Behavioural Management and Sedation

Question 1

What percentage of the population have a true dental phobia

Answer 1

around 5%

Question 2

in the 2008 adult dental health survey, what % of people had moderate to severe dental anxiety

Answer 2

49%

Question 3

What factors have a major impact on dental fear and anxiety

Answer 3

previous events/past experience

pain

cost

word of mouth

Question 4

What are the four components involved in the cycle of improvement

Answer 4

improved information

increased predictability

decreased fear

decreased pain

Question 5

Which three methods can be employed to make adminstering LA less painful?

Answer 5

Vibrajet
Buzzy
STA (wand)

Question 6

What is the next step when behavioural management and therapy fails?

Answer 6

conscious sedation

Question 7

What is conscious sedation

Answer 7

a technique in which the use of a drug/drugs creates a state of depression of the CNS, allowing treatment to be carried out

Question 8

What is inhalation sedation

Answer 8

Nitrous oxide plus oxygen

Question 9

What are the benefits of inhalation sedation

Answer 9

safe 
rapidly reversible 
no needles
generally well accepted
provides analgesia 
few contraindications 
rapid recovery 
limited side effects if enough oxygen is given in the recovery phase

Question 10

What are the contraindications for inhalation sedation

Answer 10

no nasal airway

not for patients with chronic obstructive airway disease

not for use in unstable MH patients

Neurological conditions such as myasthenia gravis

Pernicious anaemia

Question 11

What does IHS do?

Answer 11

decreased stress and anxiety

decreased pain perception

decreased gagging

Question 12

What kind of drug is midazolam

Answer 12

benzodiazepine

Question 13

What is the half life of midazolam

Answer 13

15-40 mins

Question 14

What is the elimination half life of midazolam in patients who are obese

Answer 14

1.5-2.5 hours

Question 15

How is midazolam titrated?

Answer 15

2mg over 2 mins and then 1mg every 30 seconds until level of sedation is achieved

Question 16

When is maximal sedation reached with midazolam

Answer 16

within 5-8 mins

Question 17

What is the usual dose of midazolam

Answer 17

between 2.5-7.5mg, the average is between 4-5mg

Question 18

what are the disadvantages of conscious sedation

Answer 18

• interacts with lots of drugs
• unpredictable in younger patients
• causes respiratory depression and so needs constant monitoring
• patient may have hallucinations
• requires the dentist, second qualified person and a third person for nursing. for legal reasons