Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA Anthony Charles Caputo 25 th Annual Meeting on Special Care Dentistry Dentistry and Anesthesia in

Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA

Anthony Charles CaputoAnthony Charles Caputo

2525thth Annual Meeting on Special Annual Meeting on Special Care DentistryCare Dentistry

Dentistry and Dentistry and Anesthesia in the Anesthesia in the

Office-Based Office-Based Setting:Setting:

Bringing the OR to Bringing the OR to the Office!the Office!


A little about me…A little about me… President, Southwest Dental Anesthesia ServicesPresident, Southwest Dental Anesthesia Services Past President, American Society of Dentist Past President, American Society of Dentist

AnesthesiologistsAnesthesiologists Fellow, American College of DentistsFellow, American College of Dentists Fellow, International College of DentistsFellow, International College of Dentists Diplomat, American Dental Board of Diplomat, American Dental Board of

AnesthesiologyAnesthesiology Diplomat, National Dental Board of AnesthesiologyDiplomat, National Dental Board of Anesthesiology Director of Anesthesiology, The Scottsdale Center Director of Anesthesiology, The Scottsdale Center

for Dentistryfor Dentistry Assistant Director, Lutheran Medical Center, Assistant Director, Lutheran Medical Center,

Advanced Education in General DentistryAdvanced Education in General Dentistry ProgramProgram


Please feel free to Please feel free to contact me!contact me!

Office- 520/571-7951Office- 520/571-7951 Mobile- 520/975-4927Mobile- 520/975-4927 Fax- 520/571-7999Fax- 520/571-7999 Email- Email-

[email protected]


Who Receives Who Receives Sedation?Sedation?

Initial examination:Initial examination:This is the time to determine the This is the time to determine the need need for sedation!for sedation!

patient evaluation/assessmentpatient evaluation/assessment treatment plantreatment plan

Determine benefits to the patient Determine benefits to the patient and and practitionerpractitioner



Case selectionCase selection HygieneHygiene Intraoral examinationIntraoral examination

The case does not typically The case does not typically influence if sedation is influence if sedation is neededneeded



Anesthesia consultation:Anesthesia consultation:The ability to develop a The ability to develop a comprehensive approach to comprehensive approach to patient care by considering patient care by considering available treatment optionsavailable treatment options

Oral, Inhalational, IV, CombinationOral, Inhalational, IV, Combination Operator/Anesthetist, Operator/Anesthetist, AnesthesiologistAnesthesiologist


Why Provide Why Provide Sedation for Sedation for

Patients?Patients? Behavior managementBehavior management Patient profilePatient profile Failure of other adjunctsFailure of other adjuncts Patient requestPatient request Provider requestProvider request


Patient ProfilePatient Profile Medically compromisedMedically compromised

COPD, HTN, IDDMCOPD, HTN, IDDM Physically compromisedPhysically compromised

Quadriplegic, Cerebral palsyQuadriplegic, Cerebral palsy Mentally compromisedMentally compromised

Downs syndrome, AutismDowns syndrome, Autism


Failure of Other Failure of Other AdjunctsAdjuncts

HeadphonesHeadphones Music, StoriesMusic, Stories

VideosVideos Distraction techniquesDistraction techniques

Tell, Show, DoTell, Show, Do Office environmentOffice environment


Patient RequestPatient Request Type of procedureType of procedure

ImplantsImplants CleaningCleaning

Desire for comfortDesire for comfort PhysicalPhysical MentalMental


Provider RequestProvider Request Need for patient controlNeed for patient control

Complexity of procedureComplexity of procedure periodontal surgeryperiodontal surgery multiple restorationsmultiple restorations

High stimulus caseHigh stimulus case extraction of third molarsextraction of third molars


Provider RequestProvider Request Behavior managementBehavior management

PediatricsPediatrics Mentally/physically Mentally/physically compromisedcompromised

Phobic/fearfulPhobic/fearful


What is Sedation ?What is Sedation ?

