• Journal of the korean academy of Pediatric Dentistry
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• v.38 no.2
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• pp.181-186
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• 2011

Autism is characterized by pervasive impairments in social interaction, verbal and non-verbal communication and restricted and stereotyped behavior. It is difficult for autism patients to receive dental treatment as lack of cooperation, so various behavior management method have been tried for dental treatment in clinic. The patients with mild autism can be managed by conventional behavior modification method and phamaco-logical conscious sedation. But the patients with severe autism and multiple dental caries can be treated by deep sedation or general anesthesia. The benefits of children's dental care in general anesthesia are full-mouth rehabilitation in one single appointment. We reported three cases of autism patients who were treated by various behavior management method as to severity of autism.

• The Journal of the Korean dental association
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• v.53 no.8
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• pp.530-537
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• 2015

Conceptually, the emergency is classified as an urgency and an emergency. The Urgency is not immediately life threatening, but could become so if not resolved promptly. So, it requires prompt patient care same as in the emergency situation. However, the emergency is immediately life threatening and requires immediate action, such as calling 119 and basic life support. Most medical emergencies in the dental clinic cases are urgencies. The incidence of true emergencies is approximately 1/1,000,000. Adequate managing medical urgencies are important because the chance of encountering medical emergencies in the dental clinic is high and higher these days especially because of rapidly aging Korean society. Many dentists indicate that many dentists feel difficulties to recognize and treat medical problems. This paper reviews the concept of medical emergencies and how to cope with commonly occurring urgencies in the dental clinic such as loss of consciousness, hypoglycemia, hyperventilation syndrome. The best treatment for medical urgencies and emergencies in the dental clinic is prevention. Also, it is required to make preparation for emergency situations such as CPR education for dentists and being well-acquainted with equipment and drugs for the emergency care as well as to systemic medical evaluation, patient monitoring, and sedations for controlling patient's anxiety and pain. In this paper, simple algorithms based on guidelines for common urgencies in the dental clinic are suggested. In conclusion, every dentist has competencies to do the urgency care adequately and basic life support. Also, advanced cardiac life support is strongly recommended when sedation is performed in the clinic.

• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.3
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• pp.183-190
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• 2017

Background: It is important to evaluate preoperative anxiety and prepare sedation when performing dental surgery under local anesthesia. Spielberger's State-Trait Anxiety Inventory (STAI) is useful for predicting preoperative anxiety. State anxiety is defined as a subjective feeling of nervousness. Reduction in the number of the state anxiety items (questions) will be clinically important in allowing us to predict anxiety more easily. Method: We analyzed the STAI responses from 1,252 patients who visited our institution to undergo dental surgery under local anesthesia. Multiple linear regression analysis was conducted for 9 groups comprising anxiety level determinations using the STAI; we then developed a coefficient of determination and a regression formula. We searched for a group satisfying the largest number of requirements for regression expression while setting any necessary conditions for accurately predicting anxiety before dental surgery under local anesthesia. Results: The regression expression from the group determined as normal for preoperative state anxiety was deemed the most suitable for predicting preoperative anxiety. Conclusion: It was possible to reduce the number of items in the STAI by focusing on "Preoperative anxiety before dental surgery."

• Journal of the korean academy of Pediatric Dentistry
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• v.25 no.3
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• pp.525-532
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• 1998

The autism is a complex disorder, characterized language impairment, perceptual-motor difficulties, and social disturbance. The autistic children have hyperactivity, lack of communication' lack of cooperation, inappropriate patient/dentist interaction, so they require professionally recognized behavioral management technique during dental treatment such as behavior modification, phamacological agents, and general anesthesia. A behavior management technique can be chosen by factors such as the severity of autism and possible accompanying disabilities, degree of cooperation, oral and general conditions of children. A non-pharmacological behavior modification may be selected for the autistic children who are able to communicate with dentist with mild dental caries, without compromised medical history. In case of excessively hyperactive, destructive, antisocial, and/or severe communicative disorder, a sedation technic with chloral hydrate, hydroxyzine, midazolam or nitrous oxide gas might to be performed. General anesthesia is preferred for severe communicative and/or behavioral disorder, elder age, excessive dental care need, and living a remote area.

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.5
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• pp.301-304
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• 2018

Awake fiberoptic nasotracheal intubation is a useful technique, especially in patients with airway obstruction. It must not only provide sufficient anesthesia, but also maintain spontaneous breathing. We introduce a method to achieve this using a small dose of fentanyl and midazolam in combination with topical anesthesia. The cases of 2 patients (1 male, 1 female) who underwent oral maxillofacial surgery are reported. They received $50{\mu}g$ of fentanyl 2-3 times (total $2.2-2.3{\mu}g/kg$) at intervals of approximately 2 min. Oxygen was administered via a mask at 6 L/min, and 0.5 mg of midazolam was administered 1-4 times (total 0.02-0.05 mg/kg) at intervals of approximately 2 min. A tracheal tube was inserted through the nasal cavity after topical anesthesia was applied to the epiglottis, vocal cords, and into the trachea through the fiberscope channel. All patients were successfully intubated. This is a useful and safe method for awake fiberoptic nasotracheal intubation.

