Blay Solomon

Pharmacologic Behavioral technique

Conscious sedation

A technique in which the use of a drug or drugs produces a state of

depression of the nervous system enabling treatment to be carried out, but
during which verbal contact with the patient is maintained throughout the
period of sedation.
The drugs and techniques used to provide conscious sedation for dental
treatment should carry a margin of safety wide enough to render loss of
consciousness unlikely.
Objectives
For the child For the dentist
Reduce fear and perception of pain Facilitate accomplishment of dental
during the treatment procedures
Facilitate coping with the treatment Reduce stress and unpleasant
emotions
Prevent development of dental fear Prevent burn-out syndrome
and anxiety

Patient selection and assessment

I. Full medical & dental history
II. Each patient classified according to the ASA Physical Status Classification
System
III. ASA Class I or Class II (considered candidates for CS as outpatients)
IV. ASA Class III and Class IV (treated in a hospital environment, involving the
assistance of medical doctors when appropriate)

ROUTES
1. Oral
Oral refers to two methods of administration which is applying topically
to the mouth and swallowing for absorption along the gastrointestinal
tract into systemic circulation.

Indication
Behavior management problems
Dental fear and anxiety

Contraindications
Very young children
Intellectually challenged children
 Hyper motive/obstinate children
Systemic diseases like respiratory distress, Neuromuscular disorders
etc.

Procedure
Oral administration of tablets can be given either as a single dose 1
hour before treatment, or fractionated, with half the dose taken on the
night before, and the remaining half 1 hour prior to treatment.
Tablets can be crushed and mixed in sweetened drink to facilitate
administration.

Side effect
Interactions with other medication
Paradoxical reaction
Over sedation
Hallucinations

2. Intramuscular
Intramuscular (also IM or im) injection is the injection of a
substance directly into a muscle. In medicine, it is one of several
alternative methods for the administration of medications.

Indication
Intramuscular injections are used when other types of delivery
methods are not recommended. These include oral (swallowed
into the stomach), intravenous(injected into the vein),
and subcutaneous (injected into the fatty tissue just under the
layer of skin). Intramuscular injection may be used instead of
intravenous injection because some drugs are irritating to veins
or because a suitable vein cannot be located. It may be used
instead of oral delivery because some drugs are destroyed by the
digestive system when a drug is swallowed.

Contraindication
Allergy
Liver and renal dysfunction

Procedure
Wash your hands
Gather all needed supplies
Locate injection site
Clean injection site
Prepare syringe with medication
 Self-injection with a syringe
inject medication
remove needle
apply pressure to the injection

Side effect
Severe pain at the injection
Tingling or numbness
Redness,swelling or warmth at the injection site
Drainage at the injection site
Prolonged bleeding
Sings of an allergic reaction,such as difficulty breathing or facial
swelling

Intravenous
Intravenous therapy is the infusion of liquid substances directly
into a vein. Intravenous (IV) means "within
vein". Intravenous infusions are commonly referred to as drips.
The intravenous route is the fastest way to deliver fluids and
medications throughout the body

Indication
IV medication is often used because of the control it provides
over dosage. For instance, in some situations, people must
receive medication very quickly. This includes emergencies, such
as a heart attack, stroke, or poisoning. In these instances, taking
pills or liquids by mouth may not be fast enough to get these
drugs into the bloodstream. IV administration, on the other hand,
quickly sends a medication directly into the bloodstream

Contraindication
Drug reversal is not possible
Difficulty in titration
Allergy
Liver and renal dysfunction cases

Procedure
Wash your hands
Gather all needed supplies
Locate injection site
Clean injection site
 Prepare syringe with medication
Self-injection with a syringe
inject medication
remove needle
apply pressure to the injection

Side effects
infection
damage to blood vessels and injection site
air embolism
blood clots

Inhalation
Any drug or solution of drugs administered (as by means of nebul
izers or aerosol) by the nasal or oral respiratory route.

Indication
A fearful or anxious patient.
Certain patients with special health care needs.
A patient whose gag reflex interferes with dental care.
A patient for whom profound local anesthesia cannot be obtained.
A cooperative child undergoing a lengthy dental procedure.

Contraindications
Pre-co-operative children
Patients with upper airway problems as common cold, tonsillitis or
nasal blockage
Patients with sinusitis or recent ENT operations (within 14 days)
Patients in bleomycin chemotherapy
Psychotic patients
Patients with porphyria

Procedure
Selection of an appropriately sized nasal hood should be made.
A flow rate of 5-6 L/min generally is acceptable to most patients.
Introduction of 100 % oxygen for 1-2 minutes followed by titration of
nitrous oxide in 10 % intervals is recommended.
During nitrous oxide/oxygen analgesia/anxiolysis, the concentration of
nitrous oxide should not routinely exceed 50 %.
Nitrous oxide concentration may be decreased during easier
procedures (eg, restorations) and increased during more stimulating
ones (eg, extraction, injection of local anesthetic).
 Side effects
Over sedation
Nausea
Panics
Sweating
Headache
Vomiting

ii. General anesthesia

Under general anesthesia, you are completely unconscious and unable to

feel pain during medical procedures. General anesthesia usually uses a
combination of intravenous drugs and inhaled gasses (anesthetics).

General anesthesia is more than just being asleep; the anesthetized brain
doesn't respond to pain signals or reflexes.

An anesthesiologist is a specially trained doctor who specializes in

anesthesia. While you're unconscious, the anesthesiologist monitors your
body's vital functions and manages your breathing.

In many hospitals, an anesthesiologist and a certified registered nurse

anesthetist (CRNA) work together during your procedure.

Indications

related to the patients general condition:

I. behavior that prevents an oral or dental assessment
and/or treatment with the patient conscious (attempts at
treatment in the dentists chair have failed);
II. - if urgent major oral treatment is needed before
emergency surgery or medical treatment, e.g. in
oncology, hematology, cardiology, organ transplantation;
III. - limited mouth opening precluding immediate
examination and/or treatment;
IV. - strong gag reflex;
related to the intervention:
1. long, complex, or multiple procedures at a single session;
2. - local or regional infection requiring emergency
intervention (e.g. concomitant drainage and/or
 debridement, extractions in a patient with
osteoradionecrosis);
related to local anesthesia:
1. Known contraindications to local anesthesia, i.e.
allergy confirmed by allergy tests and the
contraindications specified in the Marketing
Authorization (porphyria, epilepsy not controlled
by drugs, etc.) ;
2. - Impossibility of achieving an adequate level of
local anesthesia after repeated attempts over
several sessions.

(iv) Contrandications:
- major risks of anaesthesia: the benefit-risk ratio should be weighed up;
- refusal by patient and/or patients relatives or legal representative.
Procedure

Induction
Excitement stage
Surgical anaesthesia
Overdose

2.pre-anesthetic assessment
The stage from full consciousness to a state of sedation or tranquilization
with varying degrees of muscle relaxation and immobilization.
Reasons for preanesthesia
1. Induce sedation
2. Calm patient
3. Reduce general anesthethic drug
requirments
4. Provide analgesia and muscle relaxation

Preanesthesia drugs
1. Anticholinergics
2. Tranquilizers
3. Sedatives