ADSA/NDBA Abstracts

Abstract

Ahmed M, Martinez HRThis poster presents a new graph that easily allows the dental practitioner to determine the child's maximum local anesthetic dosage in milliliters (cartridges) based on his or her weight. Local anesthesia is used daily in dentistry to manage pain, and different kinds of agents available in the market may be selected, depending on the strength and duration of anesthesia required. Each anesthetic agent has a maximum recommended dose, and it is very important to calculate the maximum recommended dose, especially in children. This will avoid the risk of toxicity that could lead to death. Currently the series of calculations used to determine the maximum recommended dose for local anesthetics is often perceived as taxing and difficult to understand. This presentation offers a newly developed recommended dose technique that may be easier for the practitioner to use in clinical practice. Dentists can utilize this graph to obtain the maximum allowed dose and, most important, decrease or eliminate the risks of toxicity and overdose, especially when treating small children.Flores J, Moore PA, Boynes SGA mail survey of 2003–2007 dental school graduates was undertaken by the Department of Anesthesiology at the University of Pittsburgh School of Dental Medicine to assess the strengths and weaknesses of the predoctoral curriculum in anesthesia, and to determine the preparedness of practicing dentists to provide anesthesia services for their dental patients. Subsets of the survey responses were created to specifically evaluate the effectiveness of an advanced selective program in sedation offered to approximately 20 third and fourth year predoctoral students. This 14-month “Anesthesia Selective” provides advanced didactic instruction and clinical experiences needed to establish competency in mild to moderate sedation. Overall, graduates reported being best prepared in assessment of medical histories, physiology, and pharmacology while being least prepared in oral sedation, intravenous sedation, and general anesthesia. Among graduates currently in general practice, those who had participated in the Anesthesia Selective program reported that they were better prepared in most subjects related to anesthesia and patient care. Participants in the Selective also were more likely to treat special needs patients in their private practices. Respondents' written comments indicated a desire for a greater number of clinical experiences involving sedation procedures within the predoctoral curriculum. This outcome assessment indicated that a greater emphasis should be placed on instruction and training experiences for enteral sedation within the predoctoral dental curriculum. Advanced training and increased clinical experiences in anesthesia may be effective means to better prepare graduates to assess medical histories, to manage medical emergencies, and to be willing to treat medically complex patients, as well as patients with special health care needs.Massaro C, Haber-Cohen HMany techniques learned in dental school are administered for the first time to patients. This process can be particularly stressful for the dental student, because no matter how capable or knowledge-based the student may be in a particular concept, the first administration of a technique is a huge challenge. A key example in the dental student's education is administering the first inferior alveolar block, which creates an enormous amount of fear for the student. However, a clinical education model that appears to have an effect on students involved in this process is the following: In conjunction with didactic lectures in technique, pharmacology, and possible complications, Temple Dental sophomore students pair up to deliver and receive these injections. A senior student directly supervises each sophomore couple. Faculty members are present and circulating throughout the l0-chair clinic as 20 students per 1-hour session are shepherded through this process. The same configuration is used for first-time administration of nitrous oxide sedation. In this way, 120 students (Temple University Dental School sophomore class) are given the opportunity to overcome these hurdles in 6 sessions. This type of clinical education model provides the following impact: Greater reduction in anxiety is seen in sophomore students when senior students are used as the first tier of instruction. Identification between sophomores and seniors is greater because they realize that they are only 2 years apart in training. This results in less tension for the sophomores, because they are spared the perceived embarrassment of appearing inept in front of faculty and patients. This clinical education model has been very successful for students and faculty. A quantifiable measure of success is the drop in student syncopal episodes. Currently 0 to 1 event occurs per course, as opposed to 5 to 8 events that occurred previously.Rashewsky S, Jesin ML, Levine LMajor depression is one of the most common psychiatric illnesses, with a lifetime prevalence in the United States of 12% in men and 20% in women, respectively. Dental patients often have preexisting psychiatric illnesses, and a range of psychosocial problems may be evident in the perioperative period. According to research, patients with preexisting psychological issues are more likely to have postoperative psychological complications; furthermore, those individuals with postoperative physical