Stainless steel crowns in Pediatric DentistryRajesh Bariker
A crown is a tooth shaped covering which is cemented to the tooth structure & its main function is to protect the tooth structure & retain the function
Stainless steel crowns in Pediatric DentistryRajesh Bariker
A crown is a tooth shaped covering which is cemented to the tooth structure & its main function is to protect the tooth structure & retain the function
An inlay may cap none, or may cap all but one cusp.
Sturdevant’s 4th ed. page579
Inlays may be used as single-tooth restorations for proximo-occlusal or gingival lesions with minimal to moderate extensions
Shillingburg page 1
An inlay may be defined as a restoration which has been constructed out of mouth from gold, porcelain, or other material & then cemented into the prepared cavity of a tooth.
William McGehee pg410
This lecture present to you the very basics of dental management of asthmatic patient in dental clinics. I kept it short and comprehensive as I can, for more info please refer to the reference mentioned in the lecture
Due to the complex morphology of the root canal system in primary teeth, the clinician must rely primarily on chemical cleansing and sterilization and secondarily on mechanical instrumentation during pulpectomy procedure.
And in order to increase the chance of success of the endodontic treatment, substances with antimicrobial properties are frequently used as root canal filling materials in deciduous teeth
Non –pharmacological behavior management in childrenDr. Harsh Shah
Overview on nonpharmacological managent of behaviour in children
Presented by : Mayuri Karad
SDDCH Parbhani
Guided by : Dr. Rehan Khan
Dept, of Pediatric and preventive dentistry
An inlay may cap none, or may cap all but one cusp.
Sturdevant’s 4th ed. page579
Inlays may be used as single-tooth restorations for proximo-occlusal or gingival lesions with minimal to moderate extensions
Shillingburg page 1
An inlay may be defined as a restoration which has been constructed out of mouth from gold, porcelain, or other material & then cemented into the prepared cavity of a tooth.
William McGehee pg410
This lecture present to you the very basics of dental management of asthmatic patient in dental clinics. I kept it short and comprehensive as I can, for more info please refer to the reference mentioned in the lecture
Due to the complex morphology of the root canal system in primary teeth, the clinician must rely primarily on chemical cleansing and sterilization and secondarily on mechanical instrumentation during pulpectomy procedure.
And in order to increase the chance of success of the endodontic treatment, substances with antimicrobial properties are frequently used as root canal filling materials in deciduous teeth
Non –pharmacological behavior management in childrenDr. Harsh Shah
Overview on nonpharmacological managent of behaviour in children
Presented by : Mayuri Karad
SDDCH Parbhani
Guided by : Dr. Rehan Khan
Dept, of Pediatric and preventive dentistry
Overview on midline diastema and its unesthetic effects
Presented by : Anamika Thorat
Guided by : Dr. Rehan Khan
Dept. of Pediatric Dentistry
SDDCH PBN
Midline shift /certified fixed orthodontic courses by Indian dental academy Indian dental academy
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Status epilepticus (SE) is a medical emergency that starts when a seizure hits the 5-minute mark (or if there’s more than one seizure within 5 minutes).
Convulsive Status epilepticus-
The convulsive type is more common and more dangerous.
It involves tonic- clonic seizures (grand mal seizures)
In the tonic phase ( lasts less than 1 minute), body becomes stiff and person lose consciousness. Eyes roll back into head, muscles contract, back arches, and trouble breathing.
As the clonic phase starts, body spasms and jerks occur. Neck and limbs flex and relax rapidly but slow down over a few minutes.
Once the clonic phase ends, patient might stay unconscious for a few more minutes. This is the postictal period.Non-convulsive Status epilepticus-
Patient lose consciousness but is in an “epileptic twilight” state.
There might not able any shaking or seizing at all, so it can be very hard for someone observing patient to figure out what’s happening.
A non-convulsive seizure can turn into a convulsive episode.
