What do they say?? Too embarrassed Too embarrassed He didnt listen/stop He didnt listen/stop Pain Pain Noises Noises Smells Smells Panic attacks Panic

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Slide 2 Slide 3 What do they say?? Too embarrassed Too embarrassed He didnt listen/stop He didnt listen/stop Pain Pain Noises Noises Smells Smells Panic attacks Panic attacks Being judged Being judged Too busy Too busy Slide 4 WHAT IS SEDATION? ANXIOLYSIS: chemically induced state of consciousness, awake but has decreased anxiety to facilitate coping skills, retains interaction ability ANXIOLYSIS: chemically induced state of consciousness, awake but has decreased anxiety to facilitate coping skills, retains interaction ability CONSCIOUS SEDATION: minimally depressed level of consciousness, maintains their own airway and reflexes, responds to physical and verbal stimuli CONSCIOUS SEDATION: minimally depressed level of consciousness, maintains their own airway and reflexes, responds to physical and verbal stimuli Slide 5 Who Should Be Sedated Anxious and Phobic Patients Anxious and Phobic Patients Embarrassed Patients Embarrassed Patients Gaggers Gaggers Time Oriented Patients Time Oriented Patients Slide 6 What Patients Can Expect Diminished anxiety Diminished anxiety No pain No pain Diminished memory Diminished memory Less gagging Less gagging Slide 7 ASA Physical Status Classification System ASA1 Normal healthy patient ASA 2 Patient with mild systemic disease can walk up one flight of stairs but must rest at completion can walk up one flight of stairs but must rest at completion Patients with mild systemic disease Patients with mild systemic disease Mild hypertension Mild hypertension Well controlled diabetes Well controlled diabetes Well controlled asthma Well controlled asthma Slide 8 ASA 3 PATIENT WITH SEVERE SYSTEMIC DISEASE PATIENT WITH SEVERE SYSTEMIC DISEASE Able to walk up a flight of stairs but must rest MI < 6 months Well controlled insulin diabetic Chronic heart failure COPD Moderate HTN Angina Slide 9 Method of Anxiety and Pain Control Analgesia - the diminution or elimination of pain Analgesia - the diminution or elimination of pain Local Anesthesia - the elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug Local Anesthesia - the elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug Minimal Sedation - minimally depressed level of consciousness that retains the patients ability to maintain an airway and respond normally to tactile stimulation and verbal command. Cognitive function and coordination may be modestly impaired. Minimal Sedation - minimally depressed level of consciousness that retains the patients ability to maintain an airway and respond normally to tactile stimulation and verbal command. Cognitive function and coordination may be modestly impaired. Slide 10 Slide 11 Routes of Administration INHALATION INHALATION ENTERAL: any technique of admin in which the agent is absorbed through the GI tract or oral mucosa ENTERAL: any technique of admin in which the agent is absorbed through the GI tract or oral mucosa PARENTERAL: the drug bypasses the GI tract (im, iv, subm, subq,) PARENTERAL: the drug bypasses the GI tract (im, iv, subm, subq,) Slide 12 PHARMACOLOGY OF SEDATION 1. NITROUS OXIDE 2. BENZODIAZEPINES DIAZEPAM DIAZEPAM TRIAZOLAM TRIAZOLAM LORAZEPAM LORAZEPAM VERSED po VERSED po 3. IV VERSED Slide 13 Slide 14 Slide 15 Slide 16 RELAXED BUT RESPONDS Slide 17 What Can Be Done? Slide 18 Slide 19 Slide 20 Slide 21 What Can be Accomplished for the HYGIENE PATIENT Surgical hygiene Surgical hygiene Non surgical hygiene Non surgical hygiene Examinations Examinations Initial treatment Initial treatment Irrigation Irrigation Scaling Scaling Root debridement Root debridement Slide 22 The Sedated Hygiene Patient There must be non sedated visits with the hygienist to: There must be non sedated visits with the hygienist to: Review oral home careReview oral home care begin medicationsbegin medications AntibioticsAntibiotics antimicrobialsantimicrobials disclose and show patient where they need to improve home caredisclose and show patient where they need to improve home care Slide 23 COMPLETE PERIO CHARTING POCKET DEPHTHS POCKET DEPHTHS 6 sites 6 sites RECESSION RECESSION MOBILITY MOBILITY BIFURCATIONS BIFURCATIONS BLEEDING SITES BLEEDING SITES Slide 24 Slide 25 6 mm + BleedingSites # Perio Sites # Teeth Slide 26 TOTAL THE NUMBER OF: BLEEDING SITES BLEEDING SITES POCKETS >4MM POCKETS >4MM TEETH INVOLVED IN DISEASE TEETH INVOLVED IN DISEASE Slide 27 ROOT DEBRIDEMENTS Divide the number of teeth involved Divide the number of teeth involved By three or four depending on pocket depths to get the number of root debridements visits By three or four depending on pocket depths to get the