Transcript ASA

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
CONSCIOUS SEDATION: minimally
depressed level of consciousness,
maintains their own airway and reflexes,
responds to physical and verbal stimuli
Who Should Be Sedated

Anxious and Phobic Patients

Embarrassed Patients

Gaggers

Time Oriented Patients
What Patients Can Expect

Diminished anxiety

No pain

Diminished memory

Less gagging
ASA Physical Status Classification
System
ASA1
Normal 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

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



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



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
1.
NITROUS OXIDE
2.
BENZODIAZEPINES




3.
DIAZEPAM
TRIAZOLAM
LORAZEPAM
VERSED po
IV VERSED
RELAXED BUT RESPONDS
What Can Be Done?
What Can be Accomplished for the
HYGIENE PATIENT

Surgical hygiene

Non surgical hygiene





Examinations
Initial treatment
Irrigation
Scaling
Root debridement
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






POCKET DEPHTHS
6 sites
RECESSION
MOBILITY
BIFURCATIONS
BLEEDING SITES
6 mm
+
Bleeding
Sites
# Perio #
Teeth
Sites
TOTAL THE NUMBER OF:

BLEEDING SITES

POCKETS >4MM

TEETH INVOLVED IN DISEASE
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
Bleeding
sites
Perio sites # Teeth
73
25
10
5
5
2
Bleeding
sites
Perio sites # Teeth
54
31
12
5
0
0
DATE
6+
BLEED
PERIO
TEETH
MAY 06
67
2
126
27
MARCH 06 0
75
41
18
OCT 06
0
69
25
10
DEC 06
0
4
5
2
MAY 07
2
6
20
13
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)

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
1.
2.
Non sedation instructional
Sedation:
• Root debride
• Laser therapy
• Irrigate
3.
4.
Non sedation monitoring
Sedation definitive treatment
INSTRUCTIONAL VISIT







DISCLOSE
PLAQUE CONTROL
PERSCRIPTIONS
CHLORHEXADINE
ANTIBIOTICS
SEDATION MEDS
HEALTH HISTORY AND BLOOD
PRESSURE
THE SEDATION VISIT





ROOT DEBRIDEMENT THERAPY
LASER THERAPY
IRRIGATION
SCALE AND POLISH HEALTHY TEETH
ARESTIN
PMA
(periodontal maintenance apt)

DISCLOSE AND DISCUSS

DO NOT PROBE

RE-ENFORCE THE SEDATION VISIT
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
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





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







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

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







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
ACADEMY OF LASER
DENTISTRY

STANDARD PROFICIENCY

ADVANCED PROFICIENCY

EDUCATOR STATUS
ADVANCED HYGIENE
CONCEPTS
800.400. 6772