Introduction to Pain & Anxiety Control

Question 1

What are some medical indications for use of sedation in dentistry?

Answer 1

Conditions aggravated by stress of dental treatment:
- ischaemic heart disease
- hypertension
- asthma
- epilepsy
- psychosomatic illness
- ulcerative collitis or crohn’s disease

Question 2

What are some cooperation medical indications for use of sedation in dentistry?

Answer 2

• spasticity disorders
• parkinson’s disorders

Question 3

What are some psychosocial indications for use of sedation in dentistry?

Answer 3

• phobias
• gagging
• persistent fainting (anxiety related)
• idiosyncracy to LA (feeling faint)

Question 4

what is a phobia?

Answer 4

An irrational and uncontrollable fear, which is related to a specific object or situation. It is persistent,, despite avoidance of the provoking stimulus. It has a direct effect on the patient’s lifestyle.

Question 5

What are some causes of dental anxiety?

Answer 5

• trauma (usually in childhood)
• transferred or learned (parents/playground)
• fear of criticism
• fear of dress
• lack of communication
• helplessness
• invasion of body orifice
• environment & surgery appearance
• staff continuity

Question 6

what are some dental indications for sedation?

Answer 6

• difficult or unpleasant procedures (surgical extraction of wisdom teeth, orthodontic extractions, implants)

Question 7

what are some medical contra-indications to use of sedation?

Answer 7

• severe of uncontrolled systemic disease
• severe mental or physical disability (lack of understanding)
• severe psychiatric problems
• narcolepsy
• hypothyroidism

Question 8

What is an ASA 1?

Answer 8

A normal healthy patient

Question 9

What is an ASA 2?

Answer 9

A patient with mild systemic disease

Question 10

What is an ASA 3?

Answer 10

a patient with severe systemic disease (poorly controlled diabetes)

Question 11

What is an ASA 4?

Answer 11

A patient with severe systemic disease that is a constant threat to life

Question 12

What is an ASA 5?

Answer 12

A moribund patient who is not suspected to survive without the operation

Question 13

What is an ASA 6?

Answer 13

a declared brain-dead patient whose organs are being kept alive for donation purposes

Question 14

What level of ASA patients can dentists treat?

Answer 14

ASA 1 & 2 (anything further must be treated by anaesthetist)

Question 15

What are some medical contraindications to intravenous sedation?

Answer 15

• intracranial pathology
• COPD
• myasthenia gravis
• hepatic insufficiency (unable to metabolise drug properly)
• pregnancy & lactation

Question 16

What are some medical contraindications to inhalational sedation?

Answer 16

• blocked nasal airway
• COPD
• pregnancy (sedates the fetus)

Question 17

What are some social contraindications to sedation?

Answer 17

• unwilling
• uncooperative
• unaccompanied
• children (for IV… must be inhalation)
• very old

Question 18

What are some dental contraindications to intravenous sedation?

Answer 18

• procedure too difficult for LA
• procedure too long
• spreading infection (airway threatening & limits LA)
• procedure too traumatic

Question 19

What are the advantages of use of sedation in dentistry?

Answer 19

• decrease dentist stress
• decrease staff stress
• decrease patient stress
• fewer medical incidents
• more productive appointments

Question 20

What are the disadvantages of use of sedation in dentistry?

Answer 20

• training required (both dentist & nurse)
• equipment required
• recovery time & after care