Control of pain and anxiety

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pharmacology in odontopdiatria

dl control pain and anxiety

the vast majority d ls pa100ts dntals pdiatricos puedn rcibir MDIO Odontologico enl treatment with tcnico ADCU convncional d d Manjo behavior and pain.

alg1s casosl dl in control pain and anxiety ncsita ir + d ls tcnico convncionals governess.

pharmacological treatment children s indicates xa q no treatment puedn rcibir tcnico tradicionals d ls d Manjo anstsia conduct and local.

sdacion cons100t

dfinicion: minimal reduction q cons100cia dl nivl d d prmit mantnr Manra indpndient and continuous vias prmabilidad d ls rspondr adcuadamnt aeras and the physical and stimulacion ls ordns vrbals.

nivls d sdacion cons100t:

- Sdacion Liger (mouth)
- Sdacion with nitrous oxide (via inalatoria)

** sdacion deep (via rctal, nasal or im)

anstsia gnral

considracions spcials
monitoring in sc
- Oximtro d pulse
- Sttoscopio prcordial
- Cuff d prsion artrial

the tcnico d sdacion impid ql q pct. dspierta facilmnt and interplay as ls intncional to ordns vrbals throughout momnto, sx dfinicion:
sdacion deep.

if ls sdacion cons100t tcnico d d s of the 1st Manra ADCU and corrcta monitorizacion ay, l pa100t prsntara 1st Show cardiovascular and rspiratoria ADCU.

pa100t or difficult the 1st I suffered partial or prdida complte rfljos d d ls protccion and can not mantnr d Manra indpndient the prmabilidad rspiratoria apna or ipoxemia may suffer, as q conyeva pligro d muert.

sdacion deep cons100t sdacion

d objtivos the sdacion cons100t

-Reduced-Flow Serie pa100t dl oliminar anxiety, so feel Sgura cm acr qs and comfortable guest can ralizars 1 xa q dntal good treatment.

- Reduced-Flow Serie movements and ls ls raccions advrsas durantl treatment.

- Aumntar the coopracion dl pa100t.

- Ls incrmntar its tolrancia durant long treatments.

- Help ls d enl pa100ts compromti2 treatment physical and sikicamnt.


1 .- dl propratoria evaluation comxtamiento.

2 .- tate d dl propratoria assessment and oral health gnral.

3 .- collaboration, participation and padrs d ls x ls consntimiento signed them.

4 .- considracions economicas.

5 .- altrnativas d treatment.

6 .- formation and profsional and expriencia dl dl d prsnal work.

Indicacions sdacion cons100t

- Pr-pa100ts with pathologies existnts:
* altracions Sikiatra or pa100ts with mntals modra
* musculars or pa100ts with spastic altracions modra
- Pa100ts with dntista phobia (aprnsivo adult) children d hard Manja (not rcptivos)
- Prvi to surgery
- Loop i and ii pa100ts

** ls pa100ts with intolrancia to anstsicos locals (anstsia
** Pa100ts with physical disabilities or mntal SVRA (anstsia

ASA sistma d

q d sistma used classification society of anstsiologists Amrica (asa) xa q stimarl RISG anstsia plant the STA2 dl xa ls pa100t different.

clas i pa100t Saludabl Somtas not to cirugialctiva

Class II enfrmdad sistmica lv pa100t with controlled and not disabling. may or may not cause d rlacionars with the intrvncion.

Class III enfrmdad sistmica grav pa100t with the program or disabling.

Class IV pa100t with severe and disabling enfrmdad sistmica, q is constant ad + xa amnaza life, and q s can not always corrgir x MDIO d surgery.

Class V s is enfrmo trminal dl or dying, as life expctativa d s largest Spra sa oras d 24, with or without treatment kirurg.

x agnts d administration via oral (sdacion Liger)

narcotics: mpridina

anxiolytics: * idroxizina

bnzodiacpinas: diazpam
* midazolam

ipnoticos: * idrato d chloral

tienne snc sobrl anxiolytic activity, sdant, ipnotica, rlajant muscle sdant, amnsica, anticonvulsants and muscle rlajant dl sqltico.
adm. oral or parntral.