complications are more likely to simultaneously experience psychological complications. Despite the prevalence of patients on psychotropic medications, little literature is available on the anesthetic management of the dental outpatient, specifically regarding drug interactions and treatment recommendations. The aim of this project was to conduct a systematic literature review to assess the current state of knowledge on the anesthetic management of the dental outpatient, including evaluating the prevalence of psychotropic use in dental patients, understanding drug interactions and safety concerns, and, finally, making recommendations for anesthetic management in the dental outpatient. Most of the literature on psychiatric problems in the dental outpatient is anecdotal or incomplete. Little agreement has been reached on the anesthetic management of the dental outpatient using psychotropic medications. In an attempt to be more scientific than anecdotal, this project aims to use the current literature to understand the main psychiatric problems afflicting dental patients, to review the interactions of psychotropic medications and anesthesia during the perioperative period, and to make recommendations for the delivery of safe office-based ambulatory anesthesia. Ultimately, we would like to create definitive guidelines for anesthetic management of the dental outpatient as a resource for dental professionals, thereby minimizing risks and potential complications.Bastin M, Zovko J, Grillo MA, Shingledecker B, Boynes SGThe goal of this assessment was to investigate educational experiences and the use of local anesthesia by dental hygiene providers in the United States. Undertaken from February to May of 2009 and approved by the Institutional Review Board at the University of Pittsburgh, this study was designed by using a questionnaire-based survey. With the use of a randomized list obtained via the American Dental Hygiene Association (ADHA), survey questionnaires were sent via direct mail to 1200 dental hygienists in the United States. Quantitative evaluations were confined to standard summation, an estimation of means, and a valid percent for identified variables. A total of 432 (n = 432) of the 1200 survey questionnaires were returned, which represents a 36.0 percent response rate. Respondents represented a total of 296 dental hygiene training programs and included practice sites that span all 50 United States. Findings indicate that most responding dental hygienists administer local anesthetic injections and perceive a need for use of this modality in their practice. Additionally, most of the respondents who administer local anesthetic injections reported that they perform local anesthetic administration for cases in which the dentist provides total care. Furthermore, results revealed that hygienists who received training in the administration of local anesthesia injections reported a higher rate of educational preparedness in 6 of the 7 educational topics listed in this survey: local anesthesia–related topics (local anesthesia administration, local anesthetic pharmacology, and local anesthetic complications), basic pharmacology, medical emergency management, and special needs care. This examination parallels the results presented in previous studies while offering new data related to local anesthesia administration by hygienists. With the majority of dental hygienists reporting use of and a perceived need for this modality, this practice appears to represent a significant addition to overall dental care and dental hygiene education.Crawford B, Thikkurissy S, Smiley MKThe purpose of this study was to examine the relationship between passive tobacco exposure (PSE) and airway complications during dental rehabilitation of early childhood caries with patients under general anesthesia. Subjects 19 months to 12 years old were randomly selected in this IRB-approved double-blind study. Medical histories significant for asthma, recent upper respiratory infection, or other conditions affecting airway reactivity were excluded. Parents were given a questionnaire preoperatively so they could assess the child's PSE level. General anesthesia was induced in a standard manner, and all children were nasally intubated. Children were then evaluated throughout the course of the surgical stay for laryngospasm, hypersecretion, bronchospasm, breath holding, and coughing by a dentist anesthesiologist (DA) and a PACU recovery nurse (RN), both blinded to the child's PSE status. Categorical variables were analyzed using the Fisher Exact Test, as were continuous variables using a 2-tailed t test. Data from 100 children (47 female and 53 male) were analyzed. Children were divided into PSE (+) and PSE (−) cohorts. The overall mean age of children was 63.3 months (±25.6), with the PSE (+) cohort significantly older (P = .034). No significant difference in the amount of time spent at home versus at daycare was observed between the 2 cohorts (P = .27). Overall, 52% of primary caregivers smoked, with 36% smoking 10 to 30 cigarettes daily. Mean length of surgery and recovery was 104 minutes (±34 min), and a mean of 9.2 carious teeth were charted (±4.5). No statistically significant differences were noted upon observation of the DA or RN of breath holding, coughing, laryngospasm, or bronchospasm. PSE does not increase pediatric airway morbidity in healthy children during or immediately following general anesthesia to treat early childhood caries.