Sedation Flashcards
what does DFA stand for
dental fear and anxiety
what questionnaire do we use to get a score for the patient’s DFA and how does it work
Modified Child Dental Anxiety Scale faces (MCDASf)
each question has a score from 1-5 (1 = feeling comfortable, 5 = feeling very anxious)
what is MTD
Message to dentist
it is a form patients can fill out before they come into the dentist
it asks simple questions about how the patient feels about the dentist and about things the patient likes / dislikes
also asks what can be done to help the patient feel more comfortable during the appointment
behavioural tool used in CBT
what is IS
inhalation sedation
what is inhalation sedation
technique used by dentists to make you more comfortable at the dentist
patient wears a mask and breathes in nitrous oxide through their nose and this helps to relax the central nervous system
how does inhalation sedation make the patient feel
- more relaxed
- less stressed and anxious
- warm fuzzy feeling (kind of like a day dream / zoned out but still aware of surroundings)
- giggly
- sleepy
- mild tingling or fuzziness in stomach, hands, feet or round their mouth
what is CBT
cognitive behaviour therapy
how does CBT work
it is a talking therapy
works by taking your fears and breaking them down into smaller parts which you can more easily overcome
used to help patients think more positively
teaches the patient how to deal with overwhelming emotions and how to manage them
gives the patient tools to overcome unhelpful thoughts
how can relaxation exercises help an anxious patient
helps to slow down breathing and heart rate which then it run has a calming effect
works on patients physiology to try and calm them down and work against their fight or flight response
what kind of anxiety does IS work for? (mild, moderate, severe)
good for mild anxiety
ok for moderate anxiety
doesnt always work for severe anxiety
how does nitrous oxide and oxygen work
mix together and breath it in trough the nose and they act on receptors in the body
goes into lungs then into blood pressure will drive it into the blood and the concentration then moves it to the brain to cross the blood-brain barrier
At the brain, it acts on CNS where it has a depressive effect
how do you stop the effects of IS
just stop breathing in the gases
pressures and concentration in blood will reduce so that it will come back out of the brain so you are just breathing it all back out again
why do you want the patient to breathe out through their nose
if they breathe out through their mouth the operator or assistance can inhale the gases
it also enters the environment / room if breathed out this way
not good for environment
what is nitrous oxide
Sedative agent
where does nitrous oxide remain for the longest time
adipose tissue
lots of adipose tissue = takes longer to return to normal
what is the minimum amount of oxygen that can be given alongside nitrous oxide
30%
still higher than the oxygen you get from air
what are the safe mechanisms of IS machines
If patient starts to breathe at a higher rate and you don’t watch the reservoir bag
The bag can go flat there is a room air valve so that the patient then just breathes air
Ensures patient doesn’t suffocate
Oxygen flush button to fill reservoir bag
can the child speak to the dentist during IS treatment
yes
how long does it usually take child to return to normal after treatment
5 to 10 mins
how is oxygen and nitrous oxide usually titrated
Gradually titrate it
Start at 100% oxygen
Then 10% nitrous 90% oxygen
After 1min bring it to 80:20
Then 70:30 ~ most treatment can be done at this
Can then do 60:40 ~ usually don’t have to go any further than that
50:50 ~ get with child birth or in an ambulance
When finished bring them back to 100% oxygen to recover for at least 2 mins
what should the parent and patient do before attending the appointment
have the child eat and drink as normal but avoid a heavy meal just before the appointment
ie avoid really fatty foods as it can make the child more likely to feel nauseous and be sick
who consents for IS treatment
need parent or legal guardian to give written consent
usually consent on a different day to the IS appointment
who can accompany the child for IS treatment
once the consent documentation is complete any adult can accompany the child to the appointments as long as that person is aware of and able to provide the appropriate after care for the child
please tell dentist if the accompanying person is pregnant
how many can attend the appointment with the child
recommended only one adult accompany the child in the dental surgery
other adults and children can wait in the waiting room
does IS work with a blocked nose
no
the appointment would need to be re-arranged
what advice should be given to parents for after IS is completed
recommend your child is supervised by a responsible adult for the result of the day
it is safe for the child to return to school but tell the teacher they have had IS
avoid contact sports or riding a bike for the rest of the day
