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What do they say??. Too embarrassed He didn’t listen/stop Pain Noises Smells Panic attacks Being judged Too busy. WHAT IS SEDATION?. ANXIOLYSIS : chemically induced state of consciousness, awake but has decreased anxiety to facilitate coping skills, retains interaction ability

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What do they say l.jpg
What do they say??

Too embarrassed

He didn’t listen/stop

Pain

Noises

Smells

Panic attacks

Being judged

Too busy


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WHAT IS SEDATION?

  • ANXIOLYSIS: chemically induced state of consciousness, awake but has decreased anxiety to facilitate coping skills, retains interaction ability

  • CONSCIOUS SEDATION: minimally depressed level of consciousness, maintains their own airway and reflexes, responds to physical and verbal stimuli


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Who Should Be Sedated

Anxious and Phobic Patients

Embarrassed Patients

Gaggers

Time Oriented Patients


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What Patients Can Expect

  • Diminished anxiety

  • No pain

  • Diminished memory

  • Less gagging


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ASA Physical Status Classification SystemASA1Normal healthy patient

ASA 2

Patient with mild systemic disease

can walk up one flight of stairs but must rest at completion

Patients with mild systemic disease

Mild hypertension

Well controlled diabetes

Well controlled asthma


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ASA 3

  • PATIENT WITH SEVERE SYSTEMIC DISEASE

    Able to walk up a flight of stairs but must rest

    MI < 6 months

    Well controlled insulin diabetic

    Chronic heart failure

    COPD

    Moderate HTN

    Angina


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Method of Anxiety and Pain Control

  • Analgesia- the diminution or elimination of pain

  • Local Anesthesia - the elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug

  • Minimal Sedation - minimally depressed level of consciousness that retains the patient’s ability to maintain an airway and respond normally to tactile stimulation and verbal command. Cognitive function and coordination may be modestly impaired.


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Routes of Administration

  • INHALATION

  • ENTERAL: any technique of admin in which the agent is absorbed through the GI tract or oral mucosa

  • PARENTERAL: the drug bypasses the GI tract (im, iv, subm, subq,)


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PHARMACOLOGY OF SEDATION

  • NITROUS OXIDE

  • BENZODIAZEPINES

    • DIAZEPAM

    • TRIAZOLAM

    • LORAZEPAM

    • VERSED po

  • IV VERSED




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    What Can be Accomplished for the HYGIENE PATIENT

    • Surgical hygiene

    • Non surgical hygiene

      • Examinations

      • Initial treatment

      • Irrigation

      • Scaling

      • Root debridement


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    The Sedated Hygiene Patient

    • There must be non sedated visits with the hygienist to:

      • Review oral home care

      • begin medications

      • Antibiotics

      • antimicrobials

      • disclose and show patient where they need to improve home care


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    COMPLETE PERIO CHARTING

    • POCKET DEPHTHS

    • 6 sites

    • RECESSION

    • MOBILITY

    • BIFURCATIONS

    • BLEEDING SITES


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    TOTAL THE NUMBER OF:

    • BLEEDING SITES

    • POCKETS >4MM

    • TEETH INVOLVED IN DISEASE


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    ROOT DEBRIDEMENTS

    • Divide the number of teeth involved

      By three or four depending on pocket depths to get the number of root debridements visits

      Schedule 10 minutes for each tooth


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    LASER

    ACRONYM

    LIGHT AMPLIFICATION BY STIMULATED EMISSION OF RADIATION


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    SUCULAR DEBRIDEMENT

    removes infected pocket lining

    Reduce the bacterial count in the soft tissue

    APTHOUS ULCER

    HERPETIC LESIONS

    TISSUE ABLATION (vaporization)

    LASER IN HYGIENE


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    ADVANTAGES TO LASER THERAPY

    • BETTER TISSUE RESPONSE

    • VAPORIZE BACTERIA

    • REDUCED NEED FOR LOCAL ANESTHESIA

    • DECREASED POST OP DISCOMFORT

    • DECREASE IN TISSUE TRAUMA

    • CONSERVES HEALTHY TISSUE


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    Hygiene Protocol

    Non sedation instructional

    Sedation:

    Root debride

    Laser therapy

    Irrigate

    Non sedation monitoring

    Sedation definitive treatment


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    INSTRUCTIONAL VISIT

    • DISCLOSE

    • PLAQUE CONTROL

    • PERSCRIPTIONS

    • CHLORHEXADINE

    • ANTIBIOTICS

    • SEDATION MEDS

    • HEALTH HISTORY AND BLOOD PRESSURE


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    THE SEDATION VISIT

    • ROOT DEBRIDEMENT THERAPY

    • LASER THERAPY

    • IRRIGATION

    • SCALE AND POLISH HEALTHY TEETH

    • ARESTIN


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    PMA(periodontal maintenance apt)

    • DISCLOSE AND DISCUSS

    • DO NOT PROBE

    • RE-ENFORCE THE SEDATION VISIT


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    DEFINITIVE THERAPY

    • REPROBE ALL AREAS

    • RETREAT THE AREAS OF DISEASE

    • LASER ALL POCKETS

    • RETREAT THE HEALTHY TEETH

    • IRRIGATE

    • PLACE ARESTIN

    • CLOSYS 2 RINSE AND TOOTHPASTE


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    Supportive Periodontal Therapy( 8 TO 12 WEEKS)

    • Disclose and review hygiene

    • Ultrasonic debridement

    • Relaser pocket sites on bacteria vaporization setting

    • Irrigate with antimicrobials

    • Polish


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    LASER USES

    • ABILITY TO SEAL BLOOD VESSELS

    • SEAL LYMPHATIC VESSELS

    • REDUCES BACTERIA COUNT FOR 60 DAYS (HEALING TAKES 35-40 DAYS)

    • Facilitate access to root surface by – de-epithelialize the tissue lining

    • REDUCES MECHANICAL TRAUMA


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    APHTHOUS ULCERS

    • No contact between tissue and fiber

    • Maintain a distance of 1- 2 mm

    • 30 sec. in a circular motion at .4 watts

    • 10 sec cool down

    • Repeat 30 sec at .5 watts

    • 10 sec cool down

    • Repeat 30 sec at .6 watts


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    SULCULAR DEBRIDEMENT

    • Removes diseased or inflamed tissue in the periodontal pocket and to improve clinical indices including gingival index, gingival bleeding index, probe depth, attachment losss and tooth mobility. Clinical data supports efficacy of laser therapy in pockets over 4 mm.


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    LASER TECHNIQUE

    • Fiber parallel to the root surface or slightly tipped toward the gingival surface in order to maximize ablation.

    • Fiber kept in contact with epithelium

    • Horizontal and vertical direction

    • Debride all granulation tissue

    • 30 sec for 4&5 mm pockets

    • 45 sec for 6 and above

    • No contraindications



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