DOCSLIB.ORG

Criteria for Treatment of Children Under General Anesthesia by Pediatric Dentists and Parents

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Criteria for Treatment of Children Under General Anesthesia by Pediatric Dentists and Parents Criteria for Treatment of Children Under General Anesthesia by Pediatric Dentists and Parents THESIS Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University By Elizabeth Sutton Gosnell DMD Graduate Program in Dentistry The Ohio State University 2011 Master's Examination Committee: Professor Sarat Thikkurissy DDS, MS, Advisor Professor Dennis McTigue DDS, MS Professor Megann Smiley DDS, MS Professor Simon Prior DDS, MS Copyright by Elizabeth Sutton Gosnell 2011 Abstract Purpose: As of 2011, 70% of all states (35/50) have legislation outlining criteria for the use of general anesthesia (GA) to manage early childhood caries (ECC). Criteria are inconsistent, with varying age, health and disease requirements. The purpose of this study was to compare parental and pediatric dentist criteria for treatment of dental disease under GA. Method: This case cohort series surveyed caregivers at both a large urban tertiary hospital and also at a suburban private pediatric dental practice. Caregiver responses were compared to results from an electronic survey sent to Board-certified members of the American Academy of Pediatric Dentistry (AAPD). Results: Data were collected from 195 parents 631 dentists. Parents believe that children (a) from ages 3-4, (b) with 2-4 carious teeth or (c) requiring 2-4 extractions or restorations all immediately qualify for GA; all significantly different (P<.0001) from surveyed dentists, who felt the above did not provide a solely adequate criteria. Thirty- two percent of parents felt that a developmental delay automatically qualified a patient ii for GA, significantly more than the 12% of dentists (P<.0001). Parents and dentists did agree that a behavior problem at any age qualified a patient for GA (P=<.78). When asked “who was most qualified to determine appropriateness for treatment of dental cavities under GA?” both parents and dentists ranked dentists first, and insurance companies last. However, parents ranked themselves above physicians, while dentists ranked physicians higher. This difference was significant (P<.0001). Pediatric dentists report they consult the AAPD guidelines first when considering a child for general anesthesia, followed by state legislation and insurance company reimbursement last. Fifty-five percent of pediatric dentists report they have delayed urgent/ emergent care waiting for insurance pre-authorization. Conclusion: Board certified pediatric dentists were less likely to have specific tooth number or disease-criteria for GA than parents. Most pediatric dentists referred to the AAPD guidelines for GA, with less than 10% citing state legislation as their first choice. Twenty-seven percent of parents felt they were most qualified to request GA, while 11% of parents felt physicians were most qualified. iii Dedication This document is dedicated to my husband William who has shown me boundless love and unwavering support through this entire process. iv Acknowledgments Thank you to my entire thesis committee who has given me support and guidance through the entire thesis process. A special thank you to my thesis advisor for keeping me focused and giving me constant support and encouragement. v Vita May 2001 .......................................................Dutch Fork High School 2005................................................................BS Chemistry, University of South Carolina 2009................................................................DMD, Medical University of South Carolina 2009 to present ..............................................Pediatric Dental Resident, The Ohio State University and Nationwide Children‟s Hospital Fields of Study Major Field: Dentistry Pediatric Dentistry vi Table of Contents Abstract ............................................................................................................................... ii Dedication .......................................................................................................................... iv Acknowledgments............................................................................................................... v Vita ..................................................................................................................................... vi List of Tables ...................................................................................................................... x List of Figures……………………………………………………………………………xii Chapter 1: Introduction ...................................................................................................... 