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.

What do they say??What do they say??

Too embarrassedToo embarrassed He didn’t listen/stopHe didn’t listen/stop PainPain NoisesNoises SmellsSmells Panic attacksPanic attacks Being judgedBeing judged Too busyToo busy

WHAT IS SEDATION?WHAT IS SEDATION?

ANXIOLYSISANXIOLYSIS: chemically induced state of : chemically induced state of consciousness, awake but has decreased consciousness, awake but has decreased anxiety to facilitate coping skills, retains anxiety to facilitate coping skills, retains interaction abilityinteraction ability

CONSCIOUS SEDATIONCONSCIOUS SEDATION: minimally : minimally depressed level of consciousness, depressed level of consciousness, maintains their own airway and reflexes, maintains their own airway and reflexes, responds to physical and verbal stimuliresponds to physical and verbal stimuli

Who Should Be SedatedWho Should Be Sedated Anxious and Phobic PatientsAnxious and Phobic Patients

Embarrassed PatientsEmbarrassed Patients

GaggersGaggers

Time Oriented PatientsTime Oriented Patients

What Patients Can ExpectWhat Patients Can Expect

Diminished anxietyDiminished anxiety

No painNo pain

Diminished memoryDiminished memory

Less gaggingLess gagging

ASA Physical Status Classification ASA Physical Status Classification SystemSystem

ASA1ASA1Normal healthy patientNormal healthy patient

ASA 2ASA 2Patient with mild systemic diseasePatient with mild systemic disease

can walk up one flight of stairs but must rest at can walk up one flight of stairs but must rest at completioncompletionPatients with mild systemic diseasePatients with mild systemic disease

Mild hypertensionMild hypertensionWell controlled diabetesWell controlled diabetesWell controlled asthmaWell controlled asthma

ASA 3ASA 3

PATIENT WITH SEVERE SYSTEMIC DISEASEPATIENT WITH SEVERE SYSTEMIC DISEASE

Able to walk up a flight of stairs but must restAble to walk up a flight of stairs but must rest

MI < 6 monthsMI < 6 months

Well controlled insulin diabeticWell controlled insulin diabetic

Chronic heart failureChronic heart failure

COPDCOPD

Moderate HTNModerate HTN

AnginaAngina

Method of Anxiety and Pain ControlMethod of Anxiety and Pain Control

AnalgesiaAnalgesia - the diminution or elimination of pain- the diminution or elimination of pain Local AnesthesiaLocal Anesthesia - the elimination of sensation, - the elimination of sensation,

especially pain, in one part of the body by the especially pain, in one part of the body by the topical application or regional injection of a drugtopical application or regional injection of a drug

Minimal SedationMinimal Sedation - minimally depressed level of - minimally depressed level of consciousness that retains the patient’s ability to consciousness that retains the patient’s ability to maintain an airway and respond normally to maintain an airway and respond normally to tactile stimulation and verbal command. tactile stimulation and verbal command. Cognitive function and coordination may be Cognitive function and coordination may be modestly impaired.modestly impaired.

Routes of AdministrationRoutes of Administration

INHALATIONINHALATION

ENTERAL: any technique of admin in ENTERAL: any technique of admin in which the agent is absorbed through which the agent is absorbed through the GI tract or oral mucosathe GI tract or oral mucosa

PARENTERAL: the drug bypasses the PARENTERAL: the drug bypasses the GI tract (im, iv, subm, subq,)GI tract (im, iv, subm, subq,)

PHARMACOLOGY OF SEDATIONPHARMACOLOGY OF SEDATION

1.1. NITROUS OXIDENITROUS OXIDE

2.2. BENZODIAZEPINESBENZODIAZEPINES DIAZEPAMDIAZEPAM TRIAZOLAMTRIAZOLAM LORAZEPAMLORAZEPAM VERSED poVERSED po

3.3. IV VERSEDIV VERSED

RELAXED BUT RESPONDSRELAXED BUT RESPONDS

What Can Be Done?What Can Be Done?