Poorly controlled epilepsy
Low blood sugar
Stroke
Kidney failure
Liver failure
Encephalitis
HIV
Alcohol or drug abuse
Genetic diseases such as Fragile X syndrome and Angelman syndrome
Head injuries
Prof. mridul M. panditrao, discusses the fundamental aspects of Problems of Dental Chair anesthesia, conscious sedation, The management and his own experience
IMPORTANCE OF GUMS
मसूड़ों का महत्व
दांतों की आसपास की संरचनाSurrounding structures of teeth
मसूड़ा (Gingiva)
गिंगिवा आपके दांतों के नीचे नरम, गुलाबी ऊतक है।
मसूड़े की सूजन (GINGIVITIS)
मसूड़े की सूजन तब होती है जब आपके मसूड़े लाल, सूजन और छूने या ब्रश करने पर वे आसानी से खून बह सकता है। यह घटनाओं की एक श्रृंखला में पहला चरण है जो पट्टिका के निर्माण के साथ शुरू होता है।
यदि ठीक से इलाज नहीं किया जाता है, तो यह पीरियडोनिटिस (Periodontitis) और दांत के नुकसान के साथ समाप्त हो सकता है क्योंकि ऊतक जो चारों ओर से घेरे हुए है और दांतों का समर्थन करता है।
मसूड़ों की हानि ( Gingival Recession)
मसूड़ों की सिकुड़न के कारण दांतों की जड़ों में मसूड़ों की मंदी होती है। यह घर्षण, क्षरण, पेरियोडोंटल बीमारी या सर्जरी के कारण होता है।
मुंह से दुर्गंध (Halitosis)
हैलिटोसिस मौखिक या जठरांत्र मूल की खराब सांस है।
कारण :
तंबाकू
खाना
शुष्क मुँह
दांत की सफाई
क्रैश डाइट्स
दवा
Why Mouthwash ? माउथवॉश क्यों ?
सांसों की बदबू (Halitosis)
मसूड़े की सूजन (Gingivitis)
पट्टिका (Plaque removal)
शुष्क मुँह (Dry Mouth)
पीले या फीके दांत (Discoloured teeth)
मसूड़ों में कमी (Gingival Recession)
Important contents of Mouthwash
Fluoride –
फ्लोराइड यह घटक दाँत क्षय से लड़ता है और
तामचीनी को मजबूत करता है।
Cetylpyridinium Chloride –
साइटिलपिरिडिनियम क्लोराइड।
यह खराब सांस को खत्म करता है और बैक्टीरिया को मारता है।
Chlorhexidine –
यह पट्टिका को कम करता है और
मसूड़े की सूजन को नियंत्रित करता है।
Essential Oils –
आवश्यक तेल। कुछ माउथवॉश में
आवश्यक तेलों में पाए जाने वाले यौगिक होते हैं, जैसे मेन्थॉल (पेपरमिंट), नीलगिरी, और थाइमोल (थाइम), जिसमें ऐंटिफंगल और जीवाणुरोधी गुण होते हैं
Carbamide Peroxide –
कार्बामाइड पेरोक्साइड या हाइड्रोजन पेरोक्साइड। यह घटक दांतों को सफेद करता है।
Home Remedies
अनानास का रस ( Pineapple Juice )
पानी (Water)
दही (Curd)
ग्रीन टी (Green Tea)
बेकिंग सोडा के साथ घर का बना माउथवॉश (Home made mouthwash with baking soda)
सिरका के साथ घर का बना माउथवॉश
( Home made mouthwash with vinegar
गम कसैला (Gum Astringent / GumPaint)
एस्ट्रिंजेंट प्रोटीन को जमाकर, मसूड़ों के रक्तस्राव को रोकने में मदद करते हैं।
You can contact us directly in case of any help needed from my side
Dr. Harsh S. Shah
(Dental Surgeon)
Contact – 7776096239
Email- dr.shahsdentalclinic@gmail.com
Sterilization and disinfection in Dentistry Dr. Harsh Shah
An overview of significance of sterilization in safety of patients and view on all the methods being followed for sterilization and disinfection in todays' practice.
