1. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA Anthony Charles Caputo 25 th Annual Meeting on Special Care Dentistry Dentistry and Anesthesia in the Office-Based Setting: Bringing the OR to the Office!

2. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA A little about me…  President, Southwest Dental Anesthesia Services  Past President, American Society of Dentist Anesthesiologists  Fellow, American College of Dentists  Fellow, International College of Dentists  Diplomat, American Dental Board of Anesthesiology  Diplomat, National Dental Board of Anesthesiology  Director of Anesthesiology, The Scottsdale Center for Dentistry  Assistant Director, Lutheran Medical Center, Advanced Education in General Dentistry Program

3. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA Please feel free to contact me!  Office- 520/571-7951  Mobile- 520/975-4927  Fax- 520/571-7999  Email- acaputodds@sprintmail.com acaputodds@sprintmail.com

4. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA Who Receives Sedation?  Initial examination: This is the time to determine the need for sedation! patient evaluation/assessment patient evaluation/assessment treatment plan treatment plan Determine benefits to the patient and practitioner

5. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA Who Receives Sedation?  Case selection  Hygiene  Intraoral examination The case does not typically influence if sedation is needed The case does not typically influence if sedation is needed

6. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA Who Receives Sedation?  Anesthesia consultation: The ability to develop a comprehensive approach to patient care by considering available treatment options Oral, Inhalational, IV, Combination Oral, Inhalational, IV, Combination Operator/Anesthetist, Anesthesiologist Operator/Anesthetist, Anesthesiologist

7. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA Why Provide Sedation for Patients?  Behavior management  Patient profile  Failure of other adjuncts  Patient request  Provider request

8. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA Patient Profile  Medically compromised  COPD, HTN, IDDM  Physically compromised  Quadriplegic, Cerebral palsy  Mentally compromised  Downs syndrome, Autism

9. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA Failure of Other Adjuncts  Headphones  Music, Stories  Videos  Distraction techniques  Tell, Show, Do  Office environment

10. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA Patient Request  Type of procedure  Implants  Cleaning  Desire for comfort  Physical  Mental

11. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA Provider Request  Need for patient control  Complexity of procedure periodontal surgery periodontal surgery multiple restorations multiple restorations  High stimulus case extraction of third molars extraction of third molars

12. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA Provider Request  Behavior management  Pediatrics  Mentally/physically compromised  Phobic/fearful

13. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA What is Sedation ?  Psychologic  Office environment  Staff  Establishing rapport  Chairside manner  Hypnosis, suggestion

14. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA What is Sedation?  Pharmachologic  Inhalational  Oral  Parenteral- common Intramuscular (IM) Intramuscular (IM) Intravenous (IV) Intravenous (IV)

15. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA Anxiolysis/Minimal Sedation  Patient is comfortable  Patient understands and desires relaxation  Very little change in vital signs  Can achieve with oral or inhalational  Must be aware of clinical endpoint

16. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA Conscious/Moderate Sedation  Alteration of mood  Little/minor change with vital signs  Patient must remain cooperative  Can achieve with oral or IV

17. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA Deep Sedation  Patient is unconscious and not cooperative  Protective reflexes may be affected- must protect airway  Can have significant change with vital signs  Can achieve with any route!

18. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA General Anesthesia  Loss of consciousness  Loss of cooperation  Loss of protective reflexes  Need a trained provider present!

19. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA How is Sedation Provided?  Consultation  Dentist procedure procedure patient profile patient profile  Patient anesthesia and treatment plan anesthesia and treatment plan

20. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA How is Sedation Provided?  Anesthesiologist  Dentist consultation- procedure, patient profile consultation- procedure, patient profile  Patient preparation for procedure preparation for procedure

21. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA Preparation for Procedure  Anesthesia instructions  Pre-operative NPO status, clothing, escort NPO status, clothing, escort  Consent  Specific to anesthesia  Level of anesthesia  adults- discuss options  children- deep sedation/GA

22. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA Office Requirements  Space/room in the operatory  Back-up oxygen source  central versus portable  Dedicated equipment/supplies  saliva ejector/low-volume suction  back-up suction, battery powered items  Appropriate recovery area

23. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA Techniques  N 2 O/O 2  Patient profile mildly anxious, nervous mildly anxious, nervous personality, disposition personality, disposition  PO (oral)  Patient profile  Adjunct for other sedation

24. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA Techniques  IV (intravenous)  Patient profile  Combination technique  Monitors  Establishing IV access

25. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA When is It Time to Go?  Discharge criteria There are a variety of techniques available. It is important to ensure certain criteria are met regardless of the technique used. This is no different than what happens in the OR or ASC!

26. Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA Positive Outcomes  The ability to treat an otherwise difficult or impossible patient  Making your work day easier and more efficient by staying in your office  Doing quality dentistry in a controlled environment  In the end, effectively treating patients with compassion and understanding