What Can be Accomplished for the What Can be Accomplished for the HYGIENE PATIENTHYGIENE PATIENT

Surgical hygieneSurgical hygiene

Non surgical hygieneNon surgical hygiene ExaminationsExaminations Initial treatmentInitial treatment IrrigationIrrigation Scaling Scaling Root debridementRoot debridement

The Sedated Hygiene PatientThe Sedated Hygiene Patient

There must be non sedated visits There must be non sedated visits with the hygienist to:with the hygienist to:• Review oral home careReview oral home care• begin medicationsbegin medications• AntibioticsAntibiotics• antimicrobialsantimicrobials• disclose and show patient where they disclose and show patient where they

need to improve home careneed to improve home care

COMPLETE PERIO CHARTINGCOMPLETE PERIO CHARTING

POCKET DEPHTHSPOCKET DEPHTHS 6 sites6 sites RECESSIONRECESSION MOBILITYMOBILITY BIFURCATIONSBIFURCATIONS BLEEDING SITESBLEEDING SITES

6 mm 6 mm ++

BleedingBleeding

SitesSites# Perio# Perio

SitesSites# # TeethTeeth

TOTAL THE NUMBER OF:TOTAL THE NUMBER OF:

BLEEDING SITESBLEEDING SITES

POCKETS >4MMPOCKETS >4MM

TEETH INVOLVED IN DISEASETEETH INVOLVED IN DISEASE

ROOT DEBRIDEMENTSROOT DEBRIDEMENTS

Divide the number of teeth involved Divide the number of teeth involved

By three or four depending on pocket By three or four depending on pocket depths to get the number of root depths to get the number of root debridements visitsdebridements visits

Schedule 10 minutes for each toothSchedule 10 minutes for each tooth

Bleeding Bleeding sitessites

Perio sitesPerio sites # Teeth# Teeth

7373 2525 1010

55 55 22

Bleeding Bleeding sitessites

Perio sitesPerio sites # Teeth# Teeth

5454 3131 1212

55 00 00

DATEDATE

MAY 06MAY 06

6+6+

6767

BLEEDBLEED

22

PERIOPERIO

126126

TEETHTEETH

2727

MARCH 06MARCH 06 00 7575 4141 1818

OCT 06OCT 06 00 6969 2525 1010

DEC 06DEC 06 00 44 55 22

MAY 07MAY 07 22 66 2020 1313

LASERLASER

ACRONYMACRONYM

LLIGHT IGHT AAMPLIFICATION BY MPLIFICATION BY

SSTIMULATED TIMULATED EEMISSION OF MISSION OF

RRADIATIONADIATION

LASER IN HYGIENELASER IN HYGIENE

SUCULAR DEBRIDEMENTSUCULAR DEBRIDEMENT

removes infected pocket liningremoves infected pocket lining

Reduce the bacterial count in the soft Reduce the bacterial count in the soft tissuetissue

APTHOUS ULCERAPTHOUS ULCER HERPETIC LESIONSHERPETIC LESIONS TISSUE ABLATION (vaporization)TISSUE ABLATION (vaporization)

ADVANTAGES TO LASER ADVANTAGES TO LASER THERAPYTHERAPY

BETTER TISSUE RESPONSEBETTER TISSUE RESPONSE VAPORIZE BACTERIAVAPORIZE BACTERIA REDUCED NEED FOR LOCAL REDUCED NEED FOR LOCAL

ANESTHESIAANESTHESIA DECREASED POST OP DISCOMFORTDECREASED POST OP DISCOMFORT DECREASE IN TISSUE TRAUMADECREASE IN TISSUE TRAUMA CONSERVES HEALTHY TISSUECONSERVES HEALTHY TISSUE

Hygiene ProtocolHygiene Protocol

1.1. Non sedation instructionalNon sedation instructional

2.2. Sedation:Sedation:• Root debrideRoot debride• Laser therapyLaser therapy• IrrigateIrrigate

3.3. Non sedation monitoringNon sedation monitoring

4.4. Sedation definitive treatmentSedation definitive treatment

INSTRUCTIONAL VISITINSTRUCTIONAL VISIT

DISCLOSEDISCLOSE PLAQUE CONTROLPLAQUE CONTROL PERSCRIPTIONSPERSCRIPTIONS CHLORHEXADINECHLORHEXADINE ANTIBIOTICSANTIBIOTICS SEDATION MEDSSEDATION MEDS HEALTH HISTORY AND BLOOD HEALTH HISTORY AND BLOOD

