Tuesday, April 17, 2012

4 RA cases today- All different

In general, on average I treat one patient each day using Relative Analgesia (RA) or "Happy Air".  
Also known as Inhalation Sedation (I.S.

Today I found a use for it for four of my patients, all for different reasons.

Patient 1: A man in his fifties with very poor dental health. He is about to lose an upper central incisor in an otherwise intact upper arch of teeth. He fears the noise of the drill. Amongst other preventive and hygiene treatment, he needs 4 teeth removing and two, six-unit anterior bridges made UL3-UR3 and LL3 -LR3. All the lower incisors are already missing.
Today's visit was to carry out his new patient clinical examination (having already had a meet and greet non-clinical visit to discuss his issues.) AND to give him a test drive of the "Happy Air" for us both to assess his reaction.

He took to it rather well but he is clear in his own mind that he needs the amnesia that IV Midazolam can offer and the reduced awareness of what is happening and of time passing quickly as he needs several long visits.

His treatment may take the best part of 12 months and will no doubt entail at least 2 x IV sessions and probably several sessions with happy air for the simpler stages of rehabilitating his dental condition.
Still, using a toothbrush, a little more systematically, will be a good start!!

Patient 2: This late 20s young man appeared at short notice for the first time today with severe toothache in LR6.

 He hadn't seen a  dentist for at least 10 years through fear. Fear of being told off and fear of unpleasant smells. We discussed the idea of I.S. He liked it,. He gave informed consent and we were able to sedate him and give local anaesthesia in about 5 minutes.

We proceeded to undertake a vital pulpotomy (removed the top part of the nerve) and placed a temporary filling.

He recovered within 3 minutes and said that was the best dental visit he had ever had. He'll be coming back for a full examination as a new patient. He will need at least 2 root fillings, a 3-unit bridge and at least one crown.  I am confident that he'll be back.

Patient 3: This was a 14-year old referred to me by another practitioner as she would not allow him to give her a local anaesthetic injection for a specific tooth needing a filling. She came to see me a week ago for a discussion and assessment and to have a test run of the happy air without needing to open her mouth. She got on very well with this approach and returned with her mother today. 
Again she sedated very nicely and I used the single tooth anaesthesia method using
The Wand Plus®. The tooth was badly decayed but this is not the place to discuss that detail.

Post op x-ray

Both she and her mother were delighted with the outcome, which is just as well as she is likely to need a root-filling at some time in the not so distant future. She will be quite happy to return. She';ll need to for the cavity in LR7 too!!

Patient 4:

Finally we saw a 20 year old for her 3rd visit. Two fillings in upper molars, both deeper than would have been obvious. Under the influence of "RA".  Totally relaxed, it was a pleasure to carry out her treatment.



These 4 examples are the tip of the iceberg of the usefulness of this technique.
 Interested to know more?

I look forward to hearing from you.

Richard Charon


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