Indicacions: Manja d anxiety.
pr-anstsica induction.
procdimientos odontologicos.
** Use OSPITALARIA ambito.

diazpam (bnzodiazpina anxiolytics with sdant action + q ipnotica)
the 1st action-tien long (life mdia suprior to 24 rs.)
- No muxo s used in dentistry (CSTR-XEQ rt.)
- 2IS: diazpam lab. xil 5mg comp
0.1-0.2 mg / kg pso

flunitrazpam(bnzodiazpina ipnotica with ipnotica action + q sdant)
- S 10 + potnt ql diazpam vcs
- Action intrmdia (10-22 rs.)
- S given with ATCM XEQ
- Flunitrazpam lab. xil 2mg
Children: 0.5 - 1mg/2is

midazolam (bnzodiazpina ipnotica)

- Action Ultra Short (1-2 rs), dmoran 30-60 min. in efcto acr
- Causes somnolncia
- 2IS children: 0.5 - 0.7 mg / kg (30 min. Atncion ants d the)
Maximum total 2IS: 15mg
Dormon prsntacion = compr. 15 mg (adults)
7.5 mg (children)
other nombrs: midazolam, nocturnal

idrato d chloral (sdant ipnotico)

oral administration, ls dsd efctos dprsors puedn vary the sdacion to sleep, to pray d apar100do administration.

enl s not found Disponibl mrcado national farmacutico.
solicitars his prxacion pued (eg fasa) using rctario rtnido d Manra follows:

20 g chloral rp.idrato d
dstilada water 100 ml

2IS ipnotica enl child: 30 - 50 mg / kg pso.

ls efctos aparcn to 15-30 min. and max activity. s reaches the ora.

** Use OSPITALARIA ambito.


- Production and tend sdacion anxiolytic activity and
- Oral administration
- Ls ls efctos aparcn to 30 min. activivdad and reaches the maximum s ro r 1 / 2
- Be used in combination with drugs dl dprsors snc (mpridina,. Chloral d) or n2o
- Propertys antiemticas

2IS: 25 mg d 1 ants appointment.
fasarax, compr. 20 mg syrup 10 mg/5ml

sdacion x Inhalation: nitrous oxide

q inrtatoxico gas production sdacion, rlajacion and analgsia.

- Nivls sanguinhos rapi2 (low solubility in plasma).
- If s intrrump his adm., Ls rapidamnt decrease nivls sanguine.
- Xa ease 2IS control (not 50% db excdrl enl pa100t pdiatrico).
- Ausncia d efctos scundarios gravs.

acptnl children use d + q cariya (chool-age).
children with anxiety and / or distress lv, q collaborate withthe pro treatment.

- Children with conduct srios probl + d q no colaborn
withthe use the + d cariya.
- Pqños children.
- Children with nasal obstruction or probl + rspiratorios.

- Agnt Dbilas.
- Lack pa100t d acptacion xl.
- Inconvniencia.
- Potnciacion (combination with other sdants).
- Ekipo.


- Ajust scalon:
s start with the concntracion maxima and minima d d oxigno ys nitrous oxide is adjusted according to degree d d sdacion reached (s aumnta gradualmnt).
- 1a vz sdacion s is achieved anstsia place the local db.
- Then d finalizadol procdimiento s db give 100% d oxigno x 5 min.
- S mantnrl db vrbal contact withthe child fomntar the rlajacion xa rforzar the 1st and coopradora behavior.

** S can be combined d acr sdacion midazolam idroxicina + d + nitrous oxide nitrous oxide.

considracions spcials

the alternative methods of pharmacological control behavior xa dl mdiant sdacion cons100t child, rprsnta 1 ARA very complja and rkier additional training and spcializada.

the child may remain sdacion dfi100t problme d 1 control, while ql q rcibio excso d sdacion pued convrtirs rapidamnt in 1a or-die urgncia d enl dntal office.


pnicilina go bncilpnicilina:
- Increased activity against microorganisms g +, g-and anaerobic cocci productors not nursing db + a. little activity against g-bacils.
- Parntral administration.

2IS children: 100,000 IU / kg / pso / day.
inconvnients: acid labile, snsibl to btalacta + a

fnoximtilpnicilina (pnicilina v):
- Spctro smjant to pnicilina g, tb snsibl to btalacta + a.
- Oral administration (stable to gastric p, adm. Ljós d meals).
- Low availability rlativa (c/6rs).

2IS children = 25-50mg / kg / pso / day in 4 2IS.

amoxicillin spctro wide (including flora g + and -).
greater capacity. q pnicilina against g-g.
gastrointstinal absorption 80 to 90%.
CRCA d ls administrars pued meals.
infccions d tji2 blan2 skin and produced x strptococos, Staphylococci not productors d pnicilinasa, sxerixia coli and Protus mirabilis.

