التعامل مع الاطفال في عيادة الاسنان

1. Different type of pharmacological
behavior management techniques

2. different type of
pharmacological behavior
management techniques:
premedication
01
conscious sedation
parental/inhalation
02
general anesthesia
03

3. adminstration of drugs
before the induction of
anesthesia.
1-psychological
2-
pharmacological
1-premedication components
:

4. psychological premedication.
is provided by the
anesthesiologist
preoperative visit and
interview with the patient
and family members
psychological
premedication.

5. Pharmacological premedication
purpose of premedication?
premdication is often administration to reduce
apprehension anxiety fear pain and oral secretion
is adminstration of drugs orally or intramusculary
1 to 2 hours before the anticipated induction of
anesthesia.
Adminstration of
premedication
it s better adiministration premidication in
dental office as the dentist can use routs
other than oral and also accurate timing
of the administration can be don

6. Care during medication :
To enhance drug efficacy the
child s
environment should be kept
as quiet as possible .
Child who is aroused Before
the medication has reached
peak activity May remain
excited and the child Who

7. activity May be overmedicated ,,once the
desired Level of sedation Is obtained it Is
still essential to administer lacal
anesthesia , a sedated Child aroused By
painful stimuli may display considerable
agitation And confusion.

8. Postoperative instruction :
 After the completion of the treatment
the Child whether is sleep Or awake ,
will be in a sedated condition .
 The child may sleep For many hours,
depending on the drug and the dosage
used .
 Upon awakening The child may
complain of hunger or thirst if the sleep
has been prolonged .The mouth And
pharynx May be dry ,so it is better to
start with little water And then to
proceed with other food .
 Recovery period may be extended for
several hours and should be under
supervision .

9. 01 02
04 03
youngs rule=
dose = age ×adult dose / age
+12
Age
clarke s rule is better for
premdication prescription than young
s rule
Dosage =body wt (kg)×adult dose
/150
Weight
-Intravenonly
drug act more rapictly onset require lower dose
-Oally
drug act more slawly onset and require higher dose
-Intramuscular
drug act intermediate onset and does
Route of Administration
anxious child required more
Premedication than will mildly
apprehensive
the child ho display greates Physical
Emotional state and activity
01 02
03
04
Factor infuencing dosage

10. Dosage
required
1-lower does
In non stress full enviroment
and
Patient expected to remine
quite
05
05
Factor infuencing dosage
Enviroment
2-higher dose
In anxious Pateint required Premedication in
the dental office
06
Time of the day
06
Dosage reduce when children take
anap and high dose when children in
active play

11. General causes of premedication
failure
 Prescription of an insufficient dose of drug
 Accidental or intentional reduction of dosage by
the
parents
 Failure of the child to co-operate in swallowing
premedication
 Expectoration or vomiting of a portion of the
medication
 Children with medical condition such as brain
damage and other problems are often inadequately
premedicated and may require increased doses or

12. Conscious Sedation
Defined as “a minimally depressed level of
consciousness
in which the patient’s ability to maintain a patent
airway
independently and continuously and respond
appropriately to physical stimulation and or
verbal
command is retained

13. Indication of conscious
sedation:
For nervous and
apprehensive children
01
Limited degree for
uncooperative and defiant
children
02
Conscious
Sedation

14. Conscious Sedation
Aides in–
 Erasing fear, anxiety and apprehension
 Helps to reduce patient motion
 Creates a semihypnotic state
 Increases tolerance for longer appointments
 Slightly raises the pain threshold
 Maintaining the conscious of the child

15. Advantages
Conscious Sedation
 Patient is conscious
 Relative safety
 Least disturbs the metabolic process and general
functions
 Has all vital reflex intact
 Can communicate and cooperate
 Quickly returns to normal state after few minutes
 Rapid onset and recovery time, because of very low
plasma solubility
 Ease of dose control
 Lack of serious adverse effects
 Produces euphoric effect

16. Conscious Sedation
Disadvantages
•Weak agent –not so affective in moderate or severely
anxious patients, as dose cannot be increased
•Lack of patient acceptance –some may not like it
•Inconvenience –when inhalation is used the mask
may hinder exposure of the oral cavity especially
in children
•Potential chronic toxicity –retrospective survey
studies of dental office personnel who were exposed
to trace levels of N2
O suggests a possible association with and increased incidence of
spontaneous
abortions, congenital malformations, certain cancer,
liver disease, kidney disease and neurologic disease.

17. Conscious Sedation
Contraindication
•Severely unco-operative child
•Hypersensitivity to the agent
•Chronic obstructive pulmonary disorder
•Psychiatric patients
•Cardiac patients
•Epilepsy, bleeding disorder

18. Patient evaluation
The child patient must be properly evaluated prior to
the treatment procedure.
 Medical ad dental history (including medications
taken).
 Patient medical status (American Society
of Anaesthesiologists (ASA) classification .)
 History of recent respiratory symptoms or
infections.
 Assessment of the airway to determine
suitability for conscious sedation or general
anaesthesia.
 Fasting status .
 Age.
 Weight .
The tosil size is an important consideration
when assessing the airway in children as the
it may be a contributing factor to
desaturation under sedation. Therefore, a
thorough airway assessment is required
preoperatively. The clinician should also be
aware that in children the resting vital signs

19. The parents or legal guardians must be agreeable to the use of
conscious sedation for the child. They should be well informed regarding
the risk, benefits and associated particulars. Written consent must be
obtained prior to the procedure.
Patient consent:
It includes information regarding the intake of food and liquids – Food
may interfere in the absorption of the drug and if there is
vomiting the contents can get aspirated and cause
aspiration pneumonia or laryngospasm. Hence it is better
to avoid food before the sedation appointment.
Instruction to the parents:

20. The term 'conscious
sedation' has been used in
the past to imply a patient
who is awake, responsive
and able to communicate.
This verbal communication
with the child is an indicator
of an adequate level of
consciousness and
maintenance of protective
Coscious
sedation

21. 01 02 03 04
Oral sedation Rectal sedation Nasal sedation Intravenious sedation
Coscious sedation
05
Inhalation
sedation

25. Nasal sedation

27. Patiets suitable for intravenous sedation
 Child patients 8 years of age or older.
 Child is cooperative ad has a cooperative
parent.
 Adequate venous access (dorsum of hand
or antecubital fossa).
Suitable procedures for intravenous
sedation •
 Short procedures that require
approximately 30 minutes duration.
 Primary teeth extractions or up to two
permanent molars.
 1-2 quadrants of restorative dentistry.
 Short surgical procedures with good
access in the mouth.
Intravenious sedation
Intravenous sedation is usually
performed in a hospital environment or
dental surgeries which have been duly
accredited for the use of these more
advanced sedation techniques.

28. Intravenious sedation
Procedures usually not suitable for intravenous sedation •
 3-4 quadrants of restorative dentistry (unless minor
restorative).
 Extractions of permanent molars in each quadrant (invasive
procedure and bleeding from all four quadrants make airway
management more difficult).
 Obese children (in whom resuscitation procedures may be
difficult and the airway more unpredictable).
 Parents who may not provide adequate care to the child
postoperatively.

30. Agents Commonly used for Sedation
 Hydroxyzine

31.  Promethazine

32.  Benzodiazepines
diazepam, midazolam

33.  Barbiturates

34.  Chloral hydrate

35.  Narcotics
meperidine

36.  Midezolam

37.  Nitrous oxide

38.  Propofol

39.  Sevoflurane

40.  Triclofos