1 1.1: Dental Caries in Children: Epidemiology and Morbidity…………………….............1 1.2: Treatment Modalities for Dental Disease in Children- General Anesthesia…………7 1.3: Determining "Appropriateness" of General Anesthesia for Dental Rehabilitation......8 1.4: Impact of the Dental Home on GA Utilization……………………………………...11 1.5: State Legislation and Insurance Coverage for Dental Rehabilitation under GA……13 Chapter 2: Methods………………………………………………………………………16 Chapter 3: Results……………………………………………………………………….17 3.1: Pediatric Dentists- Demographics…………………………………………………..17 vii 3.2: Use of Sedation/ General Anesthesia among Pediatric Dentists……………………18 3.3: Resources Utilized by Pediatric Dentists……………………………………………19 3.4: Patient Specific Criteria for GA use in Children……………………………………20 3.4a: Age…………………………………………………………………………………20 3.4b: Minimum Number of Teeth………………………………………………………..20 3.4c: Patient Health Status…………………………………………………….................21 Section 5: Parents- Demographics……………………………………………………….22 3.5a: Analysis by Ethnicity………………………………………………………………22 3.5b: Analysis by Education……………………………………………………………..22 3.5c: Analysis by Recruitment Site………………………………………………………23 3.6: Parental Concern for General Anesthesia…………………………………………...23 3.7: Appropriateness of General Anesthesia for Children……………………….............24 Chapter 4: Discussion……………………………………………………………………38 4.1: Current use of General Anesthesia………………………………………….............38 4.2: Decision to use General Anesthesia…………………………………………………42 4.3: Location for the provision of GA…………………………………………………...45 4.4: Parents- Patient specific criteria for GA…………………………………………….46 4.5: Influence of Demographics and Location…………………………………………...48 4.6: Finances of going to GA…………………………………………………………….49 4.7: Parent Data Finding: 'Don't Know'………………………………………………….50 4.8: Appropriateness of GA for Children………………………………………………..50 4.9: Analysis of State Legislation………………………………………………………..51 viii 4.10: Analysis of Study………………………………………………………….............52 References……………………………………………………………………………….54 Appendix A: General Anesthesia State Legislation……………………………………..57 Appendix B: Dentist Survey…………………………………………………………….70 Appendix C: Parent Survey……………………………………………………………...74 ix List of Tables Table 1. Pediatric Dentist demographics……………………………………………….25 Table 2. Use of Sedation/ GA use among Pediatric Dentists…………………………..26 Table 3. Rank the following in order from highest priority to lowest priority when considering GA for dental treatment………………………………………….28 Table 4. Pediatric Dentists: When a child has suffered trauma, which of the following do you consider before the child is put under general anesthesia for dental treatment? Rank the following in order of most important (1) to least important (4) in consideration………………………………………………………………28 Table 5. Pediatric dentists: Patient specific responses………………………………….29 Table 6. Pediatric Dentists: What do you consult when considering GA for treatment? Rank the following from most important (1) to least important (3)……………31 Table 7. Parental demographics…………………………………………………………31 Table 8. Parental responses……………………………………………………………..32 Table 9. Parental responses- qualifier questions……………………………………….35 Table 10. Pediatric Dentists- Which of the following groups is most qualified to determine the appropriateness of general anesthesia for treatment of dental caries/ cavities? Rank the following from most appropriate (1) to least x appropriate (4)…………………………………………………………………37 Table 11. Parents- Which of the following groups is most qualified to determine the appropriateness of general anesthesia for treatment of dental caries/ cavities? Rank the following from most appropriate (1) to least appropriate (4)………..37 xi List of Figures Figure 1. Early childhood caries morbidity and mortality pyramid……………………...3 Figure 2. Multifactorial model of early childhood caries………………………………...6 xii Chapter 1: Introduction 1.1: Dental Caries in Children: Epidemiology & Morbidity Dental caries remains the most common chronic childhood disease, with an estimated prevalence five times that of asthma6. A hallmark of modern-day dental disease is a notable disparity in prevalence, with eighty percent of dental caries being localized in 25% of