In the last few days I have received
two very helpful and encouraging feedback testimonials from practitioners who
have undertaken our training course in Inhalation Sedation.
The first is from Dr. Parmajit
Athwal of
Chris Charon and I were invited to
run one of our one-day courses for their entire team, at in July 2014, even before the doors had been opened to
their first patient!
Yesterday I received this
heartwarming story from her..
“We have had a fantastic result
using RA with a patient who has struggled with confidence as his teeth had been
badly neglected. He was embarrassed to seek treatment due to a strong gag
reflex. We were able to take several impressions over a couple of visits
with alginate detailing posterior teeth allowing him to have a fantastically
fitting set of flexible dentures made, that
would otherwise have been impossible. The case has taken a few months
to complete and the patient is now chuffed to bits.
Thanks for all your help......it
was so satisfying to do be able to do this for him.”
Wightwick
Dental Practice’s “Nervous Patient” page including their take on Inhalation
Sedation.
And from Dr. Rob Endicott of
Stratford Dental Practice with some learning points.
“ Hi Richard, hope you are well.
I’m getting on great with my RA,
not really pushing it much but have found it very useful.
A lot of kids extractions I now
offer RA and it is superbly successful.
Have done some 70 year olds as well
recently who have found extractions a lot more sensible.
a) Where I can get it wrong is when
I or the patient has underestimated their phobias.
I had a case recently of a chap who
requested to try RA but his breathing was so shallow I wasn’t getting a lot in
his system and it didn’t work.
b) Those patients as well who opt
for it to make their IV easier seem to chug on it, desperate for an effect and
get themselves worked up about it, which seems to cancel the effect somewhat.
I still do a lot more IV than RA, I
don’t quite have the hypnotic bit worked out myself and rely on the nitrous
more than my own tone of voice – am trying though!
Still a crucial bit of the practice and wouldn’t want to
be without it! “
All the best
Rob
Dr Rob Endicott BDS
Stratford Dental
My 2 learning points from this last
post at (a) and (b) are:
a) This underlines the importance of careful case selection.
There are no absolute rules here but using the MDAS scoring system will help
both experienced and less experienced practitioners alike. Scores over 19 =
phobia ( generally not helped with “RA” or severe anxiety- which may or may not
be or may need additional consideration such as the use of or referral for
hypnotherapy instead of or as well as using RA or additional time spent in
quiet empathetic discussion and reassurance away from the dental chair BEFORE
the treatment appointment AND often the use of a short ( 10 min apt) as a trial
run without treatment so the patient fully understands what can and cannot be achieved
b) Those patients for whom the decision has been made to
offer IV Sedation are in general choosing this option as they are truly phobic or
have an extreme level of anxiety and are looking for the “oblivion” that IV
offers. Using Inhalation Sedation ahead of cannulation, I have found to be very
useful for some, in particular for needle phobics. The peripheral vasodilation that occurs with
Nitrous Oxide can also help identify and gain easier access to the vein and
seems to counteract the tendancy for vein collapse due to adrenaline and
cortisol release as their anxiety levels rise at this point. However the
sedation effect will not be what that patient is expecting for the remainder of
the session, once the IV drug had been given, so it is best to stress that at
that stage the “happy air” is just to help the first injection step after which
they will be more deeply sedated. Once the first IV dose is given, if the nasal
mask is removed, then this technique does not constitute poly-pharmacy. Using Inhalation Sedation concomitantly with
an IV (normally Midazolam) does involve poly-pharmacy and should not be
undertaken by those without further training or a great depth of experience
with both techniques.
I hope this is helpful
Richard Charon
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