hand book for dental surgeons - Indian Dental Association ...

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Hand book for dental surgeons on dental management of persons with hemophilia and other haemostatic disorders
Nitrous oxide analgesia for the handicapped child should be limited to the stage of relative analgesia, by the use
of relatively low nitrous oxide and high oxygen flows, safely below the excitement level. The major purpose of
a relative analgesia level is torelance the patient and increase his cooperation. During the most painful periods
of the dental treatment, this analgeis level can be supplemented by the use of local anesthesia when the patientís
condition permits.
Careful consideration and management of the introduction of nitrous oxide analgesia and its initial
administration to the handicapped child are the governing factors for a successful utilization of the procedure.
For most handicapped children, premedication is needed to allay the apprehension that frequently accompanies
their first experience with analgesia. The attending physician should be consulted regarding the choice of durg
therapy for each patient.
Particular patience and understanding is imperative at the initial administration of
nitrous oxide analgesia. The child must have time to adjust to this new experience, the use of the nosepiece
should be demonstrated and the flow of gases can be played on the childís hands and cheeks before placement
of the nosepiece. Resistence may be countered with gentle physical restraint and flow of 50 percent nitrous
oxide directed close to the nostrils. This mixture may have a mild euphoric effect and relax the patient
sufficiently to permit seating of the nosepiece, after which the concentration of nitrous oxide should be reduced
to the appropriate level, usually a 10 to 15 percent flow.
Since verbal communication with the handicapped child is frequently difficult and unreliable, the dentist
must be able to evaluate the level of analgesia from the physical and behavioural changes in the patient. When
the appropriate level of analgesia has been reached. The dentist can begin the treatment. Operative procedures
in these cases vary little from those routinely employed. the rubber dam and a mouth prop are helpful; however,
it is important to remember that the use of the rubber dam lessens the dilution effect created when the mouth is
open, thereby necessitating a decrease in the proportion of nitrous oxide.
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Hand book for dental surgeons on dental management of persons with hemophilia and other haemostatic disorders