Sedation and SCD Flashcards
SCD for
those with a disability or activity restriction that directly or indirectly affects their oral healthy
problems with providing dental tx to SC pts
- Communication
- Anxiety
- Moving target
- Perception of reality
- Previous experience
Often the same as providing medical care
2 common issues for SC pts getting dental tx
involuntary movements
learning difficulties (congenital or acquired)
duration of IV drug operating window approx.
40mins
5 possible congenital movement disorders
- Muscular dystrophy – slight concern on airway
- Cerebral Palsy
- Multiple Sclerosis
- Parkinson’s Disease
- Huntingdon’s Chorea – often has a learning difficulty association, tricky
possible acquired movement disorder
due to head injury
3 aspects in assessment needed for management of movement disorder
mental and physical status
anxiety
pain experience
possible causes of learning difficulties in SC pts
- Congenital
- Syndromic
- Non-syndromic
- Acquired
- Trauma
- Infection
- CVA
- Alzeheimer’s – often Elderly, additional complication e.g. drug metabolsim
3 assessment aspects for SC pts with learning difficulties
- Will behavioural management be possible?
- Many patients can be treated with TLC
- Is pharmacological management needed?
- Sedation or GA or both
- Patient understanding
- Patient’s pain experience
most important aspect of assessment for all SC pts
GET TO KNOW THE PT
what they do/don’t understand
triggers
consent key points
Adult Incapacity Act (2000) Scotland
No one else can give consent for adult to have treatment
- If not competent to give consent
- Medically qualified or appropriately trained dentists
- can complete form allowing treatment
- Lasts up to 36 months
- Patient competent to consent but can’t write.
- Not covered by legislation
- Verbal consent document in notes
4 concious sedation technqiues
- Inhalational N2O
- Intravenous - midazolam
- Oral sedation with midazolam (drink), can also get premed (milder)
- Transmucosal
- Intranasal
- sublingual
- rectal
7 considerations for choice of sedation technique
- Patient co-operation
- None ->GA
- Good -> IHS, but need them to stay still and breathe through nose – challenge
- Degree of anxiety
- Dentistry required
- Extremely invasive – IV, won’t remember
- Upper central operated on – nose piece for inhalation may inhibit?
- Skills of the dental team
- Patient’s previous experience
- Successful tx of sedation in past, likely go for that again
- Facilities available
- Hospital environment better in more complex pt, just in case
- Anaesthetist required?
inhalation sedation
consists of
Safe technique
- Nitrous oxide and oxygen combination through nasal hood
- Mild anxiety
- Rapid – both sedation and recovery
- Sedated before injection – good for needle phobia
- Flexible – can titrate, turn off on demand
need to be able to
- Nasal breathing when mouth open.
- Understanding Behavioural management
- Cooperation
IHS for
mild anxiety only