1 OMFS (Exam 3): Introduction to Sedation in Dentistry

75

__% of adults in US experience some form

of dental anxiety from mild to severe

10-15

____% suffer from severe dental phobia

fear

-Perceived to be a more immediate threat

-Physiological process that occurs in the body when threatened by danger

-Fight or flight response

anxiety

-Stress response to an ill defined or anticipated situation

-Feeling of threat

-Anticipation of the possibility of danger

phobia

-Persistent and irrational fear that results in a compulsion to avoid a specific object, activity, or situation

-The fear is recognized by the patient as unreasonable and unwarranted by the actual level of danger or the object, activity or situation

-Impedes daily function

-patient

-dentist/staff

-place

-procedure

What are the 4 etiologies of dental phobia?

Fear of pain

Personality traits

Fear of the unknown

Fear of bodily changes and mutilation

Fear of death

Fear of needles

Past traumatic dental experiences (often from childhood)

Influence of someone else's experien

What are some patient factors that contribute to the etiology of dental phobia?

Injection

Extraction

Sensation of drilling

Root canal treatment

Scaling root planing

What are some procedure factors that contribute to the etiology of dental phobia?

Communication technique

Unsympathetic/non-supportive

Negative dental team behavior

Criticism of oral hygiene

What are some dentist/staff factors that contribute to the etiology of dental phobia?

Sound of drilling/suction

Smell

Waiting room

Waiting period

Sound of moaning patients

What are some environmental factors that contribute to the etiology of dental phobia?

true

t/f: some studies have shown that the act of the dentist holding a syringe needle in front of them brings on worse fear than the actually shot itself

1. A dentist who administers a painless injection

2. A dentist who provides a painless experience

How are dentists judged most by patients?

mild

Patients that feel that the dentist is an unpleasant experience most likely have a _____ level of anxiety

moderate

Patients that feel that Delay in obtaining care and Expresses concern most likely have a _____ level of anxiety

severe

Patients that feel that Avoid dental care, have sleep disturbances, experience syncope and/or hyperventilation in the dental care setting most likely have a _____ level of anxiety

sympathetic

when a patient is stressed, which division is heightened?

- sympathetic

- parasympathetic

0.05

plasma levels of epinephrine in a normal pt is __________

- 0.05

- 0.20

- 0.27

- 4.10

0.27

plasma levels of epinephrine in a stressed pt is _________

- 0.05

- 0.20

- 0.27

- 4.10

0.20

plasma levels of norepinephrine in a normal pt is __________

- 0.05

- 0.20

- 0.27

- 4.10

4.10

plasma levels of norepinephrine in a stressed pt is __________

- 0.05

- 0.20

- 0.27

- 4.10

Higher caries prevalence

Avoids/delay treatment

Negative effect on dental esthetics and function

Increased use of antibiotics/ analgesic

What are the consequences of dental phobia on the patients:

Extremely unreliable patients

Require more chair time for management

Reduced satisfaction with treatment planned/provided

More negative patient/doctor relationship

What are the consequences of dental phobia on the dentists:

Recognize and acknowledge the patient's fear and anxiety

Systematic desensitization

Tell show do Interpersonal strategies of patient management

Scheduling and office environment

Distraction

Hypnosis

Minimize patient waiting time

What are some non-pharm methods to reduce patient anxiety:

- Minimal Sedation

- Moderate Sedation

- Deep Sedation

- General Anesthesia

What are the 4 levels of sedation/anesthesia:

local anesthesia

This is administered for relief of pain:

sedation

This is administered for relief of fear and anxiety:

general anesthesia

This is administered for relief of anxiety, pain, and all sensations:

cooperative patients

All the following are indications for sedation/anesthesia except:

- anxious and apprehensive pt

- motor dysfunction (cerebral palsy, parkinsons)

- cooperative patients

- cognitive impairment resulting in inability to cooperate

- pediatric pt who cannot cooperate

stress reduction can lower the risk of the catecholamine endogenous pathways exacerbation, placing the patient at risk of developing complications with pre-existing medical conditions

Why is sedation beneficial (and an indication) for certain medically compromised patients?

deep sedation

All of the following levels of anesthesia render the patient conscious, EXCEPT:

- local anesthesia

- deep sedation

- oral sedation

- parenteral IV sedation

minimal sedation

ID the level of sedation:

-A minimally depressed level of consciousness

-Patient can respond normally to verbal and tactile stimulation

-Patient feels relaxed

- Thinking and coordination may be affected

-Airway, respiration, and cardiovascular function are NOT affected

- Single oral medication

- Nitrous oxide

What are the ways that minimal sedation can be administered:

moderate sedation

ID the level of sedation:

