Dental clinics of North America
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Dent. Clin. North Am. · Oct 2002
ReviewInhalational and enteral conscious sedation for the adult dental patient.
There are clearly many safe and effective sedatives available to the dental practitioner for reducing patient fear and improving their level of comfort. Careful consideration needs to be given to the objectives of the sedation when deciding which pharmacologic agents to use because they all possess slightly different clinical characteristics and various degrees of risk. Patient selection also is critical when making decisions about sedation because the patient's expectations and general health status factor into keeping the procedure safe. ⋯ When N2O/O2 sedation is combined with a single enteral sedative, a more profound level of CNS depression is achieved that can be modestly altered by changing the concentration of inhaled nitrous oxide. With these many pharmacologic alternatives, many different dental patient populations can be sedated in a safe, effective manner, thus allowing the delivery of most dental treatments in a setting of reduced psychologic and physiologic stress. These pharmacologic sedatives have truly opened up a wonderful world of possibilities for the comfortable delivery of dental care, and should be integrated into every office's repertoire for delivery of care.
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With the dramatic demographic change that has resulted in the "graying of the population" has come a compelling interest in the health and health concerns of older adults. The increasing incidence and prevalence of systemic diseases, especially chronic diseases, among older adults, and the concomitant increase in medication use, have provided impetus for the subspecialty of geriatric pharmacology. This article reviews the physiologic changes, nonphysiologic aspects, and pharmacologic changes associated with aging and their implications for dental practice.
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A dentist's ability to safely administer regional anesthesia is essential for dental practice. Local anesthetic solutions used in the United States for dental anesthesia are formulated with several components. The contents of a standard local anesthetic cartridge may include an amide or ester local anesthetic drug, an adrenergic vasoconstrictor, and an antioxidant. ⋯ Although extremely rare, allergic reactions may also occur. Signs and symptoms of the various adverse reactions associated with local anesthetics are quite distinctive, permitting rapid diagnosis and treatment. Serious reactions are extremely infrequent and, when treated properly, unlikely to result in significant morbidity or mortality.
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Misconceptions about the need for pain management in pediatric patients have been shown to be wrong. We now understand that children feel pain and respond to pain medication in much the same way as adults. With this new understanding, practitioners must recognize all the factors that affect the feeling of pain. ⋯ An effective pain management protocol begins with preoperative pain and anxiety control, with the use of agents such as nitrous oxide and local anesthetics. Postoperative pain medication should be given at the correct dosage and time intervals for the appropriate duration. With our commitment to pain management in children, these protocols should easily translate into improved clinical practice.
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Dent. Clin. North Am. · Oct 2002
ReviewConscious sedation for dentistry: risk management and patient selection.
There are many safe and effective medications available to the dental practitioner for producing conscious sedation. Given the many sedatives available, all possessing slightly different clinical characteristics and various degrees of risk, careful consideration needs to be given to the objectives of the sedation when deciding which pharmacologic agents to use. Before making plans to sedate dental patients, however, one needs to make sure that several "layers" of risk management are in place to ensure the sedation procedure is as safe as possible. ⋯ Finally, even though conscious sedation is safe when all precautions are followed, being prepared to manage unexpected sedation-related emergencies is necessary. The principles of risk management covered in this article are applicable to other articles in this issue, in which N2O/O2 inhalational sedation and enteral sedation in adults and children are discussed. The remaining article in this section that reviews the prevention of medical emergencies and the pharmacologic agents necessary to treat emergency events that are likely to occur in dental settings further enhances the level of preparedness necessary when administering conscious sedation to adults and children.