2ificacion children: 50 mg / kg pso / day every 8 rs (till 20 kg)
Over 20 kg. 250-500mg w / 8 rs.

amobiotic lab. xil bottle suspnsion 5ml/250mg
amoval lab. saval
abiolx lab. Andromaco
aminopxil lab. bago

amoxicillin + clavulanate

Clavulanic acid s 1 1 Inhibiting the btalacta d + a, q ls Bactrians dstruyan prevents amoxicillin.
s indicates principalmnt in infccions d tji2 blan2 skin and, in particular with clulitis and abscsos dntals q sn clulitis disminada to mnudo produced x stapylococcus Aurus, strptococcus pyogns and bactroids spp. some cts grmns producn hese d-lactate + bta, leaving them no san ac q snsibls to amoxicillin alone.

2ificacion children:
ambil lab. xil suspnsion 5ml/250 ac-62.5 mg amoxic
50mg/kg/dia every 8 rs
clavinx lab saval
augmntin lab. gsk

Amox .- 5ml/400mg ambil 57mg bid ac
5ml w/12 duo clavinx rs.


- Prtnc group pnicilinas d ls "antistafilococicas" and q was caused infccions treat dsarroyada xa x Staphylococci productors d bta-lactate + a. s active against Staphylococci, and snsibls microorganisms rsistnts to pnicilina, strptococcus pyogns and strptococcus pnumoniae. however, s - q the pnicilina g active against the snsibls Bactrians pnicilina,entrococcus faecalis and gramngativos microorganisms.
- Adm. oral or parntral.

2IS child = 50 mg / kg / pso / day every 8 rs.

flucloxacillin lab. xil suspnsion 125mg/5ml - 250mg/5ml
flucloxacillin lab. Andromaco suspnsion 250mg/5ml
vitalpn lab. labomd suspnsion 250mg/5ml


bactriostatico macrolide antibiotic.
oral administration or parntral.
good absorption x mouth (db go with rcub. entrico).
altrnativa in pa100ts alrgicos to pnicilina.

2IS children = 50 mg / kg / day every 8 rs.

erythromycin lab. Andromaco suspnsion 5ml/200-400mg
erythromycin lab. PASTEUR
Erythromycin s lab. xil
mrcina lab. mpro


Driver d macrolide erythromycin with ls siguients
vntajas: - mjor gastrointstinal absorption.
- Mjor distribution.
- Mdia life long (adm. w/12 rs.).
- Altrnativa in PCTs. alrgicos to pnicilina.

2IS children = 7.5 mg / kg every 12 rs pso.

pr-clar lab. xil
euromicina lab. suspnsion saval 5ml / 125-250 mg
clarimax lab. Andromaco


Driver d macrolide erythromycin siguients vntajas with ls:
- Mjor q other macroli2 absorption.
- Greater volumn d distribution, high [] in ls tj.
- Mdia life prolonged, adm. c / 24 rs.
- Mjor tolrancia gastrointstinal.

2IS children =
azitrom lab. xil suspnsion 5ml/200mg
10mg/kg day 1
5mg/kg daily x 4 days ls siguients
abactn lab. Andromaco
trx lab. saval

Bactrian endocarditis

infcciosa endocarditis inflammation d s ls the 1st heart valves (endocardium).

usualmnt endocarditis rsultado d 1A bactrmia sl (d prsncia Bactrians in the blood), qs alg1s procdimientos common during dental, notif others.

enl Bactrians torrnt the Sanguine s ls puedn stablcr in damaged heart valves and the 1st CRARA multiplicars xa + ad Bactrians vgtacion or alive. stas + qs coaguls as puedn form dsprndn and travel crbro, Pulmons ls, ls riñons ol spleen.

prsnas most d ls q dsarroyan the 1st endocarditis infcciosa tienne the 1st heart disease subyacnt.

the strptococcus viridans, s rsponsabl CRCA d d d half ls all Bactrian endocarditis. ls sn comuns other agencies stapylococcus Aurus, s. epidrmidis and e. faecalis.

q rkiern prophylaxis treatments:

to2 ls procdim. q dntals manipulation involucrn d tj. gingival od the rgion prforacion d priapical or oral mucosa

procdimientos dntals s rcomienda where no prophylaxis:
- Anstsia d d inyeccions routine infcta2 not tji2.
- Take d rx dntals.
- Placement protsis or axate d d extraibls orthodontics.
- Ajust axate d d orthodontics.
- D braqt orthodontic placement.
- Prdida d dients tmxals.
- Bleeding ls x damage lips or oral mucosa.

- Pa100ts with antcdnts d ebsa.
- Cognitive cardiopathies.
- Protsica heart valve.
- Heart Transplants with rcptors d enfrm. heart

rgimn xa procdimientos dntals:

sqma traputico amoxicillin children = 50 mg / kg 1 hour pso d the atncion ants.

ls in pa100ts alrgicos to NPCI.:
clindamycin 20 mg / kg / pso 1 r. ants
clarithromycin or azithromycin 15 mg / kg pso 1 r. ants.

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