July 8, 2021 Flashcards
Chapter 1 + 2 of Oral sedation for dental procedures in children
How many Children per year that visit dentist need sedation? (%)
20-30% (this may be an underestimate)
Main limitation of non-intravenous parenteral and enteral sedation techniques?
Unable to titrate drugs
Psychological Space
An area in which and individual feels comfortable with his/her surroundings and situation
3y.o. behavioral expectation in dental office
Short attention spans, fearful of strangers, lack sufficient cognitive and language skills. Will require deeper levels of sedation
Factors that are the biggest creator of disruptive behavior in dental office?
Fear and Anxiety
Part of CNS where fear response mediates from?
Amygdala of midbrain, initially in limbic system of CNS.
Key concepts of behavior associated with sedation. There are 6 concepts.
Temperament, Attachment, Age, Experience, parenting, dental team.
What is temperament?
A child’s overt response as a basic and daily expression pattern to solitary and social situation. May aid in predicting how child will respond while under therapeutic doses of sedation
What is attachment?
Psychological concepts wherein presence and strength of emotional bonds to caregivers affects child’s response in different contextual situations.
What is Age?
Cognitive development associated with pt age.
What is Baumrind parenting triangle?
Where parenting styles as a major influence on a child’s behaviors. Correlation between authoritarian, authoritative, and permissive.
What is Authoritarian in Baumrind triangle?
Used harsh, controlling technique to control children and less compassion and dominates conversations.
What is Authoritative in Baumrind traingle?
compassionate and warm but sets limits on behavior and permits interactive communications.
What is permissive parent in Baumrind triangle?
Rarely sets limits on behavior and spoils the child.
What is the difference between active restraints and passive restraints?
Active implies human is involved in physically restraining the child. Passive is the use of a restraining device (papoose board) or mouth prop. Must gain informed consent for active/passive.
Will sedation only control the patient’s behavior?
No, must use behavior management techniques in addition to sedation.
Key factors that determine a patient’s behavior in dental setting?
temperament, age, cognitive development, fears/anxiety, family relationships, past experiences.
Child characteristics to assess prior to sedation?
Age-cognitive interactions consistent with cooperativeness.
Temperament-Activity, approachability, shyness, emotionality
Airway-presence and size of tonsils, normal respiratory sounds
Risk status- ASA I.
Advanced behavioral guidance techniques?
Protective stabilization, sedation, general anesthesia
Behavioral techniques in AAPD
TSD, voice control, nonverbal communication, positive reinforcement, distraction, parent presence/absence, N2O, protective stabilization, sedation, general anesthesia.
Infant Behavior in dental settings
Birth-1 y.o
Cognitive-basic receptive and expressive language
Emotional-calm, quiet, degree/intensity of crying
Behavior-social smile, grimace, sitting up, crawling
Dental needs-extraction natal/neonatal teeth, trauma
Intervention-G.A, topical
Toddler behavior in dental settings
Age 1-3 y.o
Cognitive-rapid evolving, language acquisition and purposeful use
Emotional- Calm, quiet, laughter, crying to screaming, anger, joy, surprise, shyness
Behavior-smiles, crying/temper tantrum, kicking, hitting
Dental needs- caries, trauma
Intervention- Short TSD, distraction, positive reinforcement, rewards, sedation (moderate to deep), G.A.
Preschooler behavior in dental setting
Age 3-6 y.o
Cognitive-Language skills rapidly progressing, speaks what he/she hears, imagination and magic dominate
Emotional-Calm, quiet, laughter, crying w/purpose, anger, sadness, recognition of others emotions
Behavior- smiles, cries, kicking, hitting, spitting, obstinacy
Dental- caries, trauma, space maintenance
Interventions- TSD, distraction, positive reinforcement, rewards, voice control, nitrous oxide, mild to deep sedation, G.A.
Primary school behavior in dental settings
Age 6-12 y.o
Cognitive- language skills approaching adult level, general compliance with authority figures begins to dominate
Emotional-calm, quiet, laughter w/purpose, crying w/purpose, anger, sadness, compassionate, interactive
Behavior-smiles, cries, obstinacy, moody, cooperative
Dental- caries, trauma, space maintenance, orthodontics
Interventions- TSD, distraction, positive reinforcement, nitrous oxide, mild to moderate sedation
High school and teenager behavior in dental settings
Age 13-19
Adult cognition
Emotional- calm, quiet, laughter, moody, anger, avoidance, challenging, peer orient
behavior-smiles, obstinacy, moody, cooperative
dental needs- caries (rampant) trauma, space maintenance, orthodontics, tabacco-related periodontal issues
Interventions- TSD, distraction, positive reinforcement, nitrous oxide, mild to moderate sedation
