level of sedation must be such that the patient remains conscious, retains protective reflexes, and is able to understand and respond to verbal commands.
- “Deep sedation” in which these criteria are not fulfilled must be regarded as general anaesthesia, done by anaesthetist
- In the case of patients who are unable to respond to verbal contact even when fully conscious the normal method of communicating with them must be maintained.
- E.g. sign language
- Must be able to communicate effectively with them
Single medication only (not multiple by sedation dentist)
3 medical indications for dental sedation
- conditions which are aggravated by the stress of dental tx
- conditions which affect cooperation
- psychosocial reasons
4 psychosocial indications for dental sedation
- Phobias
- Things in mouth
- Dental Procedures/Anxiety
- Needles can be that tolerate them elsewhere on body but not inside mouth
- Drills
- Gagging (IHS reduce gagging)
- Persistent fainting
- Idiosyncrasy to LA
- feel faint after LA - anxiety component, IHS could help
3 example conditions which can affect pt cooperations so indicate dental sedation
debatable, won’t suddenly become cooperative can actually become less cooperative as they become uninhibited – caution
- Mild to moderate movement or learning difficulties
- Spasticity disorders (unable to control/involuntary)
- Parkinson’s disease
example conditions which can be aggrevated by stress of dental tx so indicate sedation
- Stress can make their condition worse/flare up*
- So reduce stress = reduce chance of flare up*
- Ischaemic heart disease
- Hypertension
- Asthma
- Epilepsy
- Psychosomatic illness (somatoform disorders)
- Misc conditions
- Ulcerative colitis
- Crohn’s disease etc
define phobia
An irrational and uncontrollable fear, which is related to a specific object or situation. It is persistent, despite avoidance of the provoking stimulus. It has a direct effect on the patient’s lifestyle.
possible causes of dental anxiety
several
- Trauma
- Primary traumatic experience
- Usually in childhood
- May be cumulative
- Transference (Learned)
- Parenteral
- Playground
- Fear of criticism
- Fear of dress (white coat)
- Lack of communication
- Helplessness
- Invasion of body orifice
- Influenced by environment
- Surgery appearance
- Staff continuity
- Stage of development and age
- Young and old
- Learning difficulties
- Young adults
- Gender
- Reports – pinch of salt, women traditionally but could be more open about it
- Clinical experience
- FACTS
- Socio-economic group
- Deprived tend to have more dental anxiety
dental indications for dental sedation
difficult or unpleasant procedures
- surgical extraction of wisdom teeth
- orthodontic extractions/exposures
- implants
5 medical contraindications to all sedation methods
- Severe or uncontrolled systemic disease
- Severe mental or physical disability
- Unable to communicate
- Unable to fully understand procedures
- Severe psychiatric problems
- Narcolepsy
- Suddenly fall asleep – lose communication
- Hypothyroidism
- E.g. Myasthenia gravis – progressive muscle wasting disorder – muscles already weak so when provide sedation drug further relaxed, risk of affecting breathing
5 medical contraindications to IV sedation
- Intracranial pathology
- Alertness could be affected by brain bleed, monitoring this would be complicated by sedation (reduce alertness)
- COPD
- Possible effect on breathing
- Well controlled – could be ok
- Myasthenia gravis
- Above
- Hepatic insufficiency
- Unable to metabolise drug effectively
- Pregnancy and lactation
- Sedate the foetus
- Drug get to breast milk – sedate the baby
3 medical contraindications to inhalation sedation
- Blocked nasal passageway (e.g. cold)
- COPD
- Pregnancy
- Can be pathogenic (pregnant practitioners to avoid)
5 social contraindications to sedation
- Unwilling
- Uncooperative
- Unaccompanied
- Children – for IV (12 years)
- Very old
6 ASA classifications
- A normal healthy patient
- A patient with mild systemic disease (well controlled e.g. diabetes, hypertension)
- A patient with severe systemic disease or poorly controlled systemic disease
- A patient with severe systemic disease that is a constant threat to life
- A moribund patient who is not expected to survive without the operation
- A declared brain-dead patient whose organs are being removed for donor purposes
ASA class 1
a normal healthy pt