children. The majority of these children are from families of lower socioeconomic status. Dental caries prevalence has been associated with age, income, and minority status6, 32. It has been estimated that approximately 20% of preschoolers, 50% of second graders, and 67% of ninth graders have experienced tooth decay6. Data from the 1999-2004 The National Health and Nutrition Examination Survey (NHANES) indicated the prevalence of dental caries for children 2-5 years old increased from 24% in 1988-1994 to 28% in 1999-2004. The survey also indicated that 72% of decayed or filled tooth surfaces (dft) remain untreated18. In the 1988-1994 NHANES data, two-year old children defined as being in poor
Load more

Recommended publications
  • Anesthesia for Dental Treatment? Anesthesia Is Used to Help Manage Pain During Surgical Or Dental Procedures and Is an Integral Part of Dental Care
    Anesthesia for Dental Treatment bcbsfepdental.com Learn more about reasons for use, types, and side effects of anesthesia Why Anesthesia for Dental Treatment? Anesthesia is used to help manage pain during surgical or dental procedures and is an integral part of dental care. Most of us are familiar with Novocain or lidocaine – a local anesthetic used to numb a treatment area – but did you know there are other reasons a dentist might recommend a different type of anesthesia? Dentists will determine which type of anesthesia is appropriate based on: • The complexity of the procedure (how invasive or the length of time to complete procedure) • The age of the patient and level of patient cooperation (small children, special needs, dementia/Alzheimer’s) Risks of Anesthesia • Patient medical history (allergies, special needs, Though complications from dental Parkinson’s) anesthesia are rare, there are some risks involved, including: • Patient mental health history (phobias, anxiety) • Allergic reactions Types of Anesthesia • Low blood pressure • Heart attack/failure Anesthesia options are broken into three categories: • Stroke Local Anesthesia – the most commonly used anesthetic, • Breathing failure local anesthesia is used to numb a specific area of the • Death mouth and are applied topically or by injection. Both the If you are planning dental treatment pre-injection numbing gel the dentist uses (topical using anesthesia, discuss any anesthetic) and the Novocain/lidocaine shot itself are concerns with your dentist. different examples of local anesthetics. Local anesthesia is used for minor dental procedures like fillings, extractions, root canal treatments, crown placement, and deep cleanings. The numbing sensation can last for hours, but leaves the patient conscious.
    [Show full text]
  • Dental Anesthesia Division & the Dental Anesthesia Residency
    Dental Anesthesia Division & the Dental Anesthesia Residency Program The Division of Dental Anesthesia is responsible for providing anesthesia to pediatric and adult patients who require dental rehabilitation, dental alveolar surgery, treatment for facial trauma and treatment for orthognathic surgery. A major responsibility for this division is providing care for pre-cooperative children and children and adults with special needs. The Division of Dental Anesthesia has three members: Dr. Martin Boorin, Dr. Ralph Epstein & Dr. Robert Reiner. Ralph Epstein, DDS Program Director The Division of Dental Anesthesia is responsible for a 3-year accredited dental Chief of anesthesia residency program which accepts 4 residents per year. Following Dental Anesthesia completion of the residency program these dentist anesthesiologists provide anesthesia for patients receiving dental and oral surgical care in multiple venues, i.e., office-based, ambulatory surgical centers, and hospitals. In addition, many of our graduates join the faculty of dental schools to provide didactic and clinical education to pre-doctoral students and post- doctoral residents in multiple specialties. Our graduates have accepted positions in states throughout this country and in Canada. During their training, the dental anesthesia residents are responsible for providing anesthesia care for all types of medical procedures. They are scheduled in a similar way to the physician anesthesia residents except they are not scheduled in the cardiac or obstetric rotations. A major part of the clinical portion of the anesthesia residency program is spent with Dr. Boorin and Dr. Epstein in dental and oral surgery offices providing the full spectrum of anesthesia care in an office-based venue.