• Journal of the korean academy of Pediatric Dentistry
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• v.36 no.2
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• pp.209-216
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• 2009

The purpose of this retrospective study was to examine twenty four hour postsedation events after discharge in children sedated for dental treatment. The sedation sheets of 355 children were selected. Selection criteria excluded no midazolam or nasal route of midazolam, no ASA class I, absent or incomplete questionnaire. Children received orally chloral hydrate and hydroxyzine, nitrous oxide was maintained during the sedation. Midazolam was injected to buccal submucosa with titration. Parents were interviewed via telephone within twenty four hours after sedation. Questionnaire included sleeping response, sleeping time, sleeping behavior, vomiting response at home. Two hundred twenty four (67.8%) children slept and twenty one(6.3%) children had abnormal sleeping behavior. One hundred four(31.0%) children had abnormal behavior after sleep and ten(3.0%) children had vomiting response. In the children took the higher dose of midazolam, there were the great tendency to sleep after discharge (p<0.05), the more negative response to sleeping behavior(p = 0.055), the longer sleeping time(p=0.054). In this study many children slept after sedation and a few children showed negative response. However there were not any considerable emergency events. Further study is required to determine the postsedation safety for the use of submucosal midazolam combination with chloral hydrate and hydroxyzine.

• Journal of Dental Anesthesia and Pain Medicine
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• v.15 no.1
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• pp.5-10
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• 2015

Background: Patients were subjected to post-discharge follow-up (by telephone) in order to investigate the potential complications of outpatient general anesthesia or deep sedation that could develop in disabled dental patients discharged from the hospital. The ultimate aim of this study was to establish an appropriate response measure for such complications. Methods: The caregivers of 79 disabled patients who underwent dental procedures under general anesthesia at our outpatient clinic were interviewed over telephone. Necessary care instructions were provided during the phone calls when required. The patient satisfaction level regarding the telephonic follow-up care was surveyed by additional telephone calls. Results: Most of the patients did not suffer any serious complications; however, some reported fever and bleeding. The data obtained in this study can be utilized towards the development of caregiver education pertaining to the ambulatory general anesthesia of dental patients with disabilities. Conclusions: Additionally, we hope that the findings of this study will help minimize the effects of complications experienced by disabled dental patients undergoing ambulatory general anesthesia, as well as increase the overall patient satisfaction level.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.2 no.2
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• pp.153-155
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• 2006

Many patients with mental retardation need extensive dental treatment because they have much difficulty in maintaining their oral hygiene. However, because they are not cooperative and not manageable, they require physical restraints, drug induced sedation or general anesthesia. General anesthesia is useful in control of the patients who cannot be treated in other ways. Additionally, general anesthesia provides more safe environment for medically compromised patients. And medical treatment can be provided simultaneously under general anesthesia. Furthermore, almost all treatment can be provided without visiting several times. This case reports of periodontal, restorative and ophthalmological treatment of patient with mental retardation under general anesthesia.

• Journal of Dental Anesthesia and Pain Medicine
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• v.15 no.3
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• pp.173-179
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• 2015

Issues related to the control of seizures and bleeding, as well as behavioral management due to mental retardation, render dental treatment less accessible or impossible for patients with Sturge-Weber syndrome (SWS). A 41-year-old man with SWS visited a dental clinic for rehabilitation of missing dentition. A bilateral port-wine facial nevus and intraoral hemangiomatous swollen lesion of the left maxillary and mandibular gingivae, mucosa, and lips were noted. The patient exhibited extreme anxiety immediately after injection of a local anesthetic and required various dental treatments to be performed over multiple visits. Therefore, full-mouth rehabilitation over two visits with general anesthesia and two visits with target-controlled intravenous infusion of a sedative anesthesia were planned. Despite concerns regarding seizure control, bleeding control, and airway management, no specific complications occurred during the treatments, and the patient was satisfied with the results.

• Journal of The Korean Dental Society of Anesthesiology
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• v.11 no.1
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• pp.51-54
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• 2011

Wolff-Hirschorn syndrome is a condition that is caused by a deletion of genetic material near the end of the short (p) arm of chromosome 4. The major features of this disorder include a characteristic facial appearance, delayed growth and development, intellectual disability, and seizures. A 9-year-old girl was brought to the clinic with a chief complaint of dental examination. The child was diagnosed as WHS at Samsung medical center. The child was under Sodium valproate, Atrovastatin medication for epilepsy, hyperlipidemia and had a history of heart surgery. So prophylactic antibiotics were recommended. The child was mentally retarded and had seizure so it was difficult to manage her behavior effectively. Thus dental treatment was carried out under general anesthesia. For prompt sedation induction we used 8% sevoflurane shortly. This report presents the case of a 9-year-old girl with WHS, who has received treatment for extensive caries under general anesthesia.