Study Cards 3 Flashcards
Deep sedation is
Patients cannot be easily aroused but respond purposefully after repeated verbal or painful stimuli. Ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, spontaneous ventilatoin may not be adequate.
Deep sedation- requirements for monitoring
1 person must be constantly observe vitals, airway, adequacy of ventilatoin
ECG and defibrillator should be readily availiable
IV access either at beginning of procedure or a person skilled in establishing vascular access
Does DD affect both dentitions?
What do you often see below the teeth in DD type one ?
Yes
Multiple periapical radiolucencies which represent chronic abscesses, granulomas, or cysts
Does the AAPD recommend using a bonding agent with sealants?
Yes, thin layer of hydrophilic bonding material.
Ectopic eruption of permanent molars is classified into two types- what are they?
What percent are in each group?
Molars that jump (66%)
Molars that remain impacted
General anesthesia
Drug induced loss of conciousness during which patients are not arousable, even by painful stimuli. The ability to maintain adequate independent ventilation is often impaired. Cardiovascular function may be impaired (usually not so in the other forms of sedation).
How do you differentiate between DD and DI?
Dentin Dysplasia 2 types (Shields)
DD Type I: radicular, normal color, rootless teeth both dentitions, obliterated pulp chambers, AD, periapical radioluciencies without obvious source
DD Type II: coronal, amber color, primary teeth affected, permanent teeth look normal but thistle-tube shaped pulps, stones
Dentinogenesis Imperfecta (also Shields)
DI Type I-occurs with OI, amber, AD, rapid attrition, primary teeth more severely affected
DI Type II-occurs ALONE, both dentitions affected, AD
DI Type III-Brandywine, bell shaped crowns, shell teeth short roots, large pulp chambers
Osteogenesis Imperfecta-4 types, OI type I most common, OI type II-perinatal lethal, also type III, IV, blue sclera, temporal bossing
Minimal sedation (old term anxiolysis)
A drug induced state in which patients respond normally to verbal commands. Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are unaffected.
Minimal sedation guidelines for monitoring
Observation and intermittent assessment of level of sedation
Moderate sedation (old terminology conscious sedation, sedation/analgesia)
Drug induced depression of conciousness during which patients can respond to commands. No interventions are required to maintain an airway, spontaneous ventilatoin is adequate.
Pulp therapy on permanent teeth should be radiographically examined
6 and 12 months following the procedure.
Restorations with DD- different types have different needs - how?
Type I- poor crown to root ratios such that prosthetic replacement is only choice
Type II- Full coverage restorations
Supernumerary teeth are more common in the permanent or the primary dentition?
Occur 5x more often in the permanent dentition
What ASA classifications are generally considered appropriate candidates for sedation?
Class I and II
What are some valid reasons for treating a class II early?
Self esteem, decreasing negative social experiences, incisor injury
What are the 4 types of AI?
AI Type I:Hypoplastic-insufficient enamel, both dentitions, anterior open bite, subgroups (AD, AR, X Linked)
AI Type II-Hypomaturation
AI Type III-Hypocalcified
AI Type IV-Hypomaturation-hypoplastic with taurodontism
What are the contraindications for nitrous oxide usage? 5
- some COPD
- Severe emotional disturbances or drug related dependencies
- First trimester of pregnancy
- Treatment with bleomycin sulfate (anti-cancer drug)
- Methlyenetetrahydrofolate reductase deficiency
What are the three types of dentinogenesis imperfecta?
DI- associated with osteogenesis imperfecta
DI type II and type III- autosomal dominant conditions linked to 4q12-21 suggesting these may be mutations of DSPP gene
What are the types of dentin dysplasia?
Type I- Radicular dentin dysplasia, rootless teeth
Type II- Coronal dentin dysplasia
What causes the analgesic effect of nitrous oxide?
Neuronal release of endogenous opioid peptides with subsequent activation of opioid receptors and descending GABA type A receptors and noradrenergic pathways that modulate nociceptive processing at the spinal level
What causes the anxiolytic effect of nitrous oxide?
Activation of the GABA A receptor either directly or indirectly through the benzodiazepine binding site
What documentation after treatment?
Level of conciousness, oxygen saturation,
What documentation before a sedation procedure? (2)
Informed consent, Instructions provided to the responsible person (post op)
What does the literature show in terms of treating a class II- does it need to be done in 2 stages or one?
Studies show it can be corrected effectively with either a single stage or a two stage regimen
What is a common orthodontic feature of amelogenesis imperfecta?