-A drug induced depression of consciousness

-The patients can respond normally to verbal and tactile commands

-Thinking and coordination are usually affected

-Airway, respiration, and cardiovascular function are NOT affected

- IV

- oral medications

What are the ways that moderate sedation can be administered:

deep sedation

ID the level of sedation:

-A drug induced depression of consciousness

-Patient is difficult to awaken

-The patients cannot be easily aroused and cannot respond to verbal commands, but can respond to painful stimulation

-Airway and respiration may be impaired

-Cardiovascular function is usually maintained

IV

What are the ways that deep sedation can be administered:

general anesthesia

ID the level of sedation:

-A drug induced loss of consciousness, which the patients are NOT arousable even by painful stimulus

-Airway potency is impaired and intervention is required

-Spontaneous ventilation is frequently inadequate

-Patient will need intervention for airway and ventilation (positive pressure ventilation)

- Cardiovascular function may be impaired

inverse

the effectiveness of a type of anesthesia has a ________ relationship with the relative safety for the patient

moderate & deep

Between what levels of sedation do most complications occur under the care of inadequately trained dentists:

- minimal & moderate sedation

- moderate & deep

- deep % GA

continuum

Sedation and general anesthesia are a _____, it is not always possible to predict how an individual will respond.

1

A competent doctor is trained to be able to diagnose and manage the physiologic consequences (rescue) for patients ____ levels above where they are normally practicing

1. The patient recover

2. Qualified emergency medical services arrives

The office must have the equipment/medications, personnel, and training necessary to perform the rescue, until one of 2 things occur:

false

t/f: Calling 911 only is an adequate response to rescue

- enteral/oral

- transmucosal/sublingual/intranasal

- intramuscular

- inhalation

- intravenous

What are 5 routes of sedation administration:

independent

The route of administration is ______ to the level of sedation/anesthesia.

true

t/f: Minimal, Moderate, and Deep Sedation or General Anesthesia can be achieved via any route of administration

patient's clinical response

the level of sedation/anesthesia achieved depends on the _______, not the route of administration

oral medications

ID the route of administration by its advantages:

- Cost effective

- Ease of administration

- No needles involved

- Amnesic effect (with Benzodiazepine)

- High patient acceptance

- Less incidence of adverse reaction

- No special equipment

- No specialized training

nitrous oxide

ID the route of administration by its advantages:

- Cost effective

- Ease of administration

- Limited level of sedation

- Rapid onset

- Fast recovery

- Analgesia effect

- Diminished gag reflex

- No escort needed

- High patient acceptance

IV moderate sedation

ID the route of administration by its advantages:

- Fast onset

- Can titrate to effect

- Faster recovery than GA or oral mediation

- More effective and reliable than oral sedation

- Amnesia effect

- Some analgesia effect

- Less risks than GA

- Diminished gag reflex

- IV access for emergency medications

deep sedation

ID the route of administration by its advantages:

- Amnesic and unconscious

- Minimized response to pain

- Cardiovascular function is normally maintained

- Fast onset

- Ideal for short procedures (routine third molar extractions, endoscopies, etc)

general anesthesia

ID the route of administration by its advantages:

- Effective for all patients

- Secured Airway Truly “Asleep”

- No cooperation required

- Maximum comfort

- Minimized response to pain

- Best prevention of movement

- Fast onset

- Ideal for traumatic procedures

oral medications

ID the route of administration by its disadvantages:

- Unpredictable pharmacodynamics

- Empirical dosage

- Cannot titrate to effect

- Prolonged latency (onset period)

- Escort needed

- No analgesic action

- Require patient cooperation

- Paradoxical reaction

- No immediate access for emergency drugs

- Often ineffective

nitrous oxide

ID the route of administration by its disadvantages:

- Limited Use for mildly anxious &routine procedure

- Require patient cooperation

- No Amnesia

IV moderate sedation

ID the route of administration by its disadvantages:

- IV access required

- Advanced training required

- More monitoring required

- Require escort to drive patient home

- No secured airway

- More costly than oral sedation

- Patient cooperation required

- Cannot completely prevent patient movement

- Not 100% effective

deep sedation

ID the route of administration by its disadvantages:

- Protective reflexes are depressed

- Airway is not protected and may become obstructed

- Spontaneous ventilation may be impaired

- Advanced training is required

- More risk and post anesthetic complications than moderate sedation

- Additional trained personnels/ equipments/recovery area

general anesthesia

ID the route of administration by its disadvantages:

- Protective reflexes are depressed

- Cardiovascular and respiratory functions are depressed

- Advanced training is required

- More risk and post anesthetic complications

- Longer recovery time Additional trained personnels/ equipments/recovery area