Dental update
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Conscious sedation for dental procedures is constantly developing. Midazolam remains the most widely used agent, although there has been encouraging research into patient-maintained sedation (PMS) with propofol. This article reviews the use of sedation in children, recent advances with propofol, and outlines current opinion on multiple drug sedation techniques. There is also a description of the current recommendations for training in the practice of conscious sedation.
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Review
Paediatric dentistry in the new millennium: 3. Use of inhalation sedation in paediatric dentistry.
Provision of General Anaesthesia is now limited and restricted to the hospital setting. Sedation for paediatric patients is an essential tool in anxiety management and is used as an adjunct to behaviour management. Inhalation sedation with nitrous oxide/oxygen sedation to reach a plane of relative analgesia may be administered easily and safely to children in general dental practice and is a potential alternative to general anaesthesia.
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One hundred and forty one, 27-gauge local anaesthetic needles were collected, each following a single injection of local anaesthetic using four commonly performed local anaesthetic injection techniques. The needles were examined for needle tip damage under the scanning electron microscope. ⋯ Bone was contacted in 75 (59%) instances and, of these, 73 (97.3%) showed needle tip deformity. Of the four techniques used, bone contact was commonest with the inferior alveolar nerve block, occurring in 88% of instances.
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The General Dental Council guidelines regarding the use of general anaesthesia in general practice have changed; inhalation sedation with nitrous oxide has been shown as a safe alternative to general anaesthesia for many patients and is a technique particularly suited to the practice environment.
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Experience is presented of the treatment of 100 patients for routine dentistry in general dental practice under propofol (Diprivan) sedation, delivered by continuous infusion. The infusion rates were set manually according to patients' responses. There were no differences in dental treatment or propofol requirements according to gender. ⋯ A most useful feature of propofol sedation was the associated rapid recovery, with no patients needing to remain in the surgery for the purposes of recovery. The technique met with patients' approval, as all responses returned indicated a willingness to undergo the same type of sedation in future. Propofol sedation is not appropriate for the single operator/sedationist.