Anterior open bite-
50% in hypoplastic AI
31% in hypomaturation
60% in hypocalcified
What is early tooth loss in DD often attributed to?
Periodontitis.
What is the SOAPME acronym used for?
Setup and checklist for a sedation procedure
S- suction and suction apparatus
O- Oxygen supply
A- Airway equiptment
P- Pharmacy- all drugs needed to support life during an emergency, including antagonists
M- Monitors - puse ox, bp, etc.
E- Equipment or drugs that are special to the given case
What is the estimated frequency of AI?
1:7000
What is the goal with treating DD?
Goal is to retain teeth for as long as possible- shortened roots and periapical lesions make prognosis poor.
What is the incidence of ankylosis reported to be in the primary dentition?
between 7 and 14%.
What is the incidence of dentin dysplasia?
1:100,000
What is the incidence of dentinogenesis imperfecta?
1:8000
What is the most common adverse effect with nitrous oxide and how often does it occur?
nausea and vomiting, 0.5%
What is the presentation of DD type I?
Radicular Dentin Dysplasia
Crowns appear mostly normal but roots are short and constricted, blunted
Depends on the timing of dentin disorganization- very early and roots are short or absent
Later- typical root length with pulp stones and chevron shaped pulp chambers
What is the presentation of DD type II?
Root lengths are normal in both dentitions, teeth are amber colored in the primary dentition
Primary teeth have amber color which closely resembles DI
Permanent teeth have thistle tube shaped pulp chambers with multiple pulp stones
What is the presentation of DI type II?
Known as hereditary opalescent dentin
Both dentitions affected, characteristics are the same as type I
Pulp chamber obliteration can begin before teeth are totally erupted.
What is the presentation with type I DI?
With osteogenesis imperfecta,
Both dentitions affected, primary teeth affected most severely with permanet incisors and first molars being close behind, 2nd and 3 molars are least altered
Teeth have bulbous crowns, cervical constrictions, thin roots, early obliteration of the root canal and pulp chambers
PA radiolucencies and root fractures are common
What is the presentation with type III DI?
Brandywine, rare, Bell shaped crowns, shell teeth with short roots and enlarged pulp chambers, multiple pulp exposures, regular tubules, enamel pitting
What level of skill must a practitioner have in terms of rescue from an intended level of sedation?
Must be able to rescue one level below the intended level- ie, if you are doing deep sedation you must be able rescue from general anesthesia
What monitoring guidelines for patients undergoing moderate sedation?
Practitioner must at a minimum be able to perform bag mask ventilatoin; an additional person who can assist, baseline vital signs, dosage of all drugs administered, intermittent recording of respiratory rate and blood pressure
After procedure-
monitoring of oxygen saturation and heart rate monitoring until appropriate discharge criteria are met
What needs to be documented when doing deep sedation/general anesthesia in the dental clinic setting?
Vitals: Pulse and respiratory rates, bp, oxygen saturation every 5 minutes
Drugs: Name, dose ,route, site, time of administration, patient effect of all drugs
Recovery: Condition of the patient, discharge criteria met, discharge signature to responsible adult
What occlusion is often seen in DI Cases?
Class III malocclusion with high incidences of posterior crossbites and openbites occur in DI type I
What percent of class III cases had a hereditary molar effect?
56%
What should be a treatment consideration when dealing with advanced cases of DI and AI?
Creating a splint to re-establish vertical dimension
What steps does the practitioner need to take prior to sedation?
Health evaluation- age/weight, allergies, medical history, family history related to anesthesia, ROS, Vitals, Physical exam, Physical status evaluation, Name, address, phone number
What vitals must be performed prior to sedation?
Heart rate, blood pressure, respiratory rate, temperature
When can an amalgam or resin restoration be used in a primary tooth receiving pulp therapy?
Less than 2 years to exfoliation, conservative prep with sound lateral walls.
When combining medications for sedations, when is the risk for an adverse outcome increased?
When giving 3 or more medications.
When should a patient that is undergoing moderate sedation be considered to be deeply sedated?
When a patient is making no spontaneous efforts to relieve an obstruction
When should you extract the primary canine when you are concerned that the permanent canine is going to be impacted?
When the canine bulge cannot be palpated and there is radiographic overlapping of the canine with the root of the lateral during the mixed dentition.
When you extract the primary canine because you are worried about the permanent canine, what percent of the permanent canines erupt?
75%