number of root debridements visits Schedule 10 minutes for each tooth Slide 28 Slide 29 Bleeding sites Perio sites # Teeth 732510 552 Slide 30 Slide 31 Bleeding sites Perio sites # Teeth 543112 500 Slide 32 Slide 33 DATE MAY 06 6+67BLEED2PERIO126TEETH27 MARCH 06 0754118 OCT 06 0692510 DEC 06 0452 MAY 07 262013 Slide 34 LASER ACRONYM L IGHT A MPLIFICATION BY S TIMULATED E MISSION OF R ADIATION Slide 35 LASER IN HYGIENE SUCULAR DEBRIDEMENT SUCULAR DEBRIDEMENT removes infected pocket lining removes infected pocket lining Reduce the bacterial count in the soft tissue Reduce the bacterial count in the soft tissue APTHOUS ULCER APTHOUS ULCER HERPETIC LESIONS HERPETIC LESIONS TISSUE ABLATION (vaporization) TISSUE ABLATION (vaporization) Slide 36 ADVANTAGES TO LASER THERAPY BETTER TISSUE RESPONSE BETTER TISSUE RESPONSE VAPORIZE BACTERIA VAPORIZE BACTERIA REDUCED NEED FOR LOCAL ANESTHESIA REDUCED NEED FOR LOCAL ANESTHESIA DECREASED POST OP DISCOMFORT DECREASED POST OP DISCOMFORT DECREASE IN TISSUE TRAUMA DECREASE IN TISSUE TRAUMA CONSERVES HEALTHY TISSUE CONSERVES HEALTHY TISSUE Slide 37 Hygiene Protocol 1. Non sedation instructional 2. Sedation: Root debrideRoot debride Laser therapyLaser therapy IrrigateIrrigate 3. Non sedation monitoring 4. Sedation definitive treatment Slide 38 INSTRUCTIONAL VISIT DISCLOSE DISCLOSE PLAQUE CONTROL PLAQUE CONTROL PERSCRIPTIONS PERSCRIPTIONS CHLORHEXADINE CHLORHEXADINE ANTIBIOTICS ANTIBIOTICS SEDATION MEDS SEDATION MEDS HEALTH HISTORY AND BLOOD PRESSURE HEALTH HISTORY AND BLOOD PRESSURE Slide 39 THE SEDATION VISIT ROOT DEBRIDEMENT THERAPY ROOT DEBRIDEMENT THERAPY LASER THERAPY LASER THERAPY IRRIGATION IRRIGATION SCALE AND POLISH HEALTHY TEETH SCALE AND POLISH HEALTHY TEETH ARESTIN ARESTIN Slide 40 PMA (periodontal maintenance apt) DISCLOSE AND DISCUSS DISCLOSE AND DISCUSS DO NOT PROBE DO NOT PROBE RE-ENFORCE THE SEDATION VISIT RE-ENFORCE THE SEDATION VISIT Slide 41 DEFINITIVE THERAPY REPROBE ALL AREAS REPROBE ALL AREAS RETREAT THE AREAS OF DISEASE RETREAT THE AREAS OF DISEASE LASER ALL POCKETS LASER ALL POCKETS RETREAT THE HEALTHY TEETH RETREAT THE HEALTHY TEETH IRRIGATE IRRIGATE PLACE ARESTIN PLACE ARESTIN CLOSYS 2 RINSE AND TOOTHPASTE CLOSYS 2 RINSE AND TOOTHPASTE Slide 42 S upportive P eriodontal T herapy ( 8 TO 12 WEEKS) Disclose and review hygiene Disclose and review hygiene Ultrasonic debridement Ultrasonic debridement Relaser pocket sites on bacteria vaporization setting Relaser pocket sites on bacteria vaporization setting Irrigate with antimicrobials Irrigate with antimicrobials Polish Polish Slide 43 LASER USES ABILITY TO SEAL BLOOD VESSELS ABILITY TO SEAL BLOOD VESSELS SEAL LYMPHATIC VESSELS SEAL LYMPHATIC VESSELS REDUCES BACTERIA COUNT FOR 60 DAYS (HEALING TAKES 35-40 DAYS) REDUCES BACTERIA COUNT FOR 60 DAYS (HEALING TAKES 35-40 DAYS) Facilitate access to root surface by de-epithelialize the tissue lining Facilitate access to root surface by de-epithelialize the tissue lining REDUCES MECHANICAL TRAUMA REDUCES MECHANICAL TRAUMA Slide 44 APHTHOUS ULCERS No contact between tissue and fiber No contact between tissue and fiber Maintain a distance of 1- 2 mm Maintain a distance of 1- 2 mm 30 sec. in a circular motion at.4 watts 30 sec. in a circular motion at.4 watts 10 sec cool down 10 sec cool down Repeat 30 sec at.5 watts Repeat 30 sec at.5 watts 10 sec cool down 10 sec cool down Repeat 30 sec at.6 watts Repeat 30 sec at.6 watts Slide 45 SULCULAR DEBRIDEMENT Removes diseased or inflamed tissue in the periodontal pocket and to improve clinical indices including gingival index, gingival bleeding index, probe depth, attachment losss and tooth mobility. Clinical data supports efficacy of laser therapy in pockets over 4 mm. Removes diseased or inflamed tissue in the periodontal pocket and to improve clinical indices including gingival index, gingival bleeding index, probe depth, attachment losss and tooth mobility. Clinical data supports efficacy of laser therapy in pockets over 4 mm. Slide 46 LASER TECHNIQUE Fiber parallel to the root surface or slightly tipped toward the gingival surface in order to maximize ablation. Fiber parallel to the root surface or slightly tipped toward the gingival surface in order to maximize ablation. Fiber kept in contact with epithelium Fiber kept in contact with epithelium Horizontal and vertical direction Horizontal and vertical direction Debride all granulation tissue Debride all granulation tissue 30 sec for 4&5 mm pockets 30 sec for 4&5 mm pockets 45 sec for 6 and above 45 sec for 6 and above No contraindications No contraindications Slide 47 ACADEMY OF LASER DENTISTRY Slide 48 STANDARD PROFICIENCY STANDARD PROFICIENCY ADVANCED PROFICIENCY ADVANCED PROFICIENCY EDUCATOR STATUS EDUCATOR STATUS Slide 49 ADVANCED HYGIENE CONCEPTS 800.400. 6772