    [Show full text]
  • General Anesthesia in Dentistry R
    Review Article General anesthesia in dentistry R. Balaji1, M. Dhanraj2*, Arunasree Vadaguru Mallikarjuna2 ABSTRACT Dentistry, in its surgical and restorative aspect, is in majority based on office practice. Limited dentists work routinely in operation theaters. Majority of the dental procedures can be performed under local anesthesia which is inherently safe. Most dentists are skilled in techniques of local anesthetics and nerve blocks. General anesthesia should not be used as a method of anxiety control but for pain control. All general anesthetics are associated with some risk, and modern dentistry is based on the principle that all potentially painful treatment should be performed under local anesthesia, if at all possible. General anesthesia is strictly limited to those patients and clinical situations in which local anesthesia (with or without sedation) is not an option such as children or individuals with learning difficulties. This review elucidates the facts and importance of general anesthesia in dentistry. KEY WORDS: Anesthesia, Complication, Extraction, Sedation INTRODUCTION would otherwise be technically unfeasible. Three broad categories of anesthesia exist: Pain has always been linked to dentistry, representing a • General anesthesia suppresses central nervous persistent challenge to the employment of preventive, system activity and results in unconsciousness and restorative, and surgical dental practice.[1,2] It is total lack of sensation. accepted that various procedures in the dental clinic • Sedation suppresses the central nervous system cause pain such as deep dental fillings, root canal to a lesser degree, inhibiting both anxiety and therapy, tooth extraction and tooth preparation. Even creation of long-term memories without resulting when analgesics are used, painful sensations induced in unconsciousness.
    [Show full text]
  • Guideline on Use of Local Anesthesia for Pediatric Dental Patients
    rEfErence manual v 32 / No 6 10 / 11 Guideline on Use of Local Anesthesia for Pediatric Dental Patients Originating Council Council on Clinical Affairs Review Council Council on Clinical Affairs Adopted 2005 Revised 2009 Purpose tion and helps minimize complications (eg, hematoma, trismus, The American Academy of Pediatric Dentistry (AAPD) intends intravascular injection). Familiarity with the patient’s medical this guideline to help practitioners make decisions when using history is essential to decrease the risk of aggravating a medical local anesthesia to control pain in infants, children, adoles- condition while rendering dental care. Appropriate medical con- cents, and individuals with special health care needs during the sultation should be obtained when needed. delivery of oral health care. Many local anesthetic agents are available to facilitate man- agement of pain in the dental patient. There are 2 general types Methods of local anesthetic chemical formulations: (1) esters (eg, procaine, This revision included a new systematic literature search of the benzocaine, tetracaine); and (2) amides (eg, lidocaine, mepiva- MEDLINE/Pubmed electronic database using the following caine, prilocaine, articaine).3 Local anesthetics are vasodilators; parameters: Terms: dental anesthesia, dental local anesthesia, they eventually are absorbed into the circulation, where their and topical anesthesia; Field: all fields; Limits: within the last systemic effect is related directly to their blood plasma level.4 10 years, humans, English, and clinical trials. One thousand one Vasoconstrictors are added to local anesthetics to constrict blood hundred thirty articles matched these criteria. Papers for review vessels in the area of injection. This lowers the rate of absorption were chosen from this list and from references within selected of the local anesthetic into the blood stream, thereby lowering articles.
    [Show full text]
  • Comparison of Mixtures of Propofol-Remifentanil Vs
    Comparison of Mixtures of Propofol-Remifentanil vs. Propofol-Ketamine for Deep Sedation for Third Molar Extraction Surgery (IRB # 2009H0306) Thesis Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University By Kyle J. Kramer, D.D.S. Graduate Program in Dentistry The Ohio State University 2010 Master's Examination Committee: Dr. Steven Ganzberg, Advisor Dr. Simon Prior Dr. Bob Rashid Copyright by Kyle J. Kramer, D.D.S. 2010 Abstract The surgical extraction of third molars is a common dental procedure performed in conjunction with deep sedation for patient comfort. Dental anesthesia providers are constantly trying to better utilize current medications and techniques in order to facilitate a more comfortable and stable sedation experience with rapid recoveries for patients and surgeons. The combination of propofol and remifentanil, while not inexpensive or ideal, is often used because of the numerous advantages it provides. Ketamine is a unique drug that has several benefits not found with remifentanil. We performed this study to compare the combination of propofol-remifentanil with propofol-ketamine for deep sedation for surgical extraction of all four third molars. Patients were randomly assigned to one of two groups, each with 18 patients, and received deep sedation for the duration of the surgical procedure. In addition to evaluating emergence and recovery times, sedation parameters and hemodynamic and respiratory stability, we also assessed patient and surgeon satisfaction, incidence of postoperative nausea and vomiting, pre-emptive analgesia secondary to ketamine administration, presence of negative behavioral effects of ketamine and the cost analysis for each experimental drug for each group.