STERILIZATION AND DISINFECTION , INFECTION CONTROL IN DENTISTRY ,
Solitary oral ulcers and systemic diseasesDr. Harsh Shah
A brief overview of different ulcerative lesions seen in the oral cavity linked to the dangerous systemic diseases and preventive measures for the disease before it turns lerhal
SDDCH, Parbhani
Apexogenesis & apexification in pediatric dentistryDr. Harsh Shah
SDDCH Parbhani
Presented by : Vipul GIratkar
Dept. of Pediatric dentitstry
Guided by . Dr. Rehan Khan
DIscussion regarding apexification and apexogenesis
Tongue thrust and mouth breathing habits in childrenDr. Harsh Shah
Overview on mouth breathing and tongue thrusting in children leading to ill effects
Presented by : Pratiksha Ahire
Guided by : Dr. Rehan Khan
Dept. of Pediatric Dentistry
SDDCH PArbhani
Dental Fluorosis : double sided sword
Overview of this deadly disease in this presentation
Presented by: Shubham Shegokar
Guided by : Dr. Rehan Khan
Pediatric Dentitstry
Growth and development of mandible in childrenDr. Harsh Shah
a brief idea about the development of mandible for indian students looking for a quick review from dentistry department
all the best to students
Presented by : Harsh SHah
Dept. of Orthodontics
SDDCH PBN
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
1. PHARMACOLOGICAL METHODS OF BEHAVIOUR
MANAGEMENT
Presented By- Yashkumar R. Shah
Final Year – II
Contents
Introduction
Definitions
PharmacologicalMethods
Objectives ofSedation in PediatricDentistry
Indication and Contraindication
Clinical Guidelinesfor use of ConsciousSedationby Dentist
Routes of administrationwith drugs
Nitrous oxide sedation
Reversalagents
Premedication
GeneralAnesthesia
Complications associated with moderateand deep sedation
Conclusion
References
2. INTRODUCTION
BEHAVIOR MANAGEMENT-
Behavior management is the means by which dental health team effectivelyand efficiently
performs treatment for a child and at the same time instills a positive dental attitude.(WRIGHT,1975)
DEFINITIONS
Conscious Sedation :
A minimally depressed level of consciousness that retains the patients ability to independently
and continuously maintain airway and respond appropriately to physical stimulation or verbal command
that is produced by a pharmacological or non pharmacological method or a combination thereof.
Deep Sedation :
A drug induced depression of consciousness during which patients cannot be easily aroused but
respond purposefully following repeated or painful stimulation. The ability to independently maintain
ventilatory function may be impaired.
General Anesthesia :
A drug induced loss of consciousness during which the patients are not arousable even by painful
stimulation . The ability to maintain ventilatory function is often impaired.
Minimal Sedation : (Anxiolysis)
A drug induced state during which patients respond normally to verbal commands
BEHAVIOUR MANAGEMENT
PHARMACOLOGICAL NONPHARMACOLOGICAL
3. PHARMACOLOGICAL METHODS
Conscious Sedation
Premedication
General Anesthesia
Objectives of sedation in pediatric dentistry
For the child
1. Reduce the fear and perception of pain during treatment.
2. Facilitate coping with the treatment .
3. Minimized physical discomfort and pain.
4. Controlled behaviour or movement so as to allow safe completion of procedure.
For the dentist
1. Facilitate accomplishment of dental procedures.
2. Reduce stress in an unpleasant emotion
3. Prevent burn out syndrome.
Indications Contraindications
Children with low coping ability Very young children
Behaviour management problems Intellectually challenged children
Dental fear and anxiety Hyper motive/obstinate children
A patient whose gag reflex interferes
with the dental care
Systemic diseases like respiratory
distress, Neuromuscular disorders etc.
Certain patients with special healthcare
needs
4. Clinical guidelines for use of conscious sedation by dentist(according to ADA,2012)
1. Patient evaluation.
2. Preoperative preparation.
3. Personnel and equipment requirements.
4. Preparation and setting up for the sedation procedures.
5. Monitoring during sedation.
6. Recoveryand discharge.
ASA PhysicalStatus ClassificationSystem
ASA Physical Status 1- A normal healthy patient
ASA Physical Status 2- A patient with mild systemic disease
ASA Physical Status 3- A patient with severe systemic disease
ASA Physical Status 4- A patient with severe systemic disease that is a constant threat to life
ASA Physical Status 5- A moribund patient who is not expected to survive without the
operation
ASA Physical Status 6- A declared brain-dead patient whose organs are being removed for
donor purposes
Preoperativepreparation
Determination of adequate oxygen supply and equipment necessary to deliver oxygen under
positive pressure must be completed.
Baseline vital signs must be obtained
Preoperative dietaryinstructions.
