Transcript Chapter 20 Management oF Pain And Anxiety

Chapter 20
Management of Pain
and
Anxiety
Anesthesia and anesthetics
 General anesthesia
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Patient becomes unconscious
alters CNS, no feeling at all in body
special needs patients,
high anxiety patients
local anesthesia is still used
Anesthesia and anesthetics
 Local anesthesia
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shot / injection
control pain during dental procedure
blocks feeling and temperature
contacts the nerve and blocks impulses to and
from the brain.
Delivered in liquid form from pre-measured
carpules. (with or w/out epinephrine).
Anesthesia and anesthetics
 Anesthetic solutions
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aka chemical base
• amides
– lidocaine, mepivicaine
• esters
– propoxycaine, procaine
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Patients may react to one type of anesthetic or
another. Note this in their chart.
Anesthesia and anesthetics
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Vasoconstrictor
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epinephrine (epi) most common added to anesthetic
constricts vessels around injection site
causes ‘blanching’ (tissue turns white)
anesthetic lasts longer
comes in ratios 1:20,000 (larger 2nd # = less epi)
CONTRAINDICATED FOR PATIENTS WITH
HEART CONDITIONS!
Types of injections
 Infiltration
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flooding anesthetic around the nerve endings.
• Numbs the area of the injection.
• Common on the maxillary
 Block
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placing anesthetic around a large nerve branch.
• Given near a foramen
• Numbs area from injections site to nerve endings.
• Common on the mandibular.
Types of injections
 Intraosseous
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anesthetic is placed in the spongy bone.
• Requires a special system and technique
• Used when profound anesthesia cannot be obtained
with other types of injections.
 Intrapulpal
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anesthetic is placed directly in the pulp
chamber.
• Used during RCT for a “HOT” tooth.
Anesthetic duration.
 Length of time numbness lasts.
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Short duration
• less than 30 minutes
• no epi
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Intermediate duration
• 30 to 90 minutes ( about 1 hour)
• may have epi
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Long duration
• 90 minutes or longer
• contains vasoconstrictor
Paresthesia
 When anesthesia lasts longer than intended
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hours
days
permanent
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caused by
trauma to the nerve
bleeding near the nerve
pressure from the bleeding
contaminated anesthetic
Topical anesthetic
 Gel that numbs gums before injection
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makes the “pinch” smaller
similar to teething medication
placed on dry mucosa for one (1) minute prior
to the injection.
Reactions are usually to coloring or flavoring in
the topical.
Topical anesthetic
 Uses
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sub-gingival scaling
root planing
crown seats
placing matrix bands
placing rubber dam clamps
depress gag reflex for impressions and x-rays.
Topical anesthetic
 Allergic reactions
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mild to severe
immediate reaction
delayed up to 24 hours
symptoms
• swelling, redness, sores, difficulty swallowing and
or breathing.
Topical anesthetic
 Toxic reaction
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due to an overdose
stimulates the CNS
symptom
• talkative, excited, apprehensive, increased pulse and
or high blood pressure
• can be fatal!
Sedation
 Uses:
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relaxation
reduce fear and anxiety.
dental phobias
children
mentally challenged
Sedation
 Forms
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Pills
• Valium
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Liquid
• Versed
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Gas
• Nitrous oxide (N20)
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Intravenous
• Many different medications!
Nitrous Oxide (N2O)
 Nitrous oxide and oxygen
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aka ‘Laughing gas’
 Advantages
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patient remains conscious
easy administration
no nurse / anesthetist needed
quick PO recovery
used for most ages
Nitrous Oxide (N2O)
 Indications
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fearful or anxious patients
sensitive gag reflex
low pain threshold
long appointments
heart condition
high blood pressure
Nitrous Oxide (N2O)
 Contraindications
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upper respiratory infection
nasal congestion / breathing disorders
very young child
severe mental retardation
pregnancy (1st trimester)
drug addict
psychiatric treatment
Nitrous Oxide (N2O)
 Facts:
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DA cannot administer/start N20
DA can adj. flow w/ Dr. instruction
Nitrous = Blue tank
Oxygen = Green tank
Must use an evacuation (scavenger) system
Oxygen flush x 5 min. (min)
Closing
 Managing pain and anxiety is a very
important part of your job as a DA.
 Always check the health history of every
patient at every visit.
 When in doubt, ask your dentist.
 Any questions?