Pediatric Dentistry: Pharmacological Behavior Management
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Questions and Answers

What is the primary goal of pre-sedation/anesthetic examination in pediatric dentistry?

  • To assign an ASA classification
  • To evaluate the anxiety level of the patient (correct)
  • To review the patient's medical history and medication use
  • To obtain informed consent from the patient's guardian

    • What is a potential risk associated with transporting infants who have received certain medications, such as chloral hydrate, in a car safety seat?

  • Increased risk of respiratory depression
  • Increased risk of death (correct)
  • Increased risk of anxiety
  • Increased risk of allergic reaction

    • What is an important consideration for a responsible person observing a child who has received sedation?

  • The ability to observe the child (correct)
  • The ability to drive
  • The ability to provide verbal instructions
  • The ability to provide written instructions

    • What is the purpose of obtaining informed consent from a patient's guardian?

    <p>To provide verbal and/or written instructions to the responsible person</p> Signup and view all the answers

    What type of sedation is characterized by a light state of relaxation, with the patient still able to respond to verbal commands?

    <p>Minimal sedation/anxiolysis</p> Signup and view all the answers

    What is the purpose of documenting informed consent?

    <p>To document that appropriate informed consent was obtained</p> Signup and view all the answers

    What is a type of sedation that is characterized by a deep state of relaxation, with the patient unable to respond to verbal commands?

    <p>Deep sedation/general anesthesia</p> Signup and view all the answers

    What is the purpose of reviewing the patient's medical history and medication use during the pre-sedation/anesthetic examination?

    <p>To identify potential interactions between medications</p> Signup and view all the answers

    What is the typical duration of action of Chloral hydrate when given orally?

    <p>4 to 8 hours</p> Signup and view all the answers

    What is a precaution to be taken when administering Diazepam (Valium) via the IV route?

    <p>Use a large vein and slow administration</p> Signup and view all the answers

    What is a common adverse effect of Chloral hydrate?

    <p>Drowsiness</p> Signup and view all the answers

    What is a characteristic of Nitrous Oxide?

    <p>It is colorless and supports combustion</p> Signup and view all the answers

    What is a contraindication for the use of a certain sedative?

    <p>History of asthma</p> Signup and view all the answers

    What is an adverse effect of a particular sedative that can occur before sedation?

    <p>Excitement and irritability</p> Signup and view all the answers

    What was the consequence of inhaling nitrous oxide during operations in Cairo's hospitals?

    <p>Lung problems and decline in blood circulation</p> Signup and view all the answers

    What is the condition in which patients are not arousable, even by painful stimulation?

    <p>Drug-induced loss of consciousness</p> Signup and view all the answers

    Which of the following is an indication for using general anesthesia?

    <p>Physically or seriously handicapped children</p> Signup and view all the answers

    What is the route of delivery of sevoflurane?

    <p>Inhalation</p> Signup and view all the answers

    Which of the following vital signs is NOT monitored during general anesthesia?

    <p>Body temperature</p> Signup and view all the answers

    What is an indication for prolonged observation in a child?

    <p>A child with an anatomic airway problem</p> Signup and view all the answers

    What is a major disadvantage of general anesthesia?

    <p>Risk of hospitalization</p> Signup and view all the answers

    What is the primary objective of conscious sedation?

    <p>To provide the most comfortable and high-quality dental service</p> Signup and view all the answers

    What is the definition of minimal sedation?

    <p>A minimally depressed level of consciousness in which the patient responds normally to verbal commands</p> Signup and view all the answers

    What is the primary difference between conscious sedation and deep sedation?

    <p>Level of consciousness</p> Signup and view all the answers

    What is the primary goal of monitoring during general anesthesia?

    <p>To prevent complications</p> Signup and view all the answers

    Which of the following is NOT a route of administration for conscious sedation?

    <p>Topical</p> Signup and view all the answers

    What is the peak level of Hydroxyzine HCL (Atarax) reached in?

    <p>2 hours</p> Signup and view all the answers

    Why should Hydroxyzine HCL (Atarax) not be injected IV or subcutaneously?

    <p>Because it may cause tissue necrosis and hemolysis</p> Signup and view all the answers

    What is the clinical effect of Hydroxyzine HCL (Atarax) seen in?

    <p>15 minutes to 30 minutes</p> Signup and view all the answers

    What is the purpose of providing a 24-hour telephone number to patients and their families?

    <p>To provide instructions on post-operative care</p> Signup and view all the answers

    What is the primary route of excretion of nitrous oxide?

    <p>Unchanged through the lungs</p> Signup and view all the answers

    Which of the following patients would be a good candidate for nitrous oxide analgesia?

    <p>A cooperative child undergoing a lengthy dental procedure</p> Signup and view all the answers

    What is the primary contraindication for nitrous oxide analgesia?