Personneland equipmentrequirements
Atleast 1 additional person trained in Basic Life Support for Healthcare providers must be
present in addition to dentist.
A Positive pressure oxygen deliverysystem suitable for the patient being treated must be
immediately available.
Preparation and setting up for sedation procedures
SOAPME
S – Size appropriate suction cathethers and a
functioning suction apparatus.
O – Adequate oxygen supply and functioning
flow meters
A – Appropriate size airway equipment
P – Pharmacy
5. M – Monitors
E – Special Equipments or drugs
Monitoring during sedation
Oxygenation
Ventilation
Circulation
Recoveryand dischargecriteria
Cardiovascular function and airway patency are satisfactorily stable.
Patient is easily arousable,
Patient can talk
ROUTES
DRUGS USED
N2O sedation
Horace Wells was an American dentist who pioneered the use of anesthesia in dentistry,
specifically nitrous oxide (laughing gas).
N2O sedation
INTRA
VENOUS
INTRA
MUSCULAR
ORAL
INHALATION
Inhalational Agents
Benzodiazepines
Other Agents With
Sedative Properties
6. Nitrous oxide/oxygen has been shown to be an effective anxiolytic and sedative inhalation
agent for conscious sedation.
Nitrous oxide is a weak analgesic, most often insufficient to ensure painless dental
treatment.
Nitrous oxide /oxygen sedation and local anesthesia is an alternative to general anesthesia
Nitrous oxide/oxygen should be the first choice for paediatric dental patients who are unable
to tolerate treatment with local anesthesia alone and who have a sufficient level of
understanding to accept the procedure.
It may be offered to children with mild to moderate anxiety to enable them to better accept
treatment which may require a series of visits.
It can also facilitate the provision of more complex time consuming procedures and dental
extractions particularly for young children or anxious patients undergoing elective
orthodontic extractions.
Typically delivered through a mask over the nose, nitrous oxide is mixed directly with
oxygen and delivered as the patient breathes in and out regularly.
The patient is usually asked
to breath normally through the nose,and as the gas begins to take effect, the child will be
come more relaxed and less nervous.
The gas mixture shall contain a maximum 50% nitrous oxide.
•Nitrous oxide/oxygen is reliable in terms of onset and recoveryas long as the patient
accepts the nasal hood and breathes through the nose.
•Nitrous oxide has minimal effect on cardiovascular and respiratory function as well as on
the laryngeal reflex.
Indications
A fearful or anxious patient.
Certain patients with special health care needs.
patient whose gag reflex interferes with dental care.
patient for whom profound local anesthesia cannot be obtained.
cooperative child undergoing a lengthy dental procedure.
7. Contraindications
Pre-co-operative children
Patients with upper airway problems as common cold, tonsillitis
or nasal blockage
Patients with sinusitis or recent ENT operations (within 14 days)
Patients in bleomycin chemotherapy
Psychotic patients
Patients with porphyria
PROCEDURE
Selection of an appropriately sized nasal hood should be made.
A flow rate of 5-6L/min generally is acceptable to most patients.
Introduction of 100%oxygen for1-2minutes followed by titration of nitrous oxide
in10%intervals is recommended.
During nitrous oxide/oxygen analgesia/anxiolysis,the concentration of nitrous oxide should
not routinely exceed50%.
Nitrous oxide concentration may be decreased during easier procedures(eg,restorations)and
increased during more stimulating ones(eg,extraction,injection of local anesthetic
During treatment, it is important to continue the visual monitoring of the patient’s respiratory
rate and level of consciousness.
The effects of nitrous oxide largely are dependent on psychological reassurance. Therefore,
It is important to continue traditional behaviour guidance techniques during treatment.
Once the nitrous oxide flow is terminated, 100%oxygen should be delivered for five minutes
due to risk of diffusion hypoxia.
The patient must return to pre treatment responsiveness before discharge
Clinical signs of sedation -
Objective Signs -
1. These signs recorded prior to and 5 minutes after administration .
2. The following signs were examined –
open or closed eyes, tears, smile, speaking, laughing, open or closed hands , limp legs,
abducted feet.