    [Show full text]
  • Do, Has, at I Longman & Aug 0 9 2~13 Walker I P.A
    iJUiJi us Ol 4~ 1 ON LEWIS DO, HAS, AT I LONGMAN & AUG 0 9 2~13 WALKER I P.A. ATTOR!'-Jt:YS AT LAW REPLY TO: TALLAHASSEE August 9, 2013 Susan Foster, Executive Director Board of Dentistry 4052 Bald Cypress Way, Bin C-08 Tallahassee, FL 32399-3258 Re: Proposed Rule 64B5-14.0038 (Direct Supervision of Qualified Anesthetist) Dear Ms. Foster: We represent the Florida Association of Nurse Anesthetists (FANA), an organization that represents more than 3,000 Certified Registered Nurse Anesthetists (CR.."NAs) licensed in Florida. F ANA is committed to ensuring the highest standards of anesthesia care and patient safety in all clinical settings. FANA would like to provide the following comments on the above-referenced proposed Rule. CRNA Record of Safety Our members object to the imposition of limitations to their practice, where anesthesiologists are not similarly limited. Under Rule 64B5-14.0032, which provides for the use of anesthesiologists in the dental office, the level of sedation is not restricted to the level of the permit held by the treating dentist. The rule will directly affect the practice of CRNAs as it creates an environment where it is more economical and convenient for a dentist to use the services of an anesthesiologist for general anesthesia, than it is to obtain the credentials necessary to use the services of a CRNA for general anesthesia (a practice specifically authorized under Florida law). As there is no practical difference between an anesthesiologist administering anesthesia and a CRNA administering anesthesia; the rule is arbitrary in this regard.
    [Show full text]
  • Effectiveness of Electronic Dental Anesthesia for Restorative Care In
    Effectivenessof electronic dental anesthesia for restorativecare in children Shiu-yinCho, BDS, FRACDS Bernadette K. Drummond, BDS,MS, PhD, FRACDS MichaelH. Anderson,BSc, MBChB, DipObs, Dip AV Med, Dip IH, MRNZCGPSheila Williams BSc(Hons) Abstract mission. The gate control theory states that activity Theeffectiveness of electronic dental anesthesia(EDA) generated by myelinated primary afferent fibers (the A fibers) inhibits the transmission of activity in the for pain control duringrestorative procedureswas compared with local anestheticinjection (LA) in 32 children aged small unmyelinatedprimary afferent fibers (the C fi- bers),6 acting via inhibitory circuits in the dorsal horn. to 12years. Eachchild selected had two antimereprimary In addition to activating local inhibitory circuits, one or permanentmolars requiring similar-sized Class I or Class II restorations.The pain levels duringrestorative treatment possible explanation for the effectiveness of TENSis that the electrical stimulationcauses release of pituitary wereassessed using a visual analoguescale. Heartrates and and hypothalamic opioid peptides into the systemic behaviorwere also recorded.A crossoverdesign was used with circulation or into the cerebrospinal fluid. 7 Another eachchild actingas his/her owncontrol. Theresults showed theory is that serotonin, dopamine,and nor-adrenalin, that overall, EDAwas less effective thanLA for cavity prepa- which may have roles in the effects of electrically ration. Thereported pain scores for EDAwere higher in per- produced analgesia, are produced.8 Drugs affecting manentteeth for the deepercavities, and with one of the these neurotransmitters have been shown to alter operators.The pre- or post-treatmentanxiety scores were not analgesia produced by stimulation or opioids. The foundto differ significantly betweenthe two restorativeap- exact mechanismof TENSremains unknownand may pointments.However, children with the highestpretreatment be a combinationof one or moreof the theories.
