Intro Pain/ Anxiety

Question 1

What is a barrier for 10-12% adults to health care?

Answer 1

Anxiety

Question 2

Is GA available for NHS dentistry?

Answer 2

Not if over 16 - unless special care

Question 3

What should be routine practice for those with health anxiety?

Answer 3

Behaviour management

Question 4

How should surgical procedures be managed for those with anxiety?

Answer 4

Behaviour management

Combination: LA, sedation

Question 5

Issue inhalation sedation?

Answer 5

Not all patients suspectible

Question 6

What can cause difficulty providing dental treatment?

Answer 6

Co-operation
Anxiety 
Phobias 
Medical conditions
Mental health issue

Question 7

What is used in dentistry to determine anxiety?

Answer 7

MDAS - modified dental anxiety scale

Question 8

What is MDAS

Answer 8

Brief questionnaire to be completed by the patient consisting of 5 questions

Question 9

What is the score range of MDAS?

Answer 9

5- 25

Question 10

What MDAS score suggests anxiety?

Answer 10

That 19+

Question 11

What does basic behaviour management include?

Answer 11

Tell/show/do
Positive reinforcement
Relaxation
Systematic desensitisation 
Gradual acclimatisation

Question 12

What is alliterative management if behaviour management doesn’t work?

Answer 12

Drugs - oral, IHS, IV

Premedication e.g diazepam

Question 13

How does sedation work?

Answer 13

Depression of CNS to allow operative tx w/ minimal stress to patient

Question 14

What are adv of sedation?

Answer 14

Simple to administer
Rapid onset and recovery
Rapdily metabolised and excreted
Low incidence of side effects
Predictable

Question 15

When is oral sedation used?

Answer 15

Often used as premedication

Question 16

Benefits of oral sedation

Answer 16

Can help reduce anxiety in advance of treatment

Question 17

What dose should give as pre-medication at home sedation?

Answer 17

Diazepam 2-5mg morning attendance

Temezapam - 10mg night before

Question 18

What are doses of oral premedication that could be given in surgery?

Answer 18

10-20mg temazepam
10mg midazolm

MONITOR

Question 19

Adv/ disadv oral sedation?

Answer 19

Adv: simple administer, low side effects, predictable actions

Disadv: slow onset (30-40mins), not rapidly metabolised

Question 20

What do you need to be able to provide inhalation sedation?

Answer 20

Patent nasal airway

Question 21

What drugs are used for IHS?

Answer 21

Nitrous oxide and oxygen

Question 22

What is entonox?

Answer 22

50:50 oxygen and nitrous oxide

Question 23

Adv IHS?

Answer 23

Simple administer
Rapid onset and recovery
Rapid metabolism/ excretion
Low side effect
Predictable

Question 24

How does IV sedation work?

Answer 24

Midazolam is titrated depending on pt response causing anterograde amnesia/ muscle relaxant

Question 25

How long does IV sedation work?

Answer 25

20-30 mins good sedation

Question 26

Does midazolam affect cardiac/ respiratory system?

Answer 26

Minimal cardiac/ respiratory depression - unless over sedated

Question 27

Reversal agent of midazolam?

Answer 27

Flumazenil

Question 28

Disadv of IV sedation?

Answer 28

Escort required
Requires cannulation - training/ risks
Need chaperone

Question 29

Issues of IV sedation?

Answer 29

Can get over sedation - CV/ respiratory depression
Toelrance - those who use opioids regularly
Sexual fantasy