PsychologicPsychologic Office environmentOffice environment StaffStaff Establishing rapportEstablishing rapport Chairside mannerChairside manner Hypnosis, suggestionHypnosis, suggestion


What is Sedation?What is Sedation? PharmachologicPharmachologic

InhalationalInhalational OralOral Parenteral- commonParenteral- common

Intramuscular (IM)Intramuscular (IM) Intravenous (IV)Intravenous (IV)


Anxiolysis/Minimal Anxiolysis/Minimal SedationSedation

Patient is comfortablePatient is comfortable Patient understands and desires Patient understands and desires

relaxationrelaxation Very little change in vital signsVery little change in vital signs Can achieve with oral or Can achieve with oral or

inhalationalinhalational Must be aware of clinical endpointMust be aware of clinical endpoint


Conscious/Moderate Conscious/Moderate SedationSedation

Alteration of moodAlteration of mood Little/minor change with Little/minor change with

vital signsvital signs Patient must remain Patient must remain

cooperativecooperative Can achieve with oral or IVCan achieve with oral or IV


Deep SedationDeep Sedation Patient is unconscious and Patient is unconscious and

not cooperativenot cooperative Protective reflexes may be Protective reflexes may be

affected- must protect airwayaffected- must protect airway Can have significant change Can have significant change

with vital signswith vital signs Can achieve with any route!Can achieve with any route!


General AnesthesiaGeneral Anesthesia

Loss of consciousnessLoss of consciousness Loss of cooperationLoss of cooperation Loss of protective reflexesLoss of protective reflexes Need a trained provider Need a trained provider

present!present!


How is Sedation How is Sedation Provided?Provided?

ConsultationConsultation DentistDentist

procedureprocedure patient profilepatient profile

PatientPatient anesthesia and treatment plananesthesia and treatment plan


How is Sedation How is Sedation Provided?Provided?

AnesthesiologistAnesthesiologist DentistDentist

consultation- procedure, consultation- procedure, patient profilepatient profile

PatientPatient preparation for procedurepreparation for procedure


Preparation for Preparation for ProcedureProcedure

Anesthesia instructionsAnesthesia instructions Pre-operativePre-operative

NPO status, clothing, escortNPO status, clothing, escort ConsentConsent

Specific to anesthesiaSpecific to anesthesia Level of anesthesiaLevel of anesthesia

adults- discuss optionsadults- discuss options children- deep sedation/GAchildren- deep sedation/GA


Office RequirementsOffice Requirements Space/room in the operatorySpace/room in the operatory Back-up oxygen sourceBack-up oxygen source

central versus portablecentral versus portable Dedicated equipment/suppliesDedicated equipment/supplies

saliva ejector/low-volume suctionsaliva ejector/low-volume suction back-up suction, battery powered back-up suction, battery powered

itemsitems Appropriate recovery areaAppropriate recovery area


TechniquesTechniques NN22O/OO/O22

Patient profilePatient profile mildly anxious, nervousmildly anxious, nervous personality, dispositionpersonality, disposition

PO (oral)PO (oral) Patient profilePatient profile Adjunct for other sedationAdjunct for other sedation


TechniquesTechniques

IV (intravenous)IV (intravenous) Patient profilePatient profile Combination techniqueCombination technique MonitorsMonitors Establishing IV accessEstablishing IV access


When is It Time to When is It Time to Go?Go?

Discharge criteriaDischarge criteriaThere are a variety of techniques There are a variety of techniques available. It is important to available. It is important to ensure ensure certaincertain criteria are met criteria are met regardless of the technique used. regardless of the technique used. This is no different than what This is no different than what happens in the OR or ASC!happens in the OR or ASC!


Positive OutcomesPositive Outcomes The ability to treat an otherwise difficult The ability to treat an otherwise difficult

or impossible patientor impossible patient Making your work day easier and more Making your work day easier and more

efficient by staying in your officeefficient by staying in your office Doing quality dentistry in a controlled Doing quality dentistry in a controlled

environmentenvironment In the end, effectively treating patients In the end, effectively treating patients

with compassion and understandingwith compassion and understanding

Documents

Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA Anthony Charles Caputo 25 th Annual Meeting on Special Care Dentistry Dentistry and Anesthesia in