Sedation for patients with movement disorders

Quality of dental treatments under intravenous sedation among patients with disability: A self-matching study

Background/purpose

Patients with disabilities usually have difficulties in communication and mobility, and the quality of the dental treatments are often inferior. This study uses the Taiwan National Health Insurance Database to analyze the quality of dental treatment for patients with disabilities who receive intravenous sedation (IVS).

Materials and methods

This study selected patients with disabilities who received dental treatment under IVS. Their oral cavity was divided into three major sections: anterior teeth, upper posterior teeth, and lower posterior teeth. Self-matching of the same section was conducted to observe whether operative dental treatment (OD) with or without IVS affected the occurrence of dental retreatment. This study observed the occurrence of refilling and the duration from the end of treatment until retreatment to compare treatment differences with or without IVS.

Results

After self-matching, this study found 158 patients who received dental treatment within the same section with and without IVS. During a follow-up period of 17 years, 75.18% of the patients who received OD treatment required refilling, 10.87% required endodontic treatment, and 5.67% required tooth extraction. After OD treatment with IVS, the risks of refilling, endodontic treatment, and tooth extraction were 0.71 (95% CI: 0.58-0.87, P < 0.001), 0.77 (95% CI: 0.48-1.23, P = 0.28), and 0.64 (95% CI: 0.32-1.27, P = 0.20), respectively.

Conclusion

For patients with disabilities, OD treatment with IVS significantly reduces the risk of refilling compared with OD treatment without IVS. IVS can be ideal for people with disabilities who receive dental treatment.

Sedation or General Anaesthetic for Special Care Patients?

When faced with an anxious patient with complex needs who requires dental care, it can be difficult to decide on the most appropriate method to manage their pain and anxiety. There are a range of conscious sedation techniques that may be used, and on some occasions, general anaesthesia may be required. This paper describes the methods available and the factors influencing the decision-making process. The general dental practitioner (GDP) may not be able to offer care in their setting, but knowing more about the decision-making process and the information required to make that decision can help them guide patients and their families.

Conscious sedation service for geriatric and special-care dentistry: A health policy brief

Background:

Geriatric and special care dentistry (GSD) involves oral health care for seniors and individuals with disabilities. Due to ethical issues, finances, waiting times, treatment versatility and so on, conscious sedation (CS) may have a place to optimise the delivery of care.

Objectives:

This article identifies considerations for implementing CS in GSD services in Singapore.

Methods:

Taking the form of a health policy brief, this review (a) defines the situation for patients with special-care needs and justified the need for dental CS, (b) makes reference to practices from countries with established dental CS services, (c) states and evaluates available CS techniques for the GSD centre in Singapore and (d) discusses action plans and considerations for implementation.

Results:

Demographic analysis revealed that 23.8% of the GSD patients could have benefitted from CS, or 44.7% of all patients who required behavioural management. The key advantages of CS included enhanced safety, more teeth saved and a reduction in general anaesthesia wait, amongst others. Conventional dental CS techniques included midazolam via various routes, nitrous oxide and ketamine. To establish a CS service, key points of consideration need to be conceptualised first, such as adequate training, perception of patients and providers, operational costs, facilities and developing guidance specific for oral health professionals.

Conclusion:

A local CS service will be beneficial for GSD patients in view of the challenges faced. A group of experts and stakeholders is needed to provide practical consensus.

Orthodontic management of a patient with cerebral palsy: six years follow-up

AIM

Cerebral palsy (CP) is a disorder that affects muscle tone, movement and motor skills. CP can also lead to other health issues, including vision, hearing and speech problems, as well as learning disabilities and dental problems. A case report describing the successful orthodontic treatment of a 10-year-old boy with the dyskinesia type of CP and severe malocclusion is presented.

MATERIALS AND METHODS

A 10-year and 2-month old boy was presented by his parents for orthodontic treatment, complaining of his unsatisfactory occlusion and poor chewing efficacy. An extraoral examination showed a convex profle. An intraoral examination showed the patient to be in mixed dentition with a class II molar relationship, 10 mm overjet and 4 mm overbite. In addition, his maxillary and mandibular arches were severely crowded. Cephalometric analysis indicated a severe skeletal class II discrepancy, which was confrmed by an ANB of 12°. The frst phase of treatment involved the use of twin blocks with a headgear tube to attempt some growth modification and reduce the overjet. Once it was clear that the appliance was being well tolerated and the oral hygiene was satisfactory, the fxed appliance was used.

RESULTS

Because of the good participation of the patient and his parents, orthodontic treatment was successful in the patient, achieving a normal overjet in combination with successful orofacial therapy.

CONCLUSION

As demonstrated in our case report, the success of the treatment was dependent on the cooperation of the patient and his parents. Furthermore, this case illustrates the importance of the treatment by a dental team in patients with CP.