What do they say??

3. What do they say?? Too embarrassed He didn’t listen/stop Pain Noises Smells Panic attacks Being judged Too busy

4. WHAT IS SEDATION? • 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

5. Who Should Be Sedated Anxious and Phobic Patients Embarrassed Patients Gaggers Time Oriented Patients

6. What Patients Can Expect • Diminished anxiety • No pain • Diminished memory • Less gagging

7. ASA Physical Status Classification SystemASA1Normal healthy patient ASA 2 Patient with mild systemic disease can walk up one flight of stairs but must rest at completion Patients with mild systemic disease Mild hypertension Well controlled diabetes Well controlled asthma

8. ASA 3 • 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

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

11. Routes of Administration • INHALATION • 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,)

12. PHARMACOLOGY OF SEDATION • NITROUS OXIDE • BENZODIAZEPINES • DIAZEPAM • TRIAZOLAM • LORAZEPAM • VERSED po • IV VERSED

16. RELAXED BUT RESPONDS

17. What Can Be Done?

21. What Can be Accomplished for the HYGIENE PATIENT • Surgical hygiene • Non surgical hygiene • Examinations • Initial treatment • Irrigation • Scaling • Root debridement

22. The Sedated Hygiene Patient • There must be non sedated visits with the hygienist to: • Review oral home care • begin medications • Antibiotics • antimicrobials • disclose and show patient where they need to improve home care

23. COMPLETE PERIO CHARTING • POCKET DEPHTHS • 6 sites • RECESSION • MOBILITY • BIFURCATIONS • BLEEDING SITES

26. TOTAL THE NUMBER OF: • BLEEDING SITES • POCKETS >4MM • TEETH INVOLVED IN DISEASE

27. ROOT DEBRIDEMENTS • Divide the number of teeth involved By three or four depending on pocket depths to get the number of root debridements visits Schedule 10 minutes for each tooth

34. LASER ACRONYM LIGHT AMPLIFICATION BY STIMULATED EMISSION OF RADIATION

35. SUCULAR DEBRIDEMENT removes infected pocket lining Reduce the bacterial count in the soft tissue APTHOUS ULCER HERPETIC LESIONS TISSUE ABLATION (vaporization) LASER IN HYGIENE

36. ADVANTAGES TO LASER THERAPY • BETTER TISSUE RESPONSE • VAPORIZE BACTERIA • REDUCED NEED FOR LOCAL ANESTHESIA • DECREASED POST OP DISCOMFORT • DECREASE IN TISSUE TRAUMA • CONSERVES HEALTHY TISSUE

37. Hygiene Protocol Non sedation instructional Sedation: Root debride Laser therapy Irrigate Non sedation monitoring Sedation definitive treatment

38. INSTRUCTIONAL VISIT • DISCLOSE • PLAQUE CONTROL • PERSCRIPTIONS • CHLORHEXADINE • ANTIBIOTICS • SEDATION MEDS • HEALTH HISTORY AND BLOOD PRESSURE

39. THE SEDATION VISIT • ROOT DEBRIDEMENT THERAPY • LASER THERAPY • IRRIGATION • SCALE AND POLISH HEALTHY TEETH • ARESTIN

40. PMA(periodontal maintenance apt) • DISCLOSE AND DISCUSS • DO NOT PROBE • RE-ENFORCE THE SEDATION VISIT

41. DEFINITIVE THERAPY • REPROBE ALL AREAS • RETREAT THE AREAS OF DISEASE • LASER ALL POCKETS • RETREAT THE HEALTHY TEETH • IRRIGATE • PLACE ARESTIN • CLOSYS 2 RINSE AND TOOTHPASTE

42. Supportive Periodontal Therapy( 8 TO 12 WEEKS) • Disclose and review hygiene • Ultrasonic debridement • Relaser pocket sites on bacteria vaporization setting • Irrigate with antimicrobials • Polish

43. LASER USES • ABILITY TO SEAL BLOOD VESSELS • SEAL LYMPHATIC VESSELS • REDUCES BACTERIA COUNT FOR 60 DAYS (HEALING TAKES 35-40 DAYS) • Facilitate access to root surface by – de-epithelialize the tissue lining • REDUCES MECHANICAL TRAUMA

44. APHTHOUS ULCERS • No contact between tissue and fiber • Maintain a distance of 1- 2 mm • 30 sec. in a circular motion at .4 watts • 10 sec cool down • Repeat 30 sec at .5 watts • 10 sec cool down • Repeat 30 sec at .6 watts

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.

46. LASER TECHNIQUE • Fiber parallel to the root surface or slightly tipped toward the gingival surface in order to maximize ablation. • Fiber kept in contact with epithelium • Horizontal and vertical direction • Debride all granulation tissue • 30 sec for 4&5 mm pockets • 45 sec for 6 and above • No contraindications

47. ACADEMY OF LASER DENTISTRY

48. STANDARD PROFICIENCY • ADVANCED PROFICIENCY • EDUCATOR STATUS

49. ADVANCED HYGIENE CONCEPTS 800.400. 6772