Subjective symptoms-
1. These are addressed the child’s perception of nitrous oxide effects.
2. Questions regarding the child’s perception of nitrous oxide effects on the head
,abdomen,fingers,toes,and overall condition were asked prior to 5 minutes after
administration.
8. 3. The questions were how do you feel,do you feel different ,how does your head feel ,how do
your fingers feel.
Side effects
Over sedation
Nausea
Vomiting
Panics
Sweating
Headache
Restlessness
Dysphoria
Tinnitus
Desflurane-
It is a inhalational drug used for sedation.
Useful in outpatient surgery.
Produces direct skeletal muscle relaxation .
No hepatotoxicity ,No nephrotoxicity
Risks- Irritating to airway in awake patient and can provoke coughing,salivation,
and bronchospasm.
Sevoflurane-
It is inhational type drug.
Used in outpatient surgery
It is non Irritating to the airway
Concentration -2-4%
Does not produce tachycardia
No hepatotoxicity
ORAL route -
Diazepam-(5mg/5cc)
9. 1.safe agent for mild to moderate anxiety particularly in children with cerebral palsy, mental
retardation.
2. Children less than 6 years of age
3. Oral absorption equally good as parental.
Limitation- multiple doses required to achieve sedation.
4. Not effective in severe anxietywhen used alone.
Meperidine-
Dose-50 mg/5cc
Best used in combination for -
1. With promethazine or hydroxyzine
2.longer procedures with chloral hydrate.
Limitations -1.poor oral absorption
2. Contraindicated in children with COPD , hypothyroidism or liver dysfunction
Chloralhydrate –
Dose-500mg/5cc
It is a chlorinated derivative of ethyl alcohol that can act as an aesthetic when administered
in high doses.
Duration of action – 2-5hours.
Wide range of safety
Limitations - 1.Not recommended in children below 6 years of age.
2.Maximum dose not to exceed 1500mg
3.Contraindicated in children with heart disease, renal ailment.
Hydroxyzine-
Dose-25mg/5cc
It is a mild sedative along with antiemetic and anticholinergic action.
It potentiates narcotic and CNS depressants.
Better used in combinations with other agents.
10. Promethazine -
Dose -12.5mg/5cc,2.5mg/5cc
Better used in combination.
Mild sedative along with antiemetic and anticholinergic action.
Limitations – 1.for mild levels of anxiety only.
Intramuscular -
1.Ketamine-
Dose-10-50mg/ml
Ketamine was first synthesised by Parke-Davis scientist Calvin Stevens in1970.
It prevents the higher cortical centers perceiving visual ,auditary,painful,stumuli.
Potent analgesic.
It maintains cardiovascular stability as well as muscle tone.airway reflexes.
Chronic use may lead to cognitive impairment,including memory problems.
2.Midazolam-
Dose-1-5mg/ml
It possesses hypnotic ,anticonvulsant ,and muscle relaxant properties as well as being
antegrade amnesic and anxiolytic
Greater potencyas compared to diazepam.
Rapid onset of action .
Limitations –Used mainly for short procedures.
11. Intravenous -
1.Propofol-
Also called as milk of amnesia.
Diprivan:2,6di-isopropophenol.
Dose-2mg/kg bolus IV for induction .
It is a fast acting sedative with a narrower margin of safety I.e. The dose required to produce
a sedative effect is close to that used to induce anaesthesia.
Limitation and risk-
1. Respiratory depression ,in particular is commonly associated with propofol use.
2. Rarely vomiting does occur and risk of aspiration.
2.Midazolam-
Most rapid onset of action
Permits titration and is easily reversible
Maintains a line for emergency drugs.
Best for invasive procedure of short duration.
Limitations- Requires extensive armamentarium training.
Precautions to be taken in significant hepatic and thyroid disease.
Rectal,Submucosal,OrSubcutaneousare rarely used.
12. Reversalagents-
Specific reversal agents exist for benzodiazepenes and opioids.
1. Flumazenil –
. It can be used to reverse the effects of benzodiazepenes and should be immediately
available when using benzodiazepenes for sedation.
Dose-0.01mg/kg 4times as needed.
2. Naloxane-
It is a opioid antagonist and given intravenouslymostly .
Dose-0.1mg/kg for children under 20kg.
Children over 20kg is 2mg.
This drug is incredibly effective in reversing the depressive effects of the opioids.
