• The Journal of Korea Assosiation for Disability and Oral Health
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• v.5 no.1
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• pp.12-17
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• 2009

Background : To do dental treatments successfully for dentally disabled patients who are unable to cooperate to procedures needs deep sedation (DS) or general anesthesia (GA). But there are some difficulties in selecting DS because of some disadvantages such as airway problem etc. But, if we select appropriate cases, DS would be better than GA. Methods : We reviewed total 238 cases of patients who had received dental treatments under GA or DS at the clinic for the disabled in Seoul National University Dental Hospital from November 2007 to February 2009. To compare anesthesia condition between DS and GA, we reviewed preanesthesia evaluation sheet, anesthesia or sedation records and PACU sheets retrospectively. Results : The number of DS cases was 25 (11%) and that of GA was 218 (89%). To maintain DS, intravenous propofol was infused with syringe pump (100%), and sevoflurane (134 cases) or propofol (13 cases) were used for sedation induction. Mean total treatment time for DS was 36 min and 2 hour 25 min for GA. The recovery time at PACU was 44 min for DS and 80 min for GA. There were no severe complications in DS, but 18 cases showed nausea and vomiting in GA. Conclusion : Deep sedation for disabled dental patients should be selected for effective behavioral control in conjunction with general anesthesia, considering duration and pain-evoking potentials of dental treatment and type and severity of patients' disabilities altogether.

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.3
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• pp.151-158
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• 2019

Background: This study aimed to examine whether the combination of low-dose ketamine and propofol in deep sedation is clinically useful in controlling the behavior in intellectually disabled patients who are typically extremely noncooperative during dental procedures. Methods: A total of 107 extremely noncooperative intellectually disabled adult patients were analyzed. In all patients, deep sedation was performed using either propofol alone (group P) or using a combination of propofol and 0.2 mg/kg or 0.4 mg/kg ketamine (groups PK0.2 and PK0.4, respectively). The procedures were performed in the order of insertion of nasal cannula into the nostril, attachment of mouth gag, and mouth cleaning and scaling. The frequency of patient movement during the procedures, mean arterial pressure, heart rate, peripheral oxygen saturation, recovery time, discharge time, and postoperative nausea and vomiting were examined. Results: The three groups were significantly different only in the frequency of patient movement upon stimulation during single intravenous injection of propofol and scaling. Conclusion: For propofol deep sedation, in contrast to intravenous injection of propofol alone, prior intravenous injection of low-dose ketamine (0.4 mg/kg) is clinically useful because it neither affects recovery, nor causes side effects and can suppress patient movement and vascular pain during procedures.

• Journal of The Korean Dental Society of Anesthesiology
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• v.14 no.3
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• pp.167-172
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• 2014

Background: Propofol is the most commonly used anesthetic for sedation and target-controlled infusion (TCI) is useful for dental treatment. However, it is important to assess and maintain an adequate depth of sedation in patients with severe intellectual disabilities Therefore, in this study we aimed to evaluate the adequate propofol target concentration for dental treatment in severely intellectually disabled patients. Methods: We undertook retrospective review of the sedation records of severely intellectually disabled patients who underwent dental treatment under TCI propofol sedation from September 2011 to April 2012. We evaluated the initial target concentration, stabilized concentration of propofol and monitored vital signs, including BIS score using sedation records. Results: Total 20 patients (10 male and 10 female patients) were included in the study. Every participant was severely intellectually disabled. The mean sedation duration was $70{\pm}16$ (45-100) minutes. The initial propofol target concentration infusion amount was $2.7{\pm}0.45$ (2.0-3.0) mcg/ml. The propofol effect site concentration (Ce) was $2.6{\pm}0.7$ (1.0-4.0) mcg/ml. The average value of BIS was $52.6{\pm}13$ (28-81). During the treatment period, there were no severe complications. Conclusions: The average propofol Ce for deep sedation without any complications in intellectually disabled patients was 2.6 mcg/ml.

