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Paediatric Dentistry > Behaviour and pain management > Flashcards

Behaviour and pain management Flashcards

1
Q

List signs of anxiety in children

A
  • Hiding
  • Clinging to parent
  • Stuttering/not speaking
  • Nauseous or stomach ache
  • Dizzy
  • Going to the toilet
  • Nail biting
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2
Q

List factors that influence anxiety in children

A
  • Psychological make up
  • Understanding of dentistry
  • Previous exposure
  • Influence from parents/siblings/friends
  • Emotional development and ability to communicate
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3
Q

How to make the dental environment child friendly

A
  • Light colours, toys and pictures, posters and stickers on the walls
  • Hide equipment
  • No PPE on first contact
  • Good quality handpieces to minimise sound and vibration
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4
Q

List the ways we can improve behaviour and reduce anxiety in children

A
  • Appearance of staff/environment
  • Good communication
  • Positive parental attitude
  • Specific behaviour management strategies
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5
Q

Communication with children

A
  • clear, direct instructions rather than questions
  • Question for feeling during procedure
  • Give feedback on behaviour
  • Use children friendly language
  • Eye contact
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6
Q

When is parental presence favourable

A

When the parent is taking on a passive role

In younger pts - better to prevent separation anxiety

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7
Q

When is parental presence unfavourable?

A
  • Parents who are projecting their own anxiety to the child through words or behaviour
  • Parents competing with dentist for child’s attention
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8
Q

List behaviour management strategies (8)

A
  • Positive reinforcement
  • Acclimation
  • Tell, show, do
  • Systematic desensitisation
  • Voice control
  • Role modelling
  • Enhancing control / stop signalling
  • Distraction
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9
Q

What is positive reinforcement?

A

Positive behaviour is rewarded with clear and immediate rewards e.g. praise (more effective) or stickers

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10
Q

What is acclimation

A

Introducing the patient to instruments/equipment before you plan on using them e.g. the appt before you plan on using it

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11
Q

What is tell, show, do

A
  • Describing what the instrument does
  • Showing them what the instrument does it positive/neutral terms
  • Use the instrument
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12
Q

What is systematic desensitisation?

A

Hierarchy of anxiety provoking stimuli either in real life of imaginative.
Pt exposed to stimuli when instructed to relax

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13
Q

What is voice control?

A

Changing vocal tone to gain attention from patient

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14
Q

What is role modelling?

A

Presence of an older, well behaved patient e.g. sibling (e.g. observing sibling having treatment)

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15
Q

What is enhancing control?

A

Providing pt control over the dentist’s actions e.g. raise hand when you want me to stop

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16
Q

What is distraction?

A

Distracting patient from sensations

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17
Q

What is pain

A

Complex physiological and psychological (emotional) response derived from various stimuli

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18
Q

Define pain threshold

A

Level at which pain first becomes perceptible to an individual

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19
Q

Define individual ‘pain reaction’ -

A

Variation in response to the same stimulus when applied to different people

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20
Q

Factors that influence pain perception in children

A
  • Stage of development/age
  • Parental dental fear or influence from sibs/peers/media
  • Previous experience (established fear)
  • Emotional status
  • If the pt has acute dental pain
  • MH
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21
Q

What are two main categories of pharmacological pain control?

A
  • Anaesthesia

- Analgesia

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22
Q

What is anaesthesia

A

Loss of all forms of sensations (pain, touch, temperature, pressure +/- motor function)

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23
Q

What are the methods of anaesthesia used in paediatric dentistry

A

LA
LA + inahaltion sedation
GA

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24
Q

What is analgesia

A

Loss of pain sensation unaccompanied by loss of forms of sensibility

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25
Q

Analgesics used in paediatric dentistry

A

Paracetamol

Ibuprofen

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26
Q

Calculating dose of analgesics

A

Dose by age

Consider weight/height of patient - if lower/higher than ideal for age then consider different dose

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27
Q

Contraindications for ibuprofen in children

A

Asthma, liver disease, renal failure and bleeding disorder

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28
Q

What do you have to consider when calculating dose of LA

A
  • Age, weight and height

- Type of LA (2% of 4%)

29
Q

Correct use of topical LA

A

Apply to dry mucosa in a localised area

Leave for 5 mins until mucosa wrinkled

30
Q

What is an intrapupillary injection

A

Anaesthesia of the papilla used to prevent painful palatal infiltration

31
Q

What is the “chasing technique”

A

After buccal infiltration, pass needle to papilla and follow into palatal tissue

32
Q

When are intraligamental infiltrations required

A
  • To supplement infiltrations (or blocks)
  • Eliminates need for a block
  • In permanent teeth only
33
Q

Where to approach for an ID blocks in children

A

From contralateral primary molars

34
Q

Where to approach for a mental block in children

A

Advance needle in buccal sulcus between apices of 1st and 2nd primary molars

35
Q

What are the COMMON complications of LA

A
  • Failure, bleeding, pain
  • Psychogenic (syncope, hyperventilation, nausea, palpitations, mimicking allergy)
  • Lip biting and soft tissue trauma
  • Toxicity from overdose
36
Q

What are the RARE complications of LA

A

Allergy
Drug interactions
Methomoglobineamia
Paraesthesia

37
Q

What are the signs of toxicity from LA overdose

A
  • Pt initially appears sedated - slurred speech, altered mood, diplopia and disorientated
  • High blood pressure can cause tremor, respiratory depression and seizure
38
Q

What are the severe effects of toxicity from LA overdose

A

Coma, respiratory arrest and cardiovascular collapse

39
Q

What is methemoglobinemia and what LA is usually associated?