    [Show full text]
  • Dental Anesthesia Reference Number: CP.MP.61 Coding Implications Last Review Date: 03/21 Revision Log
    Clinical Policy: Dental Anesthesia Reference Number: CP.MP.61 Coding Implications Last Review Date: 03/21 Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Description Medical necessity guidelines for dental anesthesia in the inpatient or ambulatory surgery setting. Policy/Criteria I. It is the policy of health plans affiliated with Centene Corporation® that requests for general anesthesia or IV sedation in an inpatient setting or ambulatory surgery center when services are not available in the provider office are considered medically necessary when any of the following are met: A. Age younger than eight (8) years with a dental condition that requires repairs of significant complexity (e.g., multiple amalgam and/or resin-based composite restorations, pulpal therapy, extractions, or any combination of these or other dental procedures); or B. Exhibits physical, intellectual, or medically-compromised conditions, for which dental treatment under local anesthesia, with or without additional adjunctive techniques and modalities, cannot be expected to provide a humane and successful result and which, under general anesthesia, may be expected to produce a superior result; or C. Needs local anesthesia with dental treatment but the local anesthesia was or will be ineffective because of acute infection, anatomic variation, or allergy; or D. Is extremely uncooperative, fearful, anxious, or uncommunicative, with dental needs of such magnitude or that are so clinically apparent and functionally threatening to the well- being of the individual, that treatment should not be postponed or deferred, and the lack of treatment can be expected to result in dental or oral pain, infection, loss of teeth, or other increased oral or dental morbidity or mortality; or E.
    [Show full text]
  • Painful Realities: General Anesthesia Access in Sacramento Gmc Dental Managed Care
    PAINFUL REALITIES: GENERAL ANESTHESIA ACCESS IN SACRAMENTO GMC DENTAL MANAGED CARE June 2020 SACRAMENTO COUNTY ORAL HEALTH PROGRAM BARBARA AVED ASSOCIATES PREPARED FOR THE MEDI-CAL DENTAL ADVISORY COMMITTEE Sacramento County Oral Health Program Prepared by Barbara Aved Associates Funding for this study was made possible by California Department of Public Health Office of Oral Health To obtain additional copies of this report please contact: Sacramento County Department of Health Services Public Health Division 7001-A East Parkway, Suite 600 Sacramento, CA 95823 Phone: (916) 875-6259 TTY: (877) 835-2929 Website: www.scph.com 2 | Page TABLE OF CONTENTS “These families don’t return [to the dentist] as they feel embarrassed and judged and usually just wait until their special needs child is complaining of pain or some type of issue with the child’s teeth is visible.” — Alta CA Regional Center staff “Failure to accommodate patients with special health care needs could be considered discrimination and a violation of federal and/or state law.” — American Academy of Pediatric Dentistry EXECUTIVE SUMMARY .................................................................................................................... 4 INTRODUCTION ............................................................................................................................... 8 PROCESS AND DATA SOURCES ...................................................................................................... 10 Study design ............................................................................................................................
    [Show full text]
  • Pediatric Oral Health Pharmacologic Behavior
    PEDIATRIC ORAL HEALTH PHARMACOLOGIC BEHAVIOR MANAGEMENT FOR PEDIATRIC DENTAL TREATMENT Stephen Wilson DMD, MA, PhD Department of Pediatric Dentistry, The Ohio State University; and Advanced Pediatric Dentistry Residency Program, Columbus Children's Hospital, Columbus, Ohio Address reprint requests to Stephen Wilson, DMD, MA, PhD Advanced Pediatric Dentistry Residency Program The Ohio State University and Columbus Children's Hospital 700 Children's Drive Columbus, OH 43205-2696 e-mail: [email protected] Dental abnormalities, including dental caries and soft-tissue and hard-tissue anomalies, are common in children. Although the prevalence of dental caries in children has reportedly decreased over the past 5 decades, [17] [51] evidence suggests a disproportionate and alarming increase in the prevalence of caries involving primarily preschool-aged children of low socioeconomic class. [17] This subgroup is estimated to account for 25% to 50% of all carious lesions in children. This estimate is significant because children are most challenging for dentists in terms of management. The proportion of children requiring physical restraint or pharmacologic management during delivery of dental care is estimated at 10% to 25%. [42] [73] This type of management is indicated for several important reasons, including the technical complexity of the treatment, operative safety issues, pain control, and potential psychic trauma. Often, the dentistry required to restore carious teeth is technically complex and requires excellent patient cooperation. Even under optimal conditions with older cooperative patients, restorative techniques can be challenging for dentists when the desired outcome is excellent esthetics and freedom from discomfort. Several aspects of delivering dental care may be dangerous for clinicians and patients.