Side effect.- nausea
Complications.
Airway obstruction
Anaphylaxis reactions
Aspiration
Nausea
Vomiting
.PREANESTHETIC MEDICATION:
It refers to the drugs which use before anaesthesia to make it more pleasant and safe.
Objectives:
1. Relief of anxiety and apprehension preoperativelyand facilitate smooth induction.
2. supplement analgesic action of aesthetics.
3. Decrease acidity and volume of gastric juice so that it is less damaging if aspirated.
4. Antiemetic effect extending to the post operative period.
13. Some commonly used drugs for preanesthetic medication:
Opioids: morphine (10 mg )
. Pethidine (50-100mg)IM
Anticholinergic:Atropine0.6mg IM,IV
Sedative antianxietydrugs :
Diazepam--(5-10mg)oral
Lorazepam(2mg)IM
H2 blockers : Ranitidine(150mg) oral
GeneralAnaesthesia:
Definition:
It is defined as a controlled state of unconsciousness accompanied by a loss of protective
reflexes, including the ability to maintain an airway independentlyand respond purposefully to
physical stimulation or verbal command.
Indications:
1. Patients with certain physical,mental,or,medically compromising condition.
2. Patient who have sustained extensive orofacial trauma.
3. Patient wherein local anaesthesia is not effective or the patient is allergic to it.
4. Fearful,uncooperative,anxious Patient with no expectation that behavior will improve.
Procedure:
Chairsidegeneralanaesthesia –
Their are 3 common reasons for the use of general anaesthesia are-handicapped or mentally
retarded children , uncooperaative
child, and inability to come for frequent visits.
Team includes-1 . Anaesthesiologist
2. pedodontist
3. Dental surgery assistant
4. Anesthesia technicians
Pre-procedure-
Observations and recording of child behavior.
The parents are instructed to come for admission one day before the GAprocedure.
Informing parents about necessity of chairside GA and obtaining verbal consent.
Day1 -
Patient comes to pedodontic clinic.
Concerned doctor send child for preanesthetic check up.
Patient comes back to pedodontics department with report.
If aesthetist accepts the case,patient is admitted.
14. Basic investigation are done.
Written consent form is signed by parents.
Premedication given to patient
Day 2:-
Child is brought to pedodontics opds with hospital file.
Child is accompanied by the parents to the procedure room and is present till induction is done.and
then asked to leave.
Induction is usually done using inhalation route.
Once the child is ready under GA the aesthetist hands over the patient to pedodontist.
Treatment is performed using four handed dentistry.
Radiographs also taken for treatment plan.
After completion of treatment dentist handover Patient to anesthetist.
He administer reversal drugs.
Child is shifted to ICU .
Day 3:-
Check up in pedodontics opd.
Then discharge the patient after payment is done.
The doctor concerned fixes a follow up appointment.
Commonly used parental anaesthetic agents-:
Opioids –morphine
. Fentanyl
Benzodiazepenes –Diazepam
. Midazolam
Triazolam
Barbiturates -: Methohexitol
. Thiopental
Complications of generalanaesthesia:-
During anaesthesia:-
1.Respiratory depression
2.Salivation,respiratory secretions
3.Cardiac arrhythmia
4.Laryngospasm,convulsions
5.Fall in blood pressure
After anaesthesia:-
1.Nausea and vomiting
2.Organ toxicities –liver,kidney damage
3.Pneumonia
15. 4.Persisting sedation
Masks for induction:-
1.Shape of mask:-
For the children, induction is generally carried out by the use of inhalation.The shape of mask is
modified to make it acceptable to the child’s.
E.g.balloon mask ,Mickey mouse with a wide open mouth.
2.Scented mask:
. To disguise the odors of the inhalation agents includes addition of drop of fruit extract on the mask.
Also vapourizing volatile fruit flavours into the anaesthetic gas mixture is acceptable.
Conclusion:-
Pharmaccologic behaviour management is necessary for children with lack of psychological or
emotional maturity
Mental , Physical or Medical disability
One should remember the risks during pharmacologic behaviour management
References:-
Textbook of Pedodontics –Shobha Tandon
. 2 nd edition
Textbook of Paediatric Dentistry –Nikhil Marwah
. 3rd
edition
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