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SAAD Digest

Sami Stagnell
Introduction: This paper is a summary of three case reports of patients treated by Oral and Maxillofacial (OMFS) Dental Foundation Trainees (DF2s) at a busy London paediatric Accident and Emergency (A&E) department. Discussion: Behavioural management for paediatric patients is challenging. The authors discuss various non-pharmacological behavioural management methods as stand-alone techniques or as an adjunct to drugs (sedation or anaesthesia). They highlight three cases where a dedicated Play-Specialist is employed to assist treatment undertaken in an acute hospital setting...
January 2017: SAAD Digest
Arkadiusz Dziedzic
Dental practitioners dealing with children and individuals with special needs can be supported by the provision of general anaesthesia for the most challenging patients in situations where other options are insufficient. The availability of general anaesthesia will further the aim of extending access to the widest range of dental care to the greatest number of patients regardless of disability, age or phobia. The objective is to ensure patients have a pain-free and healthy mouth, and any necessary treatment in the most appropriate setting related to their specific needs...
2017: SAAD Digest
Cameron Warwicker
A pronounced gag reflex can be a burden for patients and dentists alike. It can limit the capability of a patient to undergo dental treatment and complicate the dentist’s ability to provide treatment. Understanding the somatic and psychological basis of an overactive gag reflex is key to providing treatment. The first techniques involved should be local measures to reduce anxiety. Further techniques can be used if this proves fruitless. Local anaesthetic, conscious sedation, acupuncture, hypnosis and TENS are techniques that have been suggested in the literature to overcome a pronounced gag reflex...
January 2017: SAAD Digest
Sarah Sacoor
Autism is a disability that affects how a person communicates and relates to the world around them. Patients on the autistic spectrum may be referred to a Special Care Dentistry service to be managed under sedation or general anaesthetic, as their visit to the dentist can be stressful and disruptive to their routine. As it is a spectrum disorder, each patient needs to be assessed individually in order to determine whether sedation or general anaesthetic would be appropriate for them. Some autistic patients may have good verbal communication and mild learning difficulties, and may be able to tolerate treatment under local anaesthetic with behavioural management alone...
January 2017: SAAD Digest
Jennifer S J Hare
This case report presents a Cognitive Behavioural Therapy (CBT) intervention provided for a 63-year-old male, who had experienced dental phobia for over 50-years. This gentleman initially received intravenous sedation (IVS) for 5-years within a Specialist Sedation and Special Care dental department, before being referred for the long-term management of his dental phobia, within the embedded specialist Dental Health Psychology Service in a London Dental Hospital. This brief report will consider aspects of the CBT intervention delivered in relation to assessment, case conceptualisation, course of treatment and outcomes; reflecting on the complementary aspects of sedation and CBT...
January 2017: SAAD Digest
Tashfeen Kholasi, Emily Sherwin, Chris Dickinson
The Mental Capacity Act 2005 (MCA) is one piece of legislation with which all clinicians should be familiar. As treating clinicians, a capacity assessment is carried out each time a patient is seen, in order to obtain informed consent. When clinicians question the capacity of their patients, they should ensure steps are taken to provide relevant adjuncts to aid understanding, from visual aids to alternative time and environment. If a patient is deemed to lack capacity, it should be determined if this is temporary, fluctuating or permanent, as well as the severity...
January 2017: SAAD Digest
Joe Hulin, Sarah Baker, Zoe Marshman, Sondos Albadri, Helen Rodd
Aim: To explore the decisional needs of young patients faced with the choice of dental treatment with either sedation or general anaesthetic (GA). Design: Twelve qualitative interviews were conducted with patients, aged 10-16 yr (n=12), who had prior experience of dental treatment with sedation or GA, together with their parents/ guardians (n=13). Results: A number of themes were identified as being important in the decision-making process including: the method of administration; waiting and treatment times; perceived side effects and risks; treatment type; control and communication, and the long term impact of sedation or GA...
January 2017: SAAD Digest
Laurence Folland, Emma Brown, Carole Boyle
The practice of midazolam conscious sedation is well established in dentistry. The drug flumazenil is a specific benzodiazepine antagonist and is an essential requirement in settings where midazolam is used. A literature review has been carried out, examining the available information regarding flumazenil’s safety, administration, potential complications and the regulatory documentation which governs its use. Flumazenil is a safe drug to use for the reversal of midazolam induced conscious sedation although the evidence surrounding its use is limited...
