Journal of the California Dental Association
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Inhalation sedation utilizing nitrous oxide-oxygen has been a primary technique in the management of dental fears and anxieties for more than 150 years and remains so today. Though other, more potent, anesthetics have been introduced, nitrous oxide is still the most used gaseous anesthetic in the world. Administered properly with well-maintained equipment, the nitrous oxide-oxygen technique has an extremely high success rate coupled with a very low rate of adverse effects and complications.
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As the young indigent population of this state grows, access to dental care continues to be a problem. Studies show that children from poor families suffer from a higher caries rate than those from a higher socioeconomic class. ⋯ However, because children in this demographic group frequently lack the financial resources necessary for these treatment modalities, they will either not receive the necessary care because they are deemed unmanageable or will have a traumatic experience causing them to become even more resistant to future dental care. This article demonstrates how oral conscious sedation can be a safe and cost-effective alternative to intravenous sedation and general anesthesia in facilitating dental care for children who could otherwise not be treated.
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Analgesics most commonly prescribed in dentistry for acute pain relief include the nonsteroidal anti-inflammatory drug, acetaminophen, and various opioid-containing analgesic combinations. The NSAIDs and presumably acetaminophen act by inhibiting cyclooxgenase enzymes responsible for the formation of prostaglandins that promote pain and inflammation. Opioids such as codeine, hydrocodone, and oxycodone stimulate endogenous opioid receptors to bring about analgesic and other effects. ⋯ If an NSAID cannot be prescribed because of patient intolerance, analgesic preparations that combine effective doses of an orally active opioid with 600 to 1,000 mg of acetaminophen are preferred in the healthy adult. On occasion, prescribing both an NSAID and an acetaminophen-opioid combination may be helpful in patients not responding to a single product. In all cases, however, the primary analgesic should be taken on a fixed schedule, not on a "prn" (or as needed) basis, which only guarantees the patient will experience pain.