Sedation

Question 1

what does DFA stand for

Answer 1

dental fear and anxiety

Question 2

what questionnaire do we use to get a score for the patient’s DFA and how does it work

Answer 2

Modified Child Dental Anxiety Scale faces (MCDASf)

each question has a score from 1-5 (1 = feeling comfortable, 5 = feeling very anxious)

Question 3

what is MTD

Answer 3

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

Question 4

what is IS

Answer 4

inhalation sedation

Question 5

what is inhalation sedation

Answer 5

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

Question 6

how does inhalation sedation make the patient feel

Answer 6

• 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

Question 7

what is CBT

Answer 7

cognitive behaviour therapy

Question 8

how does CBT work

Answer 8

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

Question 9

how can relaxation exercises help an anxious patient

Answer 9

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

Question 10

what kind of anxiety does IS work for? (mild, moderate, severe)

Answer 10

good for mild anxiety
ok for moderate anxiety
doesnt always work for severe anxiety

Question 11

how does nitrous oxide and oxygen work

Answer 11

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

Question 12

how do you stop the effects of IS

Answer 12

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

Question 13

why do you want the patient to breathe out through their nose

Answer 13

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

Question 14

what is nitrous oxide

Answer 14

Sedative agent

Question 15

where does nitrous oxide remain for the longest time

Answer 15

adipose tissue

lots of adipose tissue = takes longer to return to normal

Question 16

what is the minimum amount of oxygen that can be given alongside nitrous oxide

Answer 16

30%

still higher than the oxygen you get from air

Question 17

what are the safe mechanisms of IS machines

Answer 17

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

Question 18

can the child speak to the dentist during IS treatment

Answer 18

yes

Question 19

how long does it usually take child to return to normal after treatment

Answer 19

5 to 10 mins

Question 20

how is oxygen and nitrous oxide usually titrated

Answer 20

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

Question 21

what should the parent and patient do before attending the appointment

Answer 21

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

Question 22

who consents for IS treatment

Answer 22

need parent or legal guardian to give written consent

usually consent on a different day to the IS appointment

Question 23

who can accompany the child for IS treatment

Answer 23

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

Question 24

how many can attend the appointment with the child

Answer 24

recommended only one adult accompany the child in the dental surgery
other adults and children can wait in the waiting room

Question 25

does IS work with a blocked nose

Answer 25

no

the appointment would need to be re-arranged

Question 26

what advice should be given to parents for after IS is completed

Answer 26

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