    [Show full text]
  • Education Department Adopts New Dental Anesthesia Regulations
    ATTORNEY ON LAW Education Department Adopts New Dental Anesthesia Regulations The regulations, seven years in the making, are longer and, in some cases, extraordinarily more specific than their predecessors. Lance Plunkett, J.D., LL.M. After seven years of working and rework- The new dental anesthesia practice requirements ing various draft proposals, the New York State are substantially changed as well, with an un- Education Department has finally approved new usual level of attention to detail now called for dental anesthesia regulations. The regulations by the regulations. were officially adopted on Dec. 28. They will be The dental anesthesia regulations are divided rolled out in two stages: changes to various defi- into four parts. They are: definitions; certification nitions and to dental anesthesia practice require- requirements; education and training require- ments will take effect on July 1, 2017; changes ments; and practice requirements. We will deal to dental anesthesia certification and to dental with them in the order they will take effect. anesthesia education and training requirements will take effect on Jan. 1, 2018. Dental Anesthesia Definitions – July 1, 2017 The changes are extensive; and the regula- The chief change to the definitions of dental an- tions are quite complex. This article will delve esthesia is the incorporation of the concept of into all of the nuances and specifics, so it is “moderate” sedation into the definition of “con- lengthy and bears saving as a future reference scious” sedation. Thus, the new definition of con- tool. Beware that it calls for close reading, though scious (moderate) sedation is: “a drug-induced not always easy reading.
    [Show full text]
  • Classifica-Tion of the Methods of Local Anesthesia and Special Features Of
    ISSN: 2469-5734 Petrikas et al. Int J Oral Dent Health 2019, 5:086 DOI: 10.23937/2469-5734/1510086 Volume 5 | Issue 2 International Journal of Open Access Oral and Dental Health REVIEW ARTICLE Classification of the Methods of Local Anesthesia and Special Features of Vascular-Diffuse Injection Petrikas AZ1*, Medvedev DV2, Yakupova LA2, Efimova OE2, Chestnyh EV2, Kulikova KV3 and Sazonova KA4 1Professor, Cathedra of Therapeutic Stomatology, Tver State Medical University, Russia 2Professor Assistant, Cathedra of Therapeutic Stomatology, Tver State Medical University, Russia 3 Check for Graduate Student, Cathedra of Therapeutic Stomatology, Tver State Medical University, Russia updates 4Student, Tver State Medical University, Russia *Corresponding author: Arnold Petrikas, DMSc, DMD, PhD, Professor, Cathedra of Therapeutic Stomatology, Tver State Medical University, 170100, Tver, Sovetskaya, Str 4, Russia Table 1: Modified classification of the methods of local Abstract anesthesia. The main feature of modern injection methods of dental anesthesia is in the local venous spreading of the Local anesthesia anesthetic in the near-toothed spongy substance of Diffuse Vascular-diffuse the bone and dental pulp. The vascular mechanism is Topical Intraosseous controlled by the epinephrine anesthetic solution and patient vegetal system. Spongy dental anesthesia is Conductive Intraligamentary universal, highly effective, relatively safe, easy to implement Infiltrative Intraseptal and increasingly widespread. Classification proposed by us is the division of injection methods of anesthesia into Intrapulparial traditional diffuse: Infiltrative and conductive, and diffuse- vascular: Intraosseous, intraligamentary, intraseptal and is to divide the methods of anesthesia into diffuse and intrapulparial. vascular-diffuse [5-7] (Table 1). Keywords Types of spongy anesthesia significantly differ from Dental anesthesia, Intravascular injection, Aspiration, In- traditional diffuse infiltration and conduction injec- traosseous anesthesia, Intraligamentous anesthesia, Epi- tions.
    [Show full text]