Sedation - Special Care

Question 1

What problems are associated with providing dental treatment for a special care patient? (5)

Answer 1

Communication
Anxiety
Unable to sit/cooperate for dental treatment
Perception of reality
Previous experience

Question 2

List congenital/genetic causes of movement disorders. (5)

Answer 2

• Muscular dystrophy
• Cerebral Palsy (uncontrolled movements)
• Multiple Sclerosis
• Parkinson’s Disease
• Huntingdon’s Chorea

Question 3

List acquired causes of movement disorders. (1)

Answer 3

head injury

Question 4

List congenital/genetic causes of learning difficulties. (2)

Answer 4

• Syndrome
• Non-syndrome

Question 5

List acquired causes of learning difficulties. (4)

Answer 5

• Trauma
• Infection
• CVA
• Alzheimer’s

Question 6

How is oral sedation carried out?

Answer 6

Patient drinks oral midazolam (20ml) Infront of dentist
- not the same as premed

Question 7

What are the advantages of oral sedation? (4)

Answer 7

• Avoids canulation – cannot tolerate canula = indication for use
• Can make induction more pleasant
• Ensure better px coordination
• Improves future behaviour

Question 8

What are the disadvantages? (7)

Answer 8

• Requires baseline readings (monitored throughout)
• Takes 30 mins to be absorbed and act on sedation levels
• Poor taste – bitter or stinging
• Untitratable
• Difficult to monitor level of sedation
• Difficulty in controlling behaviour during recovery
• Unpredictable - should be avoided where possible

Question 9

What method of sedation Is commonly used in special care?

Answer 9

transmucosal sedation - intranasal

Question 10

How is intranasal transmucosal sedation carried out?

Answer 10

Concentrated midazolam squirted into the nose via a syringe with an atomiser (creates fine mist which attaches to the nasal mucosa)

Question 11

What are the advantages of intranasal transmucosal sedation? (6)

Answer 11

• Avoids first pass metabolism = quicker and reliable
- Sedated within 7 mins

• Sedation comparable to the dose required since no FPM

• No canulation = more cooperation

•. Can make induction more pleasant
• Ensure better px coordination
• Improves future behaviour

Question 12

What are the disadvantages of intranasal transmucosal sedation? (4)

Answer 12

• Doesn’t completely avoid canulation as patients require canula once sedated to allow easy access if they become oversedated as we need to reverse it.

•. Poor taste – bitter or stinging
• Untitratable
• Difficult to monitor level of sedation
• Difficulty in controlling behaviour during recovery