• Journal of Korean society of Dental Hygiene
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• v.8 no.3
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• pp.1-11
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• 2008

Oral health projects that cater to the disabled should be more prevailing in order to ensure the maintenance and successful promotion of the oral health of disabled people. 70 public dental clinics that conducted oral health projects geared toward the disabled were examined to get a precise grip on their oral health projects. The findings of the study were as follows: 1. 31 out of 70 public dental clinics investigated(44.3%) were equipped with two or more dental hygienists who were professional human resources in charge of the oral health projects for the disabled. As for the age and disability type of the beneficiaries of the oral health projects, adolescents(74.3%) and people with mental retardation(87.1%) benefited most from the oral health projects. Concerning the most common implementation frequency of the projects, the projects were carried out once to three times a week(62.9%). 2. The most dominant oral disease treatment provided to disabled people was amalgam treatment and resin treatment(68.6%), which were the early dental caries treatment. The most common preventive treatment that was offered to improve their oral health was oral prophylaxis(82.9%). As for reform measures for the oral health projects, education of personnels in charge of the projects and their specialization(58.6%) were most emphasized. 3. Regarding factors related to the preventive oral health projects for the disabled, the implementation of oral prophylaxis and toothbrushing education was linked to the age of the beneficiaries. More oral prophylaxis was offered to teens, and more toothbrushing education was provided to preschoolers and adolescents. The age of the beneficiaries and the number of dental hygienists responsible for the projects had something to do with the application of fluorides. 4. Concerning the relationship of the preventive oral health projects for the disabled to the number of dental hygienists, one of the personnels in charge of the projects, the application of fluorides( 54.4%) and pit & fissure sealing(56.8%) were more prevalent when there were two or more dental hygienists. There was a statistically significant disparity in that regard(p<0.05). The above-mentioned findings illustrated that in order to boost the oral health of the disabled, dental hygienists who are responsible for the oral health projects for the disabled should put ceaseless efforts into fostering their professional knowledge and ability and offering quality service to disabled patients. Every public dental clinic should be equipped with plenty of professional personnels to enlarge the scope of treatment and ensure the efficiency of treatment and the preventive projects.

• 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.

• Journal of Dental Anesthesia and Pain Medicine
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• v.16 no.3
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• pp.217-222
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• 2016

Dental treatment is often performed under general anesthesia or sedation when an intellectually disabled patient has a heightened fear of treatment or has difficulty cooperating. When it is impossible to control the patient due to the severity of intellectual disability, conscious sedation is not a viable option, and only deep sedation should be performed. Deep sedation is usually achieved by propofol infusion using the target controlled infusion (TCI) system, with deep sedation being achieved at a slightly lower concentration of propofol in disabled patients. In such cases, anesthesia depth monitoring using EEG, as with a Bispectral Index (BIS) monitor, can enable dental treatment under appropriate sedation depth. In the present case, we performed deep sedation for dental treatment on a 27-year-old female patient with mental retardation and severe dental phobia. During sedation, we used BIS and a newly developed Anesthetic Depth Monitor for Sedation (ADMS$^{TM}$), in addition to electrocardiography, pulse oximetry, blood pressure monitoring, and capnometry for patient safety. Oxygen was administered via nasal prong to prevent hypoxemia during sedation. The BIS and ADMS$^{TM}$ values were maintained at approximately 70, and dental treatment was successfully performed in approximately 30 min.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.9 no.2
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• pp.85-90
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• 2013

The aim of this research is to compare the attitude toward the special needs of dental staffs between the special dental clinic (SDC) and the general dental clinic (GDC). Surveys were done on 21 dental staffs (7 dentists and 14 dental hygienists) of SDC and 47 dental staffs (10 dentists and 37 dental hygienists) of GDC. Attitudes were rated on a questionnaire with the five-point Likert scale. Mann-Whitney test was utilized for statistical analysis. In SDC, more female dentists and dental staffs who have relatives with disability were working. Dental staffs of SDC showed that the more experience they had, the more positive attitudes toward the communication with the patients with special needs (p<0.05). Dental staffs of SDC represented more active attitudes toward the oral health promotion, treatment, research and volunteering (p<0.05). In conclusion, dental staffs who have personal motivation were working in SDC and the experience of dental treatment to the patients with special needs influenced the dental staffs' attitudes toward them. In future, a research about the attitude toward the disabled with more exact scale should be followed.

