Case No. 20: RA for endo. in a 14 yr old

Today I undertook an endo treatment for a 14 yr old in an upper 2nd pre-molar. She has been a patient since she was about 5. She is a very pleasant young lady who is just a tad over-protected and is at the awkward teenage stage.During her fixed ortho. (Carried out on referral to an orthodontist) she dropped out of regular attendance and re-appeared with pulpitis from a deeply carious cavity a few weeks ago.

I used RA then to undertake a vital pulpotomy without problems. On titration, she took a little longer to become adequately sedated and a slightly higher % of N2O than I would have guessed. However this first session gave us a datum level to work at for the next session. She returned today for the Endo at UR5.

We quickly established sedation at the previous O2/N2O level. During induction, topical was applied and once sedated, the LA was given with no response from her. We waited a few minutes, applied a rubber Dam and the endo was completed without any reaction from her at any time. This included application of rubber dam clamp, Hawe- Neos clear Matrix and a wedge to complete a composite filling with a glass ionomer base.

The composite was placed with a compression instrument to achieve a good contact. On removal of the rubber dam clamp I noted it had compressed the unanaesthetised palatal gingival margin somewhat. Again this had elicited no response from her and will recover quickly I am sure. 2 intra-oral peri-apical films were taken with digital sensors and holders, which are generally quite uncomfortable for many, again without reaction from her.

RA can achieve this for you and your patients too!

Case No 19 Extns in a heavy smoking diabetic

One of today's RA cases has been an irregular attender over a number of years.
He is a nice chap, but with poor dental health. A teacher aged about 55 and a heavy pipe smoker (an inhaler). He sounds "chesty". 2 years ago he was diagnosed diabetic, (controlled with oral mediaction). He Required a clearance of his remaining severely periodontally compromised upper teeth. (5 of them) and fitting a F/- Immediate denture.

Implants are not an option for him. He has had RA before but asked about IV sedation. I did explain the small risk with IVS due to his restricted lung capacity possibly resulting in a rapid drop in SaO2 as his breathing slows and becomes shallower. Also a possible, but difficult to quantify, risk of blood glucose levels being adversely affected. So he happily agreed that with the high level of oxygenation available with RA, that this would be his preferred option.The whole procedure was completed without any problems – Oh and the denture looks great too!

Case No.18THE perfect advert for Relative Analgesia!

Today I was back on on cloud nine, never mind the patient. I completed a case that would have been THE perfect advert for Relative Analgesia

A young girl of 11/12 yrs of age required the extraction of 6 deciduous teeth for ortho.All were moderately firm. They were:

Upper e/cde and

lower e/e

She is a "bit of a madam" and came into the surgery with Mum, who is a sensible type." Is this going to hurt?” she says........... You get the picture! After a little banter careful explanation and reassurance she easily accepted the nasal mask.Then, under the influence of RA, titrated, in her case to 50% N2O: 50% O2 (remember every case is different) she became very well sedated. Topical was applied during the induction on CWRs to all 4 quadrants. Mother was happy to leave the room at this point.

Buccal infiltrations for all 4 quadrants plus lingual infiltrations for lower e/e plus bilateral palatal infiltrations for the upper teeth and not a murmur or a blink from her. (Yes, that is 8 x LA injections).All gingival margins probed to ensure adequate LA and all extns. carried out without so much as twitch from her.Recovery, as always was swift, mother returned to the surgery during O2 recovery phase and she left the surgery 31 minutes after entering.

Brilliant, it really made my day. I only wish I had video'd the case. There will be others.

Welcome to the Case History Section

Just three more cases to upload to this site to make the promised 20 !

Case No 17. A True Dental Phobic

Earlier this week I saw a adult male patient with extreme anxiety, verging on a true phobia. I had seen him only once before when he attended with an abscess arising from a previously root-filled LL3 (#33) about 18 months ago. On that occasion we treated him under IV Midazolam and re-treated the tooth, which has been symptomless since.

He arrived, perspiring profusely through fear, though he is otherwise an entirely pleasant chap, he has had a very adverse previous dental experience(s) as a child. His hair and shirt were soaked before he sat in the dental chair ! On this occasion, he was unaccompanied, had a mechanical # of the ML cusp of LR6 ( #46) and had gross supragingival calculus and staining anteriorly. Oh yes , and he was getting married in a few days time!

Isn't it always the way !

After all the necessary explanations and duly signing a consent form, we were able to administer RA ( inhalational sedation) there and then, provide a temporary dressing and using an ultrasonic scaler, smarten him up for his wedding. He may well not permit more than this level of treatment without I.V. sedation. This remains to be seen in the future.

This case illustrates nicely, 3 key benefits of Relative Analgesia.

• It can be used "in an emergency" situation when an escort is unavailable.
  
• In some cases it can be used to allow simple palliative treatment in otherwise fearful patients, pending an IV session at a later date.
  
• That patients who get used to IV as a sedation method, never conquer their fear, since they have little recall of the fact that the dentistry could have been or was pain free. They may well become indefinately dependant on IV sedation.

Legal and Copyright notice

Thank you for taking the time to read this RA "Blog" website. Are you convinced of the benefits yet? If you feel that you would like to be able to offer RA to your patients, please contact me for details of my Hands-on RA training courses.

Copyright © 2003 all rights reserved.

Richard Charon is a Dental Practitioner serving Dental Practitioners in their desire to provide the benefits Relative Analgesia (Inhalational Sedation) to their patients. His One day Hands-on teaching courses are currently delivered from his Private Dental Practice at St. Mary’s House Dental Practice, Newbury, Berkshire SL6 6HF.

You may copy or distribute “RA Today “as long as this copyright notice and full information about contacting the author are attached. The author is: Dr.Richard Charon Contact him at richard.charon@ntlworld.com or at St. Mary’s House Dental Practice, Newbury, Berkshire SL6 6HF. Tel: 01635 47757 Please forward this e-newsletter to your friends and colleagues.

Your recommendation is how we grow awareness of our one-day Hands-on RA course. To change or cancel your email address, e-mail me directly at richard.charon@ntlworld.com We will never release, sell or give a subscriber's name or email address to any other party or organisation. Course attendees or those making enquiries will only receive email messages that contain requested information, new articles or newsletters or announcements of new services

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Cases 15 & 16- Two Anecdotes

These next two are really short anecdotes. Both involving the use of Relative Analgesia for children.

Case 15

This youngster was one of my RA Course demonstration cases, who attended with her mother last Saturday and whose treatment under RA was video- relayed to my course participants. She is a small 7 1/2 year old who has had several restorations from the age of about 5 with Relative Analgesia (RA) and LA. Towards the end of her 20 minutes session (to place a medium sized Glass ionomer in LRd with LA ), I told her she was " breathing fresh air now" and that she "would soon be on her way home". She said she didn't want to go home because the happy air was fun and she went on to tell me that " I am the only one in my class who likes going to the dentist. I think I want to be a dentist when I grow up"! Mother was delighted at the result and quite rightly very proud her offspring too.

and in a similar vein ( no pun intended)

Case 16

We saw a thirteen year old with retained , though moderately mobile upper Es today for routine examination. Both teeth has small distal cavities which required temporary fillings to await their exfoliation in the next few months. I bgan to remove her breakfast from these areas and she asked if she could have Relative Analgesia (RA), to which I replied that there was really no need this time for sedation. " Well then can't you take them out, then I can have the happy air" she said.

Children volunteering for extractions ?!

Needless to say she didn't get her wish but left cheerfully anyway !

Relative Analgesia (RA) is a practice builder - you'd better believe it !