PRESSUREPRESSURE

THE SEDATION VISITTHE SEDATION VISIT

ROOT DEBRIDEMENT THERAPYROOT DEBRIDEMENT THERAPY LASER THERAPYLASER THERAPY IRRIGATIONIRRIGATION SCALE AND POLISH HEALTHY TEETHSCALE AND POLISH HEALTHY TEETH ARESTINARESTIN

PMAPMA(periodontal maintenance (periodontal maintenance

apt)apt)

DISCLOSE AND DISCUSSDISCLOSE AND DISCUSS

DO NOT PROBEDO NOT PROBE

RE-ENFORCE THE SEDATION VISITRE-ENFORCE THE SEDATION VISIT

DEFINITIVE THERAPYDEFINITIVE THERAPY

REPROBE ALL AREASREPROBE ALL AREAS RETREAT THE AREAS OF DISEASERETREAT THE AREAS OF DISEASE LASER ALL POCKETSLASER ALL POCKETS RETREAT THE HEALTHY TEETHRETREAT THE HEALTHY TEETH IRRIGATEIRRIGATE PLACE ARESTINPLACE ARESTIN CLOSYS 2 RINSE AND TOOTHPASTECLOSYS 2 RINSE AND TOOTHPASTE

SSupportive upportive PPeriodontal eriodontal TTherapyherapy( 8 TO 12 WEEKS)( 8 TO 12 WEEKS)

Disclose and review hygieneDisclose and review hygiene Ultrasonic debridementUltrasonic debridement Relaser pocket sites on bacteria Relaser pocket sites on bacteria

vaporization settingvaporization setting Irrigate with antimicrobialsIrrigate with antimicrobials PolishPolish

LASER USESLASER USES

ABILITY TO SEAL BLOOD VESSELSABILITY TO SEAL BLOOD VESSELS SEAL LYMPHATIC VESSELSSEAL LYMPHATIC VESSELS REDUCES BACTERIA COUNT FOR 60 REDUCES BACTERIA COUNT FOR 60

DAYS (HEALING TAKES 35-40 DAYS)DAYS (HEALING TAKES 35-40 DAYS) Facilitate access to root surface by – Facilitate access to root surface by –

de-epithelialize the tissue liningde-epithelialize the tissue lining REDUCES MECHANICAL TRAUMAREDUCES MECHANICAL TRAUMA

APHTHOUS ULCERSAPHTHOUS ULCERS

No contact between tissue and fiberNo 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 30 sec. in a circular motion at .4

wattswatts 10 sec cool down10 sec cool down Repeat 30 sec at .5 wattsRepeat 30 sec at .5 watts 10 sec cool down10 sec cool down Repeat 30 sec at .6 wattsRepeat 30 sec at .6 watts

SULCULAR DEBRIDEMENTSULCULAR DEBRIDEMENT

Removes diseased or inflamed tissue Removes diseased or inflamed tissue in the periodontal pocket and to in the periodontal pocket and to improve clinical indices including improve clinical indices including gingival index, gingival bleeding gingival index, gingival bleeding index, probe depth, attachment losss index, probe depth, attachment losss and tooth mobility. Clinical data and tooth mobility. Clinical data supports efficacy of laser therapy in supports efficacy of laser therapy in pockets over 4 mm.pockets over 4 mm.

LASER TECHNIQUELASER TECHNIQUE

Fiber parallel to the root surface or slightly Fiber parallel to the root surface or slightly tipped toward the gingival surface in order tipped toward the gingival surface in order to maximize ablation.to maximize ablation.

Fiber kept in contact with epitheliumFiber kept in contact with epithelium Horizontal and vertical directionHorizontal and vertical direction Debride all granulation tissueDebride all granulation tissue 30 sec for 4&5 mm pockets30 sec for 4&5 mm pockets 45 sec for 6 and above45 sec for 6 and above No contraindicationsNo contraindications

ACADEMY OF LASER ACADEMY OF LASER DENTISTRYDENTISTRY

STANDARD PROFICIENCYSTANDARD PROFICIENCY

ADVANCED PROFICIENCYADVANCED PROFICIENCY

EDUCATOR STATUSEDUCATOR STATUS

ADVANCED HYGIENE ADVANCED HYGIENE CONCEPTSCONCEPTS

800.400. 6772800.400. 6772