• Journal of Korean society of Dental Hygiene
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• v.13 no.2
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• pp.297-303
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• 2013

Objectives : The purpose of this study was to evaluate the oral health status of the disabled people in Ulsan. Methods : Two dentists taken a calibration training for national oral health survey examined the Oral health status on 110 disabled people in Ulsan, in 2009. The surveyed disabled people, 6 to 19 years old, have been supplied with the oral health care services by dentists, oral hygienists and volunteers at dental clinics of schools and a dental clinic supported from Ulsan Metropolitan City Nam-Gu Health Center since 1997. The obtained data from these surveys were analyzed with the SPSS statistical package. Results : Among subjects aged 12-14 years, DMF rate was 38.2%; Active D rate, 17.6%; DMFT index, 1.15; DT rate, 33.33%; MT rate, 0.00%; FT rate, 66.67%. Oral heath status of disabled people in Ulsan were evaluated to be a similar level to the Ulsan non-disabled citizens from 2010 Korean National Survey. Conclusions : The oral health care programs for disabled people using voluntary dentists, oral hygienists and other workers in Ulsan are evaluated to be effective for the disabled people.

• Journal of Korean society of Dental Hygiene
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• v.10 no.6
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• pp.1001-1014
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• 2010

Objectives : The purpose of this study is about discovering the basic references to find the ways to vitalize handicapped dental clinics. Methods : The study was analyzed by the satisfactions of those patients who took the advantages of using the dental care at B-welfare center and also their transformed perceptions after the services are influenced. The analysis was the questionnaire consisting of 100 items and survey data. Results : 1. The satisfaction of the dental service for the disabled was respectively high which was the average of 4.49. 2. Their satisfactions of receiving kindness services by volunteers and employees were the highest in the entire research of successful handicapped dental services and it was 4.78 overall. 3. The satisfaction of using handicapped dental clinic has the higher range of female users than male's. In the mean time treatment details of the dental care and the satisfaction towards to the volunteers and faculty at the center show the statistical significance gap. 4. The oral care service after experiencing the dental clinic for handicapped relived their discomforts of using the regular dental clinic which shows their highest satisfaction as it is the point of 4.75. 5. the change perception after dental treatment for handicapped has the higher range of females than men's and solving the problems of mouth reference and discomfort of using regular clinics show the statistical significance gap. 6. In the change perception after having dental treatment for handicapped the thought of the possibility of periodical dental care shows the highest perception when the number of visiting is usually shorter and it shows the statistical significance. Conclusions : According to the satisfaction of those inpatients who use free dental care services that belong to dental clinics for handicapped in a part of Seoul welfare centers human services were appeared as the most important factor due to their advantages of taking services from volunteers and staff members. On the other hand to enhance the medical treatment information and environment which showed the weakest factors each inpatient should be specifically specialized for their needs and also further study on plans which enhance their perceptions toward to a better quality of oral-related life is required after using dental treatment service.

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.4
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• pp.217-226
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• 2019

Background: We aimed to assess the dose needed to achieve the propofol effect-site concentration using target-controlled infusion in intellectually disabled patients and to detail the most effective method for achieving a safe level of consciousness without hemodynamic changes as well as detail any resulting adverse effects. Methods: We performed a retrospective review of sedation service records of 138 intellectually disabled patients (51, mental retardation; 36, autism; 30, brain lesion, 12 genetic diseases, 9 dementia) aged over 15 years and weighing over 30 kg. These patients had received propofol via target-controlled infusion in the special care dental clinic of Seoul National University Dental Hospital from May 2008 to September 2018 for restorative treatment (112), minor surgery (13), prosthodontics (7), periodontics treatment (5), and implant (1). Results: For all groups, the duration of dental treatments was $43{\pm}18$ minutes, total sedation time was $73{\pm}23$ minutes, and total BIS values was $57{\pm}12$. The propofol maintenance dosage values for each group were: mental retardation, $3{\pm}0.5(2-4){\mu}g/ml$; autism, $3.1{\pm}0.7(2-5){\mu}g/ml;$; brain lesion, $2.8{\pm}0.7(1.5-5){\mu}g/ml;$; genetic disease, $2.9{\pm}0.9(1-4){\mu}g/ml;$ and dementia $2.3{\pm}0.7(1-3.4){\mu}g/ml;$. Conclusions: The dementia group needed a lower dosage to reach a safe, effective propofol effect-site concentration than the other groups. Since there were no complications, deep sedation is a great alternative to general anesthesia for dental treatment of intellectually disabled patients.