Stress reduction protocol in dentistry 2013
-
Upload
neil-pande -
Category
Health & Medicine
-
view
4.337 -
download
2
description
Transcript of Stress reduction protocol in dentistry 2013
Stress Reduction Protocol in Dentistry
Dr Neil PandeBDS MFGDP(UK) MFDS RCS(Eng)General Dental PractitionerKathmandu, Nepalwww.smilenepal.com
Stressa physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation
factors that tend to alter an existent equilibrium
Cause of 3/4 Medical Emergencies in Dentistry
Stages of Stress ResponseHans Selye
Stage 1: One of the Five senses sends stimuli to the brain
Stage 2: Brain analyzes it as a ‘Threat’ or ‘No Threat’
Stage 3: Body aroused until threat is over
Stage 4: Body returns to homeostasis (calm) once threat is gone.
Anxiety:StressRelease of epinephrine, nor-epinephrine
⬆ Heart Rate
⬆ Blood Flow
⬆ Respiration
Vasodilatation in the periphery (arms and legs)
⬆ Serum Glucose Level
Signs of Acute AnxietyCold, sweaty palms or forehead
Flushing of face
Altered facial expression such as bulging eyebrows
Dry mouth or increase in salivation
Bruxism or clenching of teeth
Increased need to urinate
Unnaturally stiff posture
Acute AnxietyInability to sit still
Trembling or tremors
Fiddling with items in his or her hands
“White-knuckle” syndrome
Tapping feet or fingers
Crying out or moaning
Hyperventilation, syncope, nausea, or vomiting
Increased respiration, blood pressure, and heart rate
Stress Reduction in Dentistry
Pre-Treatment Peri-Treatment Post-TreatmentMedical History
ASA PSAnxiety Reduction
MDAS
IatrosedationRelaxation TechMusic, Aroma,
Massage
Written Instructions
Analgesics
Proper Rest / DietTransportation
MedicationShort Morning Appointment
HypnosisAcupuncture
Local Anaesthetic followed by Topical
Follow-up Telephone
Referral, if needed
First ConsultationGet to know the patient
Try to befriend him/her
Thorough Medical History
Written
Verbal (Re-enforced)
Discuss likes and dislikes, acknowledge feelings
Empathy
Understand him/her well - it’s a long term affair...
Medical HistoryWritten, signed and verbal
Categorization as per ASA PS Score
ASA I A normal healthy patient
ASA II A patient with mild systemic disease
ASA III A patient with severe systemic disease
ASA IV A patient with severe systemic disease that is a constant threat to life
Check vitals
Communication
Let them talk
Be a good listener
Show interest in their conversation
At an eye level
Away from the equipment
ExaminationDo a thorough check-up including; examination of
Extra-oral: TMJ, Lymph Nodes, abnormalities (A gentle palpation of the area ensuring that you care.)
Intra-oral: Soft Tissues
Occlusion
Periodontal Tissues
Teeth
Diagnosis and Treatment PlanTry to find the cause of the problem and discuss with patient rather than just trying to pick up that handpiece...
Make a preventive programme for the patient
Make a comprehensive treatment plan in phases
Emergency
Stabilization
Maintenance
Definitive
Modified Dental Anxiety Scale MDAS
Helps us to recognize the level of anxiety in patients
Plan treatment accordingly
Anxious PatientShort Morning Appointment followed by a good morning breakfast
Pre-medication with Lorazepam 1mg (check interaction with other drugs) night before sleep followed by 90 minutes prior to procedure
No driving
Need to be accompanied by friend/relative/escort
Extremely short or no waiting time in the waiting area
During the treatmentDuration, only as much as patient can tolerate
Making sure patient feels he/she is in command
Better to have a short and simple procedure first to gain patient’s confidence
Pain free
Topical Gel
Local Anaesthetics with 30G needle, slow, warm
Iatrosedation
IatrosedationVocal
Music
Aroma
Massage
Hypnosis
Acupuncture
Relaxation Techniques
Deep Breathing
Guided Imagery
Progressive Relaxation
Vocal Sedation“I will be careful.”
“You may feel a slight sting.”
“I will make the area numb so that it is comfortable for both, you and me.”
“I will apply this strawberry surface anesthetic first and you will hardly feel anything.”
“I am slowly putting some solution inside so that you will not feel a thing.”
Vocal Sedation
Avoid “needle”, “hurt”, “sharp”
Talk to them as you go through the procedure.
It will make them feel more relaxed and compliant.
Post Treatment
Clear verbal and written instructions
Pain control medications
Phone number of the treating doctor (to call in case of emergency)
Protocol for referral if needed
Friend for life...
Relationship between a patient and a dentist is the one that is made for life.
Helping people in making their quality of life, better...
You treat patients well, and they will treat you well.
Respect is a 2 way street. You get what you give...
MDAS Scale
CAN YOU TELL US HOW ANXIOUS YOU GET, IF AT ALL,
WITH YOUR DENTAL VISIT?
PLEASE INDICATE BY INSERTING ‘X’ IN THE APPROPRIATE BOX
1. If you went to your Dentist for TREATMENT TOMORROW, how would you feel?
Not Anxious
Slightly Anxious
Fairly Anxious
Very Anxious
Extremely Anxious
Not Anxious
Slightly Anxious
Fairly Anxious
Very Anxious
Extremely Anxious
2. If you were sitting in the WAITING ROOM (waiting for treatment), how would you feel?
3. If you were about to have a TOOTH DRILLED, how would you feel?
4. If you were about to have your TEETH SCALED AND POLISHED, how would you feel?
5. If you were about to have a LOCAL ANAESTHETIC INJECTION in your gum, above an upper back tooth, how
would you feel?
Not Anxious ☐
Slightly Anxious ☐
Fairly Anxious ☐
Very Anxious ☐
Extremely Anxious ☐
Not Anxious ☐
Slightly Anxious ☐
Fairly Anxious ☐
Very Anxious ☐
Extremely Anxious ☐
Not Anxious ☐
Slightly Anxious ☐
Fairly Anxious ☐
Very Anxious ☐
Extremely Anxious ☐
Instructions for scoringThe Modified Dental Anxiety Scale. Each item scored as follows:
Not anxious = 1
Slightly anxious = 2
Fairly anxious = 3
Very anxious = 4
Extremely anxious = 5
Total score is a sum of all five items, range 5 to 25: Cut off is 19 or above which indicates a highly dentally anxious patient, possibly dentally phobic.