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Abstract(s)
O comportamento das crianças na consulta de Odontopediatria é muitas vezes imprevisível, o que dificulta a atuação do médico-dentista e o respetivo tratamento dentário.
Existem várias técnicas de controlo de comportamento que foram desenvolvidas com o objetivo de dar resposta a estes casos, nomeadamente não farmacológicas, tais como as técnicas de comunicação e as técnicas de modificação da conduta. Contudo, por vezes, estas revelam-se insuficientes levando o médico-dentista a recorrer a métodos farmacológicos como agentes sedantes, analgésicos e outros fármacos com ação no controlo da dor, medo e ansiedade.
A sedação moderada tem demonstrado ser um importante auxiliar no tratamento dentário de crianças com um certo grau de ansiedade e medo, bem como de pacientes especiais com incapacidades físicas ou mentais. Trata-se de uma técnica eficaz e segura, alternativa à anestesia geral, na qual o paciente se encontra moderadamente sedado, mantendo alguma colaboração e conseguindo responder a estimulação física e comando verbal, permitindo ao profissional a execução de um plano de tratamento dentário.
A sedação consciente envolve uma diversidade de técnicas e de agentes farmacológicos, como o uso de óxido nitroso e de outros fármacos, como as benzodiazepinas. O plano de tratamento para cada caso clínico vai depender de uma meticulosa análise à história médica pregressa e atual do paciente, à respetiva necessidade individual e à relação custo-benefício de todo o procedimento.
O objetivo deste trabalho é apresentar uma revisão da literatura visando descrever os diferentes métodos de sedação utilizados no tratamento dentário em pacientes odontopediátricos e com necessidades especiais, dando maior relevância à sedação moderada endovenosa. Agentes farmacológicos selecionados para as diferentes técnicas, as indicações e contraindicações, possíveis efeitos colaterais e dosagens dos mesmos, são abordados. Finalmente, para ilustrar a importância da técnica, são apresentados dois casos clínicos, de pacientes ditos especiais, realizados na Clínica Dentária Universitária. Sem o recurso a esta mais-valia, estes pacientes não teriam tido uma resposta eficaz para os seus problemas orais, uma vez que não se deixavam tratar em ambiente de consulta normal. A utilização de técnicas anestésicas avançadas é, com certeza, parte certa do futuro próximo de quem exerce exclusivamente Odontopediatria. A referência de crianças com tenra idade, com estados de saúde oral francamente comprometidos e necessidade de efetuar tratamentos pulpares múltiplos com posterior colocação de coroas de aço/zircónia, assim como crianças já sujeitas a tentativas fracassadas de tratamento e que portanto assumem uma postura de não colaboração e muitas vezes fobia aos tratamentos dentários são constantes desafios para o profissional. Para dar uma resposta a estas crianças e a estes pais necessariamente o médico dentista tem que oferecer um plano de tratamento sob sedação ou eventualmente sob anestesia geral. Este será o caminho certo de evolução da prática clínica de Odontopediatria.
Behavior management of children in pediatric dentistry consultation is often unpredictable, which hinders the performance of the dentist and the respective dental treatment. There are several behavioral control techniques that have been developed in order to respond to these cases, particularly non-pharmacological techniques, such as communication skills and techniques of modification of conduct. However, sometimes these are insufficient leading the dental surgeon to resort to pharmacological methods such as sedatives, painkillers and other drugs acting on the control of pain, fear and anxiety. Moderate sedation has been shown to be an important aid in the dental treatment of children with a certain degree of anxiety and fear, as well as patients with special physical or mental disabilities. This is an effective and safe technique, alternative to general anesthesia, in which the patient is mildly sedated, some cooperation maintaining and managing the physical stimulation and to respond to verbal commands, allowing the professional performing a dental treatment plan. Conscious sedation techniques involve a variety of pharmacological agents such as nitrous oxide and other drugs, such as benzodiazepines. The treatment plan for each clinical case will depend on a careful review of past and current medical history of the patient, the respective individual need and the cost-effectiveness of the procedure. The objective of this paper is to present a literature review aimed to describe the different methods of sedation used in dental treatment in pediatric patients and patients with special needs, giving greater emphasis to moderate intravenous sedation. Pharmacological agents selected for the different techniques, indications and contraindications, possible side actions and dosages thereof. Finally, to illustrate the importance of the technique, two cases of special patients, performed at the University Dental Clinic, are presented. Without the use of this added value, these patients would not have an effective response to their oral problems, since they do not let themselves be treated in a normal query environment. The use of advanced anesthetic techniques is, of course, some of the near future by a person exercising exclusively Pediatric Dentistry. The referral of children with early age with oral health states frankly compromised and need to make multiple pulp treatments with placement of steel/zirconia crowns, as well as children already subject to failed attempts at treatment and therefore are of no posture collaboration and often phobia of dental care are constant challenges for the professional. To give an answer to these children and these parents necessarily the dentist has to offer a treatment plan under sedation or eventually under general anesthesia. This will be the right way of development of clinical practice of Pediatric Dentistry.
Behavior management of children in pediatric dentistry consultation is often unpredictable, which hinders the performance of the dentist and the respective dental treatment. There are several behavioral control techniques that have been developed in order to respond to these cases, particularly non-pharmacological techniques, such as communication skills and techniques of modification of conduct. However, sometimes these are insufficient leading the dental surgeon to resort to pharmacological methods such as sedatives, painkillers and other drugs acting on the control of pain, fear and anxiety. Moderate sedation has been shown to be an important aid in the dental treatment of children with a certain degree of anxiety and fear, as well as patients with special physical or mental disabilities. This is an effective and safe technique, alternative to general anesthesia, in which the patient is mildly sedated, some cooperation maintaining and managing the physical stimulation and to respond to verbal commands, allowing the professional performing a dental treatment plan. Conscious sedation techniques involve a variety of pharmacological agents such as nitrous oxide and other drugs, such as benzodiazepines. The treatment plan for each clinical case will depend on a careful review of past and current medical history of the patient, the respective individual need and the cost-effectiveness of the procedure. The objective of this paper is to present a literature review aimed to describe the different methods of sedation used in dental treatment in pediatric patients and patients with special needs, giving greater emphasis to moderate intravenous sedation. Pharmacological agents selected for the different techniques, indications and contraindications, possible side actions and dosages thereof. Finally, to illustrate the importance of the technique, two cases of special patients, performed at the University Dental Clinic, are presented. Without the use of this added value, these patients would not have an effective response to their oral problems, since they do not let themselves be treated in a normal query environment. The use of advanced anesthetic techniques is, of course, some of the near future by a person exercising exclusively Pediatric Dentistry. The referral of children with early age with oral health states frankly compromised and need to make multiple pulp treatments with placement of steel/zirconia crowns, as well as children already subject to failed attempts at treatment and therefore are of no posture collaboration and often phobia of dental care are constant challenges for the professional. To give an answer to these children and these parents necessarily the dentist has to offer a treatment plan under sedation or eventually under general anesthesia. This will be the right way of development of clinical practice of Pediatric Dentistry.
Description
Keywords
Sedação moderada Odontopediatria Ansiedade dentária nas crianças Controlo do comportamento Benzodiazepinas Analgesia Moderate sedation Dental anxiety in children Behavioral control Benzodiazepines