Intro Pain/ Anxiety Flashcards
What is a barrier for 10-12% adults to health care?
Anxiety
Is GA available for NHS dentistry?
Not if over 16 - unless special care
What should be routine practice for those with health anxiety?
Behaviour management
How should surgical procedures be managed for those with anxiety?
Behaviour management
Combination: LA, sedation
Issue inhalation sedation?
Not all patients suspectible
What can cause difficulty providing dental treatment?
Co-operation Anxiety Phobias Medical conditions Mental health issue
What is used in dentistry to determine anxiety?
MDAS - modified dental anxiety scale
What is MDAS
Brief questionnaire to be completed by the patient consisting of 5 questions
What is the score range of MDAS?
5- 25
What MDAS score suggests anxiety?
That 19+
What does basic behaviour management include?
Tell/show/do Positive reinforcement Relaxation Systematic desensitisation Gradual acclimatisation
What is alliterative management if behaviour management doesn’t work?
Drugs - oral, IHS, IV
Premedication e.g diazepam
How does sedation work?
Depression of CNS to allow operative tx w/ minimal stress to patient
What are adv of sedation?
Simple to administer Rapid onset and recovery Rapdily metabolised and excreted Low incidence of side effects Predictable
When is oral sedation used?
Often used as premedication
Benefits of oral sedation
Can help reduce anxiety in advance of treatment
What dose should give as pre-medication at home sedation?
Diazepam 2-5mg morning attendance
Temezapam - 10mg night before
What are doses of oral premedication that could be given in surgery?
10-20mg temazepam
10mg midazolm
MONITOR
Adv/ disadv oral sedation?
Adv: simple administer, low side effects, predictable actions
Disadv: slow onset (30-40mins), not rapidly metabolised
What do you need to be able to provide inhalation sedation?
Patent nasal airway
What drugs are used for IHS?
Nitrous oxide and oxygen
What is entonox?
50:50 oxygen and nitrous oxide
Adv IHS?
Simple administer Rapid onset and recovery Rapid metabolism/ excretion Low side effect Predictable
How does IV sedation work?
Midazolam is titrated depending on pt response causing anterograde amnesia/ muscle relaxant
How long does IV sedation work?
20-30 mins good sedation
Does midazolam affect cardiac/ respiratory system?
Minimal cardiac/ respiratory depression - unless over sedated
Reversal agent of midazolam?
Flumazenil
Disadv of IV sedation?
Escort required
Requires cannulation - training/ risks
Need chaperone
Issues of IV sedation?
Can get over sedation - CV/ respiratory depression
Toelrance - those who use opioids regularly
Sexual fantasy
