Moderate Sedation and Emergency Medicine for Periodontists

Preface
Contents
1: Principles and the Development of Sedation in Dentistry
	1.1	 It All Began with Nitrous Oxide
	1.2	 Intravenous Anesthesia
	References
2: Sedation in Dental Practice
	2.1	 Nature of Pain
	2.2	 Fear and Anxiety
	2.3	 Spectrum of Pain Control
	2.4	 Cardiovascular Stress Response (Fig. 2.4)
	2.5	 Objectives of Moderate Sedation (Fig. 2.5)
	2.6	 Indications and Contraindications (Fig. 2.7)
	2.7	 Definitions
		2.7.1	 Minimal Sedation
		2.7.2	 Minimal Sedation via the Enteral Route
		2.7.3	 Moderate Sedation
		2.7.4	 Deep Sedation
		2.7.5	 General Anesthesia
	References
3: Preanesthetic Evaluation for Periodontal Sedation
	3.1	 Components of a Preanesthetic Evaluation
	3.2	 Review of Systems
		3.2.1	 Cardiovascular System
			3.2.1.1	 Cardiac Testing
			3.2.1.2	 Treatment Considerations
		3.2.2	 Respiratory System
			3.2.2.1	 Preoperative Testing
			3.2.2.2	 Treatment Considerations
		3.2.3	 Diabetes Mellitus
			3.2.3.1	 Preoperative Testing
			3.2.3.2	 Treatment Considerations
		3.2.4	 Neurological and Developmental Disorders
			3.2.4.1	 Motor Neuron Disease
				Treatment Considerations
			3.2.4.2	 Parkinson’s Disease
				Treatment Considerations
			3.2.4.3	 Myasthenia Gravis
				Treatment Considerations
			3.2.4.4	 Muscular Dystrophy
				Treatment Considerations
			3.2.4.5	 Cerebral Palsy
				Treatment Considerations
			3.2.4.6	 Seizure Disorders
				Treatment Considerations
			3.2.4.7	 Down Syndrome
				Treatment Considerations
	References
4: Drugs Suitable for Moderate Periodontal Sedation
	4.1	 Opioids
		4.1.1	 Adverse Effects
		4.1.2	 Tolerance and Opioid-Induced Hyperalgesia
		4.1.3	 Useful Opioids for Moderate Sedation
			4.1.3.1	 Fentanyl
			4.1.3.2	 Sufentanil
			4.1.3.3	 Alfentanil
	4.2	 Benzodiazepines
		4.2.1	 Precautions for Use
		4.2.2	 Useful Benzodiazepines for Moderate Sedation
			4.2.2.1	 Diazepam
			4.2.2.2	 Midazolam
	4.3	 Alpha-2 Adrenergic Receptor Agonists
		4.3.1	 Dexmedetomidine
	4.4	 Moderate Sedation Technique
	References
5: Periodontal Airway Management Strategies
	5.1	 Preoperative Airway Evaluation
	5.2	 Airway Management
	5.3	 Difficult Mask Ventilation and Airway Considerations in Obesity
	5.4	 Key Point to Remember
	References
6: Monitoring During Periodontal Sedation
	6.1	 Monitoring Consciousness
	6.2	 Monitoring Respiratory Function
		6.2.1	 Monitoring Oxygenation
		6.2.2	 Monitoring Ventilation
			6.2.2.1	 Visual Assessment
			6.2.2.2	 Pretracheal Stethoscope
			6.2.2.3	 Capnography
	6.3	 Monitoring Circulation
	Reference
7: Emergency Medicine for Periodontists
	7.1	 Airway Complications
		7.1.1	 Obstruction
		7.1.2	 Laryngospasm
		7.1.3	 Bronchospasm
		7.1.4	 Negative-Pressure Pulmonary Edema
		7.1.5	 Emesis/Aspiration
	7.2	 Cardiovascular Complications
		7.2.1	 Hypertension
		7.2.2	 Hypotension
		7.2.3	 Dysrhythmias
		7.2.4	 Acute Coronary Syndromes
		7.2.5	 Stroke
	7.3	 Miscellaneous Complications
		7.3.1	 Delayed Awakening and Readiness for Discharge
		7.3.2	 Local Anesthetic Toxicity
	References
8: Curricular Development and Training Requirements for Periodontal Sedation
	8.1	 Moderate Sedation for Periodontal Residents
		8.1.1	 Course Syllabus
			8.1.1.1	 Course Description
			8.1.1.2	 Course Objectives
				Semester 1
				Semester 2
				Laboratory Exercises
				Competency and Permit Requirements
	References