Tuesday, September 03, 2019

Inhalation Sedation A Golden Nugget: How to improve success with young children and very anxious adults

Richard Charon BDS

T/A The RA Coach

Inhalation Sedation

Accredited Course Provider and Trainer

IACSD (2015) RCS(STAC)2106 & 2018

Approved by The Dental Council of Ireland Dec 2017



 Inhalation Sedation

A Golden Nugget !

How to improve success with young children and very anxious adults

Unless the practitioner has already built rapport with a patient, then it is asking  a lot, usually too much, to see a patient on referral and get on with a sedation and treatment session and expect a successful outcome, more particularly for children, though this is of course possible.
Much can be learned therefore from my approach with

This approach would be my preferred way with very young patients, more particularly for patients referred to me and  I believe greatly increases the chance of success and therefore reduce the risk of creating or exacerbating dental fear/anxiety or even phobia.

Each session can be quite short and would incorporate the patient assessment, consent process , an acclimatization session with “RA” and finally treatment.

Good communication, “Tell-Show-Do” and positivity are all essential. Other strategies may be added according to the practitioners capabilities, the age and cognitive abilities of the patient

Never over-promise and under-deliver BUT at the same time the careful use of language and body language should be used to suggest if not predict a very likely positive outcome.

“Let’s give this a try and see if it work” is not the right approach.

An approach which is most likely to lead to success, would be something along these lines.
“ What we have found is that other children/people love the happy air, love the relaxation and comfortable/cosy/floaty (choose your words) that it gives. Just imagine how nice it would be if … (choose your words).”

Once the patient responds in a positive manner then proceed to the next step:
Which would be a "Trial Run" with no treatment. This is a promise that must not be broken.

More often than not I make another appointment at this point with the promise of a quick try of the ”happy air” (used for adults and children!) adding   “ I don’t even want you to see your teeth next time” or “I’d like you to keep you mouth closed next time” – is that OK?

If in the sedationist’s judgment the patient’s level of dental anxiety is not too extreme, then ask at this first visit that “when we have a trial run of the happy air, is it OK if I just count your teeth just using a dental mirror - (Show them the mirror).  If agreed, then that will give the patient the opportunity to assess their own relaxed mouth, reduced or absent gag reflex and “not minding a bit” about having a dentist’s fingers or mirror in their mouth.

Assuming that session proceeds well and the patient is positive at the end and can give you operator-sedationist the thumbs-up then go on to book the treatment appointment, reminding them that they will feel just as relaxed next time, before starting any treatment/ mending your tooth or whatever is appropriate.

Expect the patient’s level of anxiety to be lower on arrival for the treatment visit which normally proceeds very successfully.

A word of warning.
Providing truly painless local anaesthetic injections is also a key to success.

Do not take liberties. The analgesic effects of Nitrous Oxide can be overplayed. It will help but it will not “mask” a poorly given LA injection. 
I have witnessed GDPs for whom I was sedating their patients, inflict (of course unintentionally) a painful injection because they had assumed the patient would feel nothing.
The result on each occasion was a tearful child, whose nasal secretions quickly prevented the required nasal breathing and so of course the sedative effects of the nitrous oxide quickly wore off.
I would advise using topical L.A.  and waiting long enough for it to take effect.
This can be applied soon after the initial increments of nitrous oxide are given.
Once the Sedation-end point has bee reached and the patient indicated they are comfortable, the mucosal surface will have been anaesthetized or wait a little longer until it is deemed that the topical will have taken effect.

Then very slowly inject one or two drops only of LA and withdraw.
Wait a minute (be patient!) whilst the patients breathing steadies and their sedation is maintained. Then return to the injection site to very slowly give the appropriate dose for the patient and the procedure.

Then wait an appropriate time again before proceeding with any operative treatment. If the patient shows any sign of sensation, stop, reassess and take whatever appropriate action is required to ensure anaesthesia.
I hope that helps.

Richard Charon


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