Pharmacological Techniques of Behaviour Management

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is behavior management in dentistry?

A method of pain management

The means by which dental health team effectively and efficiently performs treatment for a child and instills a positive dental attitude (correct)

The technique used to anesthetize patients

A type of sedation used for fearful patients

What is conscious sedation?

A drug-induced loss of consciousness during which the patients are not arousable even by painful stimulation

A type of sedation used for adult patients only

A type of general anesthesia used for minor procedures

A minimally depressed level of consciousness that retains the patients ability to independently and continuously maintain airway and respond appropriately to physical stimulation or verbal command (correct)

What is the primary objective of sedation in pediatric dentistry for the child?

To reduce the fear and perception of pain during treatment (correct)

To minimize physical discomfort and pain

To control behavior or movement so as to allow safe completion of procedure

To facilitate coping with the treatment

What is premedication?

The prescription of a small anxiolytic dose of a sedative, to be taken by the patient outside the surgery environment Signup and view all the answers

What is general anesthesia?

A drug-induced loss of consciousness during which the patients are not arousable even by painful stimulation Signup and view all the answers

What is the objective of sedation for the dentist?

To allow safe completion of procedure with minimal disturbance from the patient Signup and view all the answers

What is moderate sedation?

A drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation Signup and view all the answers

What is anxiolysis?

A drug-induced state during which patients respond normally to verbal commands Signup and view all the answers

What is one of the goals of conscious sedation in dentistry?

To reduce stress and anxiety Signup and view all the answers

Which of the following is an indication for sedation?

Patient who is unable to cooperate due to a lack of psychological or emotional maturity Signup and view all the answers

What is a desirable characteristic of a sedative agent?

Rapid recovery Signup and view all the answers

Which of the following is NOT a consideration for sedation?

Weather conditions Signup and view all the answers

What is the minimum age requirement for conscious sedation in children?

1 year Signup and view all the answers

What is the primary route of administration for nitrous oxide sedation?

Inhalational Signup and view all the answers

Which of the following is a contraindication for conscious sedation?

Severe learning difficulties Signup and view all the answers

What is the typical concentration of nitrous oxide used in sedation?

30-50% Signup and view all the answers

What is the primary goal of conscious sedation in relation to the patient's CNS?

To depress the CNS Signup and view all the answers

What should be maintained throughout the period of sedation?

Verbal contact Signup and view all the answers

Which of the following is a characteristic of nitrous oxide?

Sweet-smelling Signup and view all the answers

What is the effect of nitrous oxide on the body?

Relaxes the muscles and reduces anxiety Signup and view all the answers

What is the primary concern when selecting a drug for conscious sedation?

The margin of safety of the drug Signup and view all the answers

Why is local anesthesia still required for dental procedures despite nitrous oxide sedation?

Nitrous oxide has a mild analgesic effect, but not sufficient for dental procedures Signup and view all the answers

What is the primary reason for using conscious sedation in patients with medical conditions such as angina and asthma?

To reduce the risk of medical complications Signup and view all the answers

What happens to exhaled nitrous oxide?

It is exhaled unchanged through the lungs Signup and view all the answers

What is one of the objectives of conscious sedation?

Reducing anxiety Signup and view all the answers

What is a contraindication for conscious sedation?

Patients with a cold Signup and view all the answers

What type of equipment is used for conscious sedation?

Nitrous oxide inhalation sedation equipment Signup and view all the answers

What is a feature of the nitrous oxide inhalation sedation equipment?

Audible alarm activated by low oxygen levels Signup and view all the answers

What is a crucial step before starting conscious sedation?

Checking the oxygen fail-safe system Signup and view all the answers

What is necessary for all patients receiving conscious sedation?

Valid informed consent in writing Signup and view all the answers

What is performed during the pre-sedation checkup?

A detailed patient history and examination Signup and view all the answers

How are patients classified during the pre-sedation checkup?

According to the American Society of Anesthesiologists (ASA) classification Signup and view all the answers

Who should be considered for sedation in dental surgery outside hospital?

Patients with ASA Grade I and II Signup and view all the answers

What is the recommended ASA Grade for pediatric patients to be sedated outside a hospital environment?

ASA Grade I only Signup and view all the answers

What is the purpose of delivering 100% O2 to the patient for 2-3 minutes at 4-6 liters per minute?

To prepare the patient for sedation Signup and view all the answers

How should the patient breathe during the procedure?

Through the nose with the mouth closed Signup and view all the answers

What is the purpose of allowing the patient to breathe 100% oxygen for 3-5 minutes after the procedure?

To prevent diffusion hypoxia Signup and view all the answers

What is a common sign of sedation?

Tingling in the fingers and toes Signup and view all the answers

What is the term for the phenomenon that may occur as the sedation is reversed at the termination of the procedure?

Diffusion hypoxia Signup and view all the answers

Why does the patient need to remain in the sitting position for a brief period after the procedure?

To prevent dizziness upon standing Signup and view all the answers

Study Notes

Behaviour Management

Definition: The means by which dental health team effectively and efficiently performs treatment for a child and at the same time instills a positive dental attitude. (WRIGHT, 1975)

Pharmacological Methods

Conscious Sedation: A minimally depressed level of consciousness that retains the patient's ability to independently and continuously maintain airway and respond appropriately to physical stimulation or verbal command.
- Minimal Sedation (Anxiolysis): A drug-induced state during which patients respond normally to verbal commands.
- Moderate Sedation: A drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation.
- Deep Sedation: A drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation.
Premedication: The prescription of a small anxiolytic dose of a sedative, taken by the patient outside the surgery environment, to reduce anxiety about attending their appointment or to aid sleep on the evening of the appointment.
General Anesthesia: A drug-induced loss of consciousness during which the patients are not arousable even by painful stimulation.

