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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
What do they say??

Too embarrassed

He didn’t listen/stop

Pain

Noises

Smells

Panic attacks

Being judged

Too busy

what is sedation
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
who should be sedated
Who Should Be Sedated

Anxious and Phobic Patients

Embarrassed Patients

Gaggers

Time Oriented Patients

what patients can expect
What Patients Can Expect
  • Diminished anxiety
  • No pain
  • Diminished memory
  • Less gagging
asa physical status classification system asa1 normal healthy patient

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

asa 3
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

method of anxiety and pain control
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.
routes of administration
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,)
pharmacology of sedation
PHARMACOLOGY OF SEDATION
  • NITROUS OXIDE
  • BENZODIAZEPINES
      • DIAZEPAM
      • TRIAZOLAM
      • LORAZEPAM
      • VERSED po
  • IV VERSED
what can be accomplished for the hygiene patient
What Can be Accomplished for the HYGIENE PATIENT
  • Surgical hygiene
  • Non surgical hygiene
      • Examinations
      • Initial treatment
      • Irrigation
      • Scaling
      • Root debridement
the sedated hygiene patient
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
complete perio charting
COMPLETE PERIO CHARTING
  • POCKET DEPHTHS
  • 6 sites
  • RECESSION
  • MOBILITY
  • BIFURCATIONS
  • BLEEDING SITES
total the number of
TOTAL THE NUMBER OF:
  • BLEEDING SITES
  • POCKETS >4MM
  • TEETH INVOLVED IN DISEASE
root debridements
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

laser

LASER

ACRONYM

LIGHT AMPLIFICATION BY STIMULATED EMISSION OF RADIATION

laser in hygiene
SUCULAR DEBRIDEMENT

removes infected pocket lining

Reduce the bacterial count in the soft tissue

APTHOUS ULCER

HERPETIC LESIONS

TISSUE ABLATION (vaporization)

LASER IN HYGIENE
advantages to laser therapy
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
hygiene protocol
Hygiene Protocol

Non sedation instructional

Sedation:

Root debride

Laser therapy

Irrigate

Non sedation monitoring

Sedation definitive treatment

instructional visit
INSTRUCTIONAL VISIT
  • DISCLOSE
  • PLAQUE CONTROL
  • PERSCRIPTIONS
  • CHLORHEXADINE
  • ANTIBIOTICS
  • SEDATION MEDS
  • HEALTH HISTORY AND BLOOD PRESSURE
the sedation visit
THE SEDATION VISIT
  • ROOT DEBRIDEMENT THERAPY
  • LASER THERAPY
  • IRRIGATION
  • SCALE AND POLISH HEALTHY TEETH
  • ARESTIN
pma periodontal maintenance apt
PMA(periodontal maintenance apt)
  • DISCLOSE AND DISCUSS
  • DO NOT PROBE
  • RE-ENFORCE THE SEDATION VISIT
definitive therapy
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
s upportive p eriodontal t herapy 8 to 12 weeks
Supportive Periodontal Therapy( 8 TO 12 WEEKS)
  • Disclose and review hygiene
  • Ultrasonic debridement
  • Relaser pocket sites on bacteria vaporization setting
  • Irrigate with antimicrobials
  • Polish
laser uses
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
aphthous ulcers
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
sulcular debridement
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.
laser technique
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
slide48
STANDARD PROFICIENCY
  • ADVANCED PROFICIENCY
  • EDUCATOR STATUS
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