A
  • (congenital or acquired) blood condition where RBC contain >1% methemoglobin
  • Prilocaine, articaine and benzocaine
40
Q

What LA is paraesthesia associated with

A

Articaine and prilocaine

41
Q

What are the categories of anxiety management in dentistry

A

Behaviour management
Behaviour therapy
Conscious sedation
General anaesthesia

42
Q

Define conscious sedation

A

Technique that produces a state of central nervous system depression to enable treatment to be delivered where verbal contact is maintained with the pt throughout.

43
Q

What features are retained in a consciously sedated patient

A

Verbal communication

Protective reflexes allowing a stable patent airway

44
Q

Aims of conscious sedation

A

Prevent/reduce dental fear, anxiety or pain
Facilitate pt cooperation
Promote positive attitude
Safe provision and completion of care with minimal disruptive behaviour

45
Q

List examples of conscious sedation

A
  • Inhalation sedation
  • Oral sedation
  • Transmucosal (nasal)
  • Intravenous sedation
46
Q

Indications for conscious sedation (in peadiatrics specifically - so we are thinking of IHS)

A
  • Dental phobia or anxiety
  • Manage gag reflex
  • Special care requirements e.g. medically compromised or behavioural conditions
  • Traumatic or prolonged tx
47
Q

Contraindications for conscious sedation in children

A
  • URT issues
  • Blocked nose/nasal obstruction
  • Pre-cooperative children
  • Medical contraindications
  • Pt unable to communicate well e.g. some behavioural conditions
48
Q

MH contraindications for inhalation sedation

A
  • Nasal obstruction or congestion
  • Severe respiratory disease
  • Middle ear infections
  • Neuromuscular disorders
  • Methotrexate
  • Porphyria
  • Chemo
49
Q

What is used in inhalation sedation

A

Titrated dose of nitrous oxide in oxygen

50
Q

Pharmacology of nitrous oxide

A
  • Colourless and almost odourless
  • Relatively insoluble
  • Excreted rapidly by lungs
51
Q

Effects of nitrous oxide on the body

A
  • Eurphoria and CNS depressant (sedative)
  • Mild analgesic
  • Minimal effect on respiratory system
  • Minor decr in cardiac output
  • Slight increase in peripheral resistance
52
Q

Nitrous oxide mode of action

A
  • Analgesic - acting on opiod receptors
  • Anxiolytic - acts on GABAA receptors
  • Anaesthetic effect - acts on GABA receptors
53
Q

What is required at the pre-operative assessment for IHS

A
  • Full asessment to confirm the need for sedation
  • Written consent from parent/pt
  • Pre and post op instructions
  • Height and weight
54
Q

What are the pre-op checks before IHS is administered

A
  • Check pt ate or if they need glucose
  • Check for nasal obstruction
  • Confirm MH
  • If consent not taken, achieve now
  • Record any pre-op analgesia
55
Q

What are the increments nitrous oxide is increased by

A

5-10%

56
Q

What gas is used at the end of the session

A

100% oxygen for 3-5 mins

57
Q

Why is 100% oxygen used at the end of the session

A

Prevent diffusion hypoxia

58
Q

What is recorded post-operatively

A
  • Mask size
  • Flow rate
  • % of N2O and oxygen
  • Time started and finished
  • Type/amount LA given
  • Dental treatment provided
  • Recovery, post op medication and discharge
59
Q

What are the signs of ideal sedation

A
  • Slightly incr bp and heart rate (initially)
  • Normal, smooth respirations
  • Flushing of extremities and face
  • Muscle relaxation
60
Q

Symptoms of ideal sedation

A
  • Lightheadedness
  • Tingling/numbing of hands and feet
  • Warm wave or vibrations
  • Numb oral soft tissues
  • Euphoric feeling
61
Q

Why may IHS fail?

A
  • Pt not breathing through nose
  • Ineffective seal around nosepiece
  • Pt too anxious and cannot cooperate
  • Fault in machine
62
Q

What are the advantages of INHS

A
  • Non-invasive - good for needle phobic
  • Titrated dose that can be altered
  • Rapidly absorbed and excreted
  • Reflexes maintained
  • Some analgesic effect
  • Cost effective and safer than GA
63
Q

What is the onset of IHS

A

2-3 mins

64
Q

How long does it take for recovery after IHS

A

Complete recovery within 5 mins

65
Q

Disadvantages of IHS

A
  • Lack of potency
  • Requires psychological reassurance
  • Nasal mask may impeded access of upper anteriors
  • Nitrous oxide pollution
  • LA still required
  • Potential adverse effects
66
Q

What are the adverse effects of IHS

A
  • headache, nausea and vomiting

- Loss of consciousness

67
Q

What are the occupational adverse effects due to chronic exposure

A
  • Impaired RBC production and pernicious anaemia

- Avoid in first trimester and preg staff should opt out

68
Q

What is the maximum conc of N2O exposure in 8 hours

A

100ppm

69
Q

How to minimise N2O pollution

A
  • Active scavenging systems
  • Good ventilation
  • Floor level extractor fans
  • Good technique with pt
  • Check equipment regularly

Paediatric Dentistry (11 decks)

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