The pharmacological aspects of the dental medicine especially to the administer of the drug on the children.

1. PHARMACOLOGICAL
METHODS
GLO ARBY ARGUELLES, DMD

2. INDICATIONS
 Children with low coping ability
 Behavior management problems
 Gag reflex interfering dental care
 Patient that requires special healthcare
needs.
CONTRAINDICATIONS
 Very young children
 Intellectually challenged children
 Systemic Diseases like Respiratory
Distress, Neuromuscular disorders etc.

3. 1. PRE-MEDICATION
* SEDATION
* SEDATIVE HYPNOTICS
* ANTI-ANXIETY DRUGS
* ANTIHISTAMINES
* NARCOTICS

4. PRE-MEDICATION
 SEDATION
I. LEVELS OF SEDATION
1. MINIMAL SEDATION - responds to verbal comment.
- Impaired cognitive and communication
2. MODERATE SEDATION - moderately responds to stimuli.
3. DEEP SEDATION - cannot be easily roused
- responds purposely after repeated verbal or
painful stimulus
- may require assistance in maintaining airway

5. PRE-MEDICATION
 SEDATION
II. GOALS OF SEDATION
o Guards the patient’s safety and welfare.
o Minimize physical discomfort and pain.
o Control anxiety.
o Minimize trauma.
o Control behavior and movement.
o Return patient to physiologic state.

6. PRE-MEDICATION
 SEDATION
III. PATIENT SELECTION AND PREPARATION
A. INDICATIONS
> Beneficial to the patient.
> Assess behavior and Anxiety of the patient.
> Thorough Medical History.
> ASA I is a suitable patient.
B. INFORMED CONSENT
> Parent/Guardian must be aggreable.
> Complete information regarding risks & benefit of techniques
> Use clear and concise terms to explain
> Should be signed

7. PRE-MEDICATION
 SEDATION
III. PATIENT SELECTION AND PREPARATION
C. INSTRUCTIONS TO PARENTS
> written
> include dietary instructions.
> parent/guardian should be present in the office during appointment.
> post-op instructions.
D. DOCUMENTATION
> meticulous and accurate
> food intake and restrictions.
> pre-operative health evaluation
> Physician’s contact number.
> type of drug, dosage, route, time of administration
> patient’s stability

8. SEDATION
NITROUS OXIDE AND OXYGEN SEDATION
- Slightly sweet-smelling
- colorless, inert gas
- non-flammable
ADVANTAGES
 Reduces or eliminate anxiety
 Enhances patient cooperation
 Raises pain threshold
 Increases tolerance
 Medically compromised
 Reduces gagging
DISADVANTAGES
 Lack of potency
 Dependent on psychological reassurance
 Must breathe through the nose
 Potential occupational exposure health hazards

9. SEDATION
NITROUS OXIDE AND OXYGEN SEDATION

10. SEDATION
ORAL SEDATION
- most universally accepted
- easiest method
- usually mixed with a palatable liquid
- syringe may be used
- dependent on the absorption thru GI mucosa
- operator cannot titrate the drug

11. SEDATION
INTRAMUSCULAR SEDATION
- requires additional training and skill
- anatomy of injection site
- prolonged time is required to reach peak effect
- allows rapid absorption of drugs into the circulation
- total lack of reversibility
- not preferred

12. SEDATION
SUBMUCOSAL SEDATION
- deposition of drug beneath the mucosa
- site: Buccal Vestibule (Mx PM or Canine)
- non-irritating to the tissue

13. SEDATION
INTRAVENOUS SEDATION
- restricted to a certain types of ages of patient
- apprehensive pre-teen or adolescent
- trained practitioner
- rapid onset
- increase monitoring of patient

14. SEDATIVE HYPNOTICS
1. BARBITURATES
> All levels of CNS depressions
> sleep-inducing and anxiety-decreasing effects
> Very limited value for pediatric patients
2. CHLORAL HYDRATE
> Route: Oral
> Onset: 30-60 minutes
> Oral duration: 4-8 hours
> irritating to the gastric mucosa
> CI: - Children below 6yo
- Children with Heart Disease and Renal disease
>SE: nausea and vomiting

15. ANTI-ANXIETY DRUGS
BENZODIAZEPINES
1. DIAZEPAM (Vallium)
- lipid and water-soluble
- rapid absorption at GI
- Rebound effect
- Strong anticonvulsant effect
- Route: PO, Rectal, IV, Parenteral
- Adverse Effect: Ataxia and Prolonged CNS Effect
2. MIDAZOLAM
- Oral: Onset 20-30 minutes
- For anxious patients requiring short dental procedures
- Better anxiolysis and retrograde amnesia
- More potent than Diazepam
ANTAGONIST:
FLUMAZENIL
- selectively inhibits CNS
effects of BENZODIAZEPINES
- For IV use only

16. ANTIHISTAMINES
1. HYDROXYZINE
> Mild sedative with antiemetic properties and anticholinergic action.
> No Cardiovascular nor Respiratory depressant
> Absorbed in GI for 15-30 minutes
> Route: PO
2. PROMETHAZINE
> Mild sedative, antihistaminic properties and anticholinergic action.
> Onset: 15-60 min
> Contraindication: Asthma, Sleep Apnea, History of SIDS
3. DIPHENHYDRAMINE
> antihistamine and sedative
> absorbs rapidly in GI tract
> maximum effect is 1 hour

17. NARCOTICS
1. MEPERIDINE
> synthetic opiate agonist
> water-soluble
> Least effective PO, IM is better
> High doses may lead to seizures
> Contraindication: Hepatic or Renal Disease, history of seizures
2. FENTANYL
> Potent narcotic analgesic
> Rapid action: 7-15 minutes
> Submuscular, Intramuscular
> Duration: 1-2 hours
> Metabolized in liver and excreted in urine
> respiratory depression
> Not for children younger than 2 yo
ANTAGONIST:
NALOXONE
- Rapid onset 2-5 minutes
- Subcutaneous or IM, IV
- Rebound Effect

18. GENERAL ANESTHESIA
Last option
 Last resort
 when two attempts are already made using other
dental technique
 INDICATED: more than 3 year old patients, cerebral
palsy patients and older mentally retarded children.

19. RISK MANAGEMENT
 USE ONLY DRUGS AND TECHNIQUES THAT ARE THOROUGHLY UNDERSTOOD.
 LIMIT THE USE OF THESE MODALITIES TO THE PATIENT.
 CONDUCT COMPREHENSIVE PRE-OPERATIVE EVALUATION ON EACH PATIENT.
 CONDUCT CONTINUOUS PHYSIOLOGIC AND VISUAL MONITORING FROM ONSET THROUGH RECOVERY.
 HAVE AVAILABLE APPROPRIATE EMERGENCY DRUGS.
 KEEP FULLY DOCUMENTED REPORTS.
 USE SUFFICIENT SUPPORT PERSONNEL.
 TREAT HIGH-RISK PATIENTS IN HOSPITAL OR AT SIMILAR SETTING TO PROVIDE CARE.