Objectives of Sedation in Pediatric Dentistry

For the Child:
- Reduce fear and perception of pain during treatment.
- Facilitate coping with the treatment.
- Minimize physical discomfort and pain.
- Control behavior or movement to allow safe completion of procedure.
For the Dentist:
- Accomplishment of dental procedures.
- Reduce stress in an unpleasant emotion.
- Prevent burnout syndrome.

Indications for Sedation

Fearful/anxious patient for whom basic behavior guidance techniques have not been successful.
Patient unable to cooperate due to lack of psychological or emotional maturity and/or mental, physical, or medical disability.
To protect patient's developing psyche.
To reduce patient's medical risk.

Conscious Sedation

Definition: A technique in which the use of a drug or drugs produces a state of depression of the central nervous system (CNS) enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation.
Indications:
- Dental phobia and anxiety.
- Traumatic and long dental procedures.
- Medical conditions aggravated by stress.
- Children more than 1 year of age.
- Mentally challenged individuals.
- Ineffective local anesthesia due to any reason.

Contraindications to Sedation

Medical conditions affecting cooperation (e.g. severe learning difficulties).
Medical conditions affecting sedation (e.g. any patient rated ASA III or worse should not be sedated outside a specialist facility).
Dental contraindication to sedation (lengthy or difficult procedures are best managed under GA).
Psychological contraindication to sedation (patients who refuse to give their consent to sedation).

Ideal Qualities of a Sedative Agent

Both sedative and analgesic effects.
Easy and acceptable method of administration.
Easy titration.
Minimal cardiovascular side-effects.
Minimal respiratory side-effects.
Rapid onset of action.
Rapid recovery.
No accumulation in renal/hepatic dysfunction.
Inactive metabolites.
Inexpensive.
No interactions with other drugs.

Agents Commonly Used for Sedation

Gases: Nitrous oxide.
Antihistamines: Hydroxyzine, promethazine, diphenhydramine.
Benzodiazepines: Diazepam, midazolam.
Barbiturates: Seconal, pentobarbital.
Chloral hydrate.
Narcotics: Meperidine, fentanyl.

Nitrous Oxide Inhalation Sedation

Definition: A technique in which the use of nitrous oxide gas produces a state of depression of the central nervous system (CNS) enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation.
Characteristics:
- Sweet-smelling, colorless, inert gas (laughing gas).
- Anxiolytic and sedative properties with varying degree of analgesia and muscle relaxation.
- Affects both GABA A and NMDA receptors.
Objectives:
- Reducing or eliminating anxiety.
- Reducing untoward movement and reaction to dental treatment.
- Enhancing communication and patient cooperation.
- Raising the pain threshold.
- Increasing tolerance for longer appointments.
- Aiding in the treatment of a patient with mental and/or physical disabilities or a medically compromised patient.
- Reducing gagging.
- Potentiating the effects of sedatives.

Contraindications to Nitrous Oxide Inhalation Sedation

Common cold.
Tonsillitis and otitis media.
Nasal blockage.
Patients with porphyria.
Severe psychological disorders and nasal hood phobia.
Maxillofacial deformities that prevent nasal hood placement.
Inability to cooperate or understand.
Myasthenia gravis and multiple sclerosis.

Equipment for Nitrous Oxide Inhalation Sedation

Machine should be of the continuous flow design, with flow meters capable of accurate regulation.
Fail-safe mechanism with automatic shutdown if O2 falls below 20%.
Audible and visual alarm activated by O2 failure.
Color coding for gases.
Efficient scavenger system.
Nasal hoods of good design and suitable sizes.

Preparation for Conscious Sedation

Consent for treatment: Valid informed consent is necessary for all patients receiving dental care under conscious sedation.
Pre-sedation checkup:
- Patient's detailed history and examination are performed so as to classify according to the American Society of Anesthesiologists (ASA) classification.
- Only patients who satisfy the criteria of ASA Grade I and II should be considered for sedation in dental surgery outside hospital.

Clinical Technique for Nitrous Oxide Inhalation Sedation

Mask of appropriate size should be introduced to the patient with an explanation delivered at the appropriate level of understanding.
Traditional behavior guidance techniques should be used.
100% O2 is delivered to the patient for 2-3 minutes at 4-6 liters per minute.
Nitrous oxide can be introduced by slowly increasing the concentration in increments of 10% to 20% until the desired level is achieved.
Encourage the patient to breathe through the nose with the mouth closed.
Communicate with the patient throughout the procedure, paying particular attention to the rate and depth of breathing.
Recovery can be achieved quickly by reverse titration.
Once the flow of nitrous oxide is reduced to zero, the patient should be allowed to breathe 100% oxygen for 3–5 minutes to prevent diffusion hypoxia.

Signs of Sedation

Tingling in the fingers and toes (parasthesia).
Reduced body and facial tension.
Reduced frequency of eye blinking.
Slowed responses.
Laughing/giggling.
Glazed eyes.
Relaxed feet.
Euphoria.
Warmth.
Feelings of lightness and/or heaviness.
Feelings of temperature change.
Floating or melting sensations.
Dissociation.
Day-dreaming.
Change of mood.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers the pharmacological methods used in behaviour management in dentistry, including conscious sedation, premedication, and general anesthesia.