    <p>Upper respiratory tract infection and Pulmonary disease</p> Signup and view all the answers

    What is the final concentration of nitrous oxide and oxygen used in the procedure?

    <p>70% oxygen and 30% nitrous oxide</p> Signup and view all the answers

    How is the child recovered from nitrous oxide analgesia?

    <p>By inhalation of 100% oxygen for 5 minutes</p> Signup and view all the answers

    What is a common complication of nitrous oxide analgesia?

    <p>Nausea</p> Signup and view all the answers

    What is a chronic toxicity of nitrous oxide exposure?

    <p>Increased in hepatic disease</p> Signup and view all the answers

    What is the recommended duration of exposure to nitrous oxide to avoid chronic toxicity?

    <p>Less than 3 hours/week</p> Signup and view all the answers

    Study Notes

    Pharmacological Behavior Management in Pediatric Dentistry

    • Pharmacological behavior management is used to manage anxious or fearful children in pediatric dentistry.

    Types of Pharmacological Behavior Management Techniques

    • Minimal sedation/anxiolysis
    • Moderate sedation/conscious sedation
    • Deep sedation/general anesthesia

    Pre-Sedation/Anesthetic Examination

    • Physical examination
    • Evaluation of anxiety level
    • Review of medical history
    • Review of medication and drug allergy
    • Assign ASA classification
    • Review past sedation/anesthetic history
    • Obtain informed consent

    Documentations

    • Informed consent: The patient record shall document that appropriate informed consent was obtained
    • Verbal and/or written instructions to the responsible person, including objectives of sedation and anticipated changes in behavior during and after sedation

    Minimal Sedation/Anxiolysis

    • Definition: A minimally depressed level of consciousness in which the patient's ability to maintain a patent airway independently and continuously and respond appropriately to physical stimulation and/or verbal command
    • Objectives: Provide comfortable, efficient, and high-quality dental service, control inappropriate behavior, and produce a positive psychological attitude toward future care
    • Routes of administration: Oral, rectal, intramuscular, intravenous, subcutaneous, and nasal
    • Drugs used: Hydroxyzine HCL (Atarax), promethazine (Phenergan), chloral hydrate (Oral/rectal suppositories), and diazepam (Valium)

    Nitrous Oxide (Inhalation Analgesia/Laughing Gas)

    • Definition: A colorless, sweet-smelling gas that is neither explosive nor flammable but supports combustion as well as oxygen
    • Indications: Anxious or fearful children, short attention span children, certain mentally, physically, or medically compromised patients, and patients with a gag reflex that interferes with dental care
    • Contraindications: Upper respiratory tract infection, pulmonary disease, nasal obstruction, children with certain psychiatric disorders, children with a history of motion sickness, acute otitis media, and maxillofacial deformities
    • Equipment: Nitrous oxide machine, reservoir bag, nasal inhalation mask, double scavenger system, oxygen and nitrous oxide tanks
    • Technique: Describe the procedure to the patient, encourage the child to breathe through the nose, and deliver nitrous oxide and oxygen gradually
    • Recovery from analgesia: Inhalation of 100% oxygen for 5 minutes
    • Complications: Nausea, vomiting, headache, deep sleep, and disorientation

    Chronic Toxicity of Nitrous Oxide

    • Increased risk of hepatic disease in dentists and dental personnel exposed to high levels of nitrous oxide for periods of time greater than 3 hours/week
    • Bone marrow depression
    • Spontaneous abortion for female dentists
    • Dental personnel sterility may occur on prolonged exposure to nitrous oxide

    General Anesthesia (GA)/Deep Sedation/Analgesia

    • Definition: Drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation
    • Indications: Physically or seriously handicapped children, very young children and/or uncooperative, extensive treatment is required, allergy to local anesthesia, children with significant mental or psychological disorder, and severe dental disease in children with significant medical disease
    • Routes of delivery: Intravenous, inhalation (nitrous oxide, sevoflurane, desflurane, isoflurane, and halothane)
    • Vital signs: Blood pressure, heart rate, respiratory rate, oxygen saturation, and level of consciousness
    • Monitoring: Level of consciousness, clinical observation, pulse oximetry, and blood pressure
    • Undesirable aspects of GA: Represents a real risk, hospitalization can be a psychic trauma, and no patient should be exposed to that risk without sufficient cause

    Comparison of Conscious Sedation and Deep Sedation

    • Conscious sedation: Interactive, arousable, maintained airway, intact protective reflexes, and responds to commands
    • Deep sedation: Non-interactive, non-arousable, inability to maintain airway, partial loss of reflexes, and difficult to respond to commands

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    Description

    This quiz covers the management of pharmacological behavior in pediatric dentistry, covering types, definitions, and objectives. It's ideal for dental students and professionals working with children.

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