January 2017: SAAD Digest
T H van den Berg, B Preckel
Objectives: To assess the efficacy and safety of Bispectral Index (BIS) guided Target Controlled Infusion (TCI) of midazolam for anxiolysis or minimal sedation during extensive periodontal or implant surgery in a single operator/sedationist model. Methods: Retrospective analysis of thirty adult ASA 1 or ASA 2 patients undergoing periodontal surgery or dental implant surgery under local anaesthesia were included. The calculated effect site concentration (Ce) of midazolam applied by TCI, BIS, heart rate (HR), and peripheral oxygen saturation (SpO2) were monitored continuously...
January 2017: SAAD Digest
Paul J Brady, Martina Hayes, Christine E McCreary, Ken D O'Halloran, Joseph A Giovannitti
Capnography monitoring during conscious sedation is not currently required for dentistry in Britain and Ireland. Other countries have introduced guidelines and standards requiring capnography monitoring for procedural sedation. This review highlights the variability of procedural sedation including the setting, the position on the sedation continuum, and the routine use of supplemental oxygen. Specific research is required for conscious sedation in a dental setting to support standards and guidelines with regard to capnography monitoring...
January 2017: SAAD Digest
Ian Brett, Christopher Holden
No abstract text is available yet for this article.
January 2016: SAAD Digest
(no author information available yet)
No abstract text is available yet for this article.
January 2016: SAAD Digest
(no author information available yet)
No abstract text is available yet for this article.
January 2016: SAAD Digest
Sadie Hughes, Francis Collier
No abstract text is available yet for this article.
January 2016: SAAD Digest
Tom Friend, Paul Allen
BACKGROUND: The first line approach to managing healthy anxious children requiring dental extractions should include behavioural management and treatment under local anaesthetic. This can be coupled with conscious sedation. AIM: To evaluate alternative methods attempted prior to treatment under general anaesthesia (GA), to establish the incidence of repeat GA procedures. METHOD: Paediatric cases requiring dental extractions under GA were audited from October 2014 - December 2014 in the Oral and Maxillofacial Department, Great Western Hospital, Swindon...
January 2016: SAAD Digest
Lucy Horsfall
A growing body of evidence is emerging for a phenomenon known as the nocebo effect. This is when a person is conditioned to expect a negative response, or to anticipate negative effects from an experience. These findings highlight the importantance of effective communication with patients and the influence that good anxiety and pain management control can have in improving treatment outcomes. The placebo effect has been widely researched, but new studies have shown that nocebo can have a greater effect than placebo The nocebo effect is prevalent in interactions between patients and healthcare workers...
January 2016: SAAD Digest
Vinson Yeung
No abstract text is available yet for this article.
January 2016: SAAD Digest
Anwen Greaves
The administration of midazolam intranasally exploits the unique structure of the nasopharynx thus ensuring rapid delivery to the systemic circulation (The Nose - Brain Pathway). The absorption of midazolam nasally is influenced by the volume and concentration of midazolam, its physicochemical properties and the characteristics of the nasal mucosa. Delivering midazolam intranasally is non-titratable. The level of conscious sedation may be equivalent to that achieved by intravenous routes but is approached in a less controlled manner...
January 2016: SAAD Digest
Stephen G Jones
Clinical audit is a tool that may be used to improve the quality of care and outcomes for patients in a health care setting as well as a mechanism for clinicians to reflect on their performance. The audit described in this short report involved the collection and analysis of data related to the administration of 1,756 conscious sedations, categorised as standard techniques, by clinicians employed by an NHS Trust-based dental service during the year 2014. Data collected included gender, age and medical status of subject, the type of care delivered, the dose of drug administered and the quality of the achieved sedation and any sedation-related complications...
January 2016: SAAD Digest
Michael R J Sury, James H MacG Palmer, Tim M Cook, Jaideep J Pandit
The National Health Service anaesthesia annual activity (2013) was recently reported by the Fifth National Audit Program of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. Within a large dataset were 620 dental cases. Here, we describe this data subset. The estimated annual dental caseload was 111,600:60% were children (< 16 y), 38.5% adults (16 - 65y) and 1.5% the elderly (> 65y). Almost all were elective day procedures (97%) and ASA 1 or 2 patients (95%)...
January 2016: SAAD Digest
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