CE0905: Nitrous Oxide & Oral Sedation Dentistry for 2010 and Beyond: Minimal and Moderate Sedation

Fred Quarnstrom, DDS, FAGD, FICD, FADSA;
David Donaldson, BDS, FDSRCS, MDS, FADSA, FADC;
Mark Donaldson, BSc (Pharm), RPh, PharmD

This course can satisfy the requirement in Washington State (WAC 246-817-701 through -790*), Oregon State (§818-026), Idaho State (§19.01.01.060.01) and the American Dental Association. Actual number of hours required by each state can vary. 

Who should attend this course:

This course is applicable to all dental professionals interested in providing minimal and moderate sedation in their office, and is an excellent refresher for those practitioners already experienced with these modalities.

Course Description:

Come to this course to learn oral sedation and nitrous oxide sedation. This course is designed for dental practitioners, hygienists and team members interested in providing safe and effective minimal and moderate sedation for their patients. For those practitioners already familiar with these modalities, this course represents the most comprehensive and up-to-date approaches to ensuring successful outcomes for you, your Team, and your patients. Our internationally-renowned Faculty has designed this curriculum around the newly approved ADA guidelines, and will review the recent state-wide adaptations based on these recommendations. They have taught well over 20,000 dentists on how to safely sedate dental patients in over 1,000 courses since 1968. Whether you are interested in getting started, or have been practicing with these tools for years, this is the only University-sponsored continuing dental education program taught by top professionals practicing in this field.

This program offers instruction in all aspects of inhalational analgesia and oral conscious sedation, including effective methods in dealing with anxiety control in general practice. Our Faculty specializes in adult learning by utilizing a multimedia approach which enhances knowledge and retention. Participants will learn various techniques and protocols designed to achieve certification in nitrous oxide/oxygen sedation as well as competency in providing oral anxiolysis. A patient-centered approach to care is emphasized with lectures on appropriate medication selection, monitoring and practical emergency management. Case studies will augment the delivery of key points and a problem-based learning approach is encouraged so that each participant's questions are addressed.

Additional topics that will be covered:

• The latest rules, regulations and guidelines
• Advances in local anesthesia and techniques
• Appropriate medical history investigation
• Polypharmacy in dentistry with a focus on references, infomatics and databases
• Sorting out what is important in older patients who collect chronic diseases requiring a mind numbing variety of drugs
• Current concepts in post-operative analgesia and antibiotic prescribing

Course Objectives - As a result of attending this course, the participant should be able to:

• Describe the most recent ADA guidelines and State Regulations for anxiolysis and sedation.
• Provide safe and effective anxiolysis and sedation using oral and inhalational techniques.
• Identify and describe areas of controversy regarding traditional dental relaxation methods and approaches to analgesia.
• Discuss new pharmacologic agents and their optimal use in dentistry.
• Describe the mechanism of action of popular pain medications and understand why some drugs work and some don’t for postoperative dental pain.
• Avoid the pitfalls of potential drug interactions.
• Understand the principles of drug metabolism including liver enzyme induction and inhibition.
• Modify dental treatment in relation to overall therapeutic regimen and recognize and manage potential emergencies.
• Update on local anesthetic controversies, equipment and techniques useful for the overall treatment of the anxious patient.

Course Schedule - Topics to be covered each day:

Friday's Topics

• Etiology of Dental Anxiety & Comparison of Techniques (Dr. David Donaldson)
  • Historical, philosophical and psychological aspects of anxiety and pain control.
• Pharmacology of Oral Sedatives (Dr. Mark Donaldson)
  • Description of the stages of drug-induced central nervous system depression through all levels of consciousness and unconsciousness, with special emphasis on the distinction between the conscious and the unconscious state.
  • Pharmacology of agents used in enteral and/or combination inhalation-enteral conscious sedation (combined conscious sedation), including drug interactions and incompatibilities.
• Oral Sedation Techniques Including “Politics” and Monitoring, Rules and Regulations (Dr. Fred Quarnstrom)
  • Importance of maintaining proper records with accurate chart entries recording medical history, physical examination, vital signs, drugs administered and patient response.
• Case Studies and Review (all instructors)
• Reversal Agents and Flumazenil (Dr. Mark Donaldson)
• Venous Drainage of the Upper Limb (Dr. David Donaldson)
• Update on local anesthetic controversies, equipment and techniques useful for the overall treatment of the anxious patient (Dr. David Donaldson)

Saturday's Topics

• Intravenous and Inhalational Sedation (Dr. David Donaldson)
  • Review of dental procedures possible under enteral and/or combination inhalation-enteral conscious sedation (combined conscious sedation).
• Pharmacology 101 (Dr. Mark Donaldson)
• Applied Physiology & Anatomy of Respiration (Dr. Fred Quarnstrom)
  • Review of pediatric and adult respiratory and circulatory physiology and related anatomy.
• Pain Theory (Dr. Fred Quarnstrom)
  • Definitions and descriptions of physiological and psychological aspects of anxiety and pain.
• Nitrous Oxide Equipment (Dr. David Donaldson)
  • Description and use of inhalation sedation equipment.
• Incremental and Rapid Induction techniques (Dr. David Donaldson)
• Drug Interactions and Databases (Dr. Mark Donaldson)

Sunday's Topics

• Medical Emergencies and Patient Assessment (Dr. Fred Quarnstrom and Dr. Mark Donaldson)
  • Patient monitoring using observation and monitoring equipment, with particular attention to vital signs, reflexes related to consciousness and airway management.
  • Prevention, recognition and management of complications and life-threatening situations.
• Contamination and Scavenging (Dr. David Donaldson)
  • Introduction to potential health hazards of trace anesthetics and proposed techniques for limiting occupational exposure and potential abuse problems
• Nitrous Oxide Installation (Dr. David Donaldson)
• Medical Emergencies and Patient Assessment (continued)
  • Patient evaluation and selection through review of medical history taking, physical diagnosis and psychological profiling
• Nitrous Oxide and Oxygen Pharmacology (Dr. David Donaldson)
  • Indications and contraindications for use of enteral and/or combination inhalation-enteral conscious sedation (combined conscious sedation).
• Local Anesthesia Update (Dr. David Donaldson)
  • Administration of local anesthesia in conjunction with enteral and/or combination inhalation-enteral conscious sedation (combined conscious sedation).
• Nitrous Oxide Complications / Contraindications (Dr. Fred Quarnstrom)
  • Discussion of hallucinatory effects and discussion of abuse potential.

  

Instructors:

FRED QUARNSTROM graduated from the University of Washington Dental School in 1964 and started his dental career as a dental officer in the United States Navy.  He served with the Marine Corps and a Naval Construction Battalion making the amphibious assault in Vietnam at Chu Lai.  After the Navy experience, he spent a year at the Washington Hospital Center in Washington, DC in the first year of a medical residency in anesthesia.  
 
He has received fellowships in the Academy of General Dentistry, American Dental Society of Anesthesiology, and the International College of Dentistry. He is a diplomate of the American Board of Dental Anesthesiology and the National Board of Dental Anesthesiology and a Fellow in the American College of Dentistry.  He is a certified dental insurance consultant of the American Association of Dental Consultants.
 
He has presented over 320 continuing education courses on nitrous oxide sedation, practice management, computer usage, electronic dental anesthesia, and IV and oral sedation. He holds a position of Affiliate Assistant Professor in the Department of Dental Public Health Sciences at the University of Washington School of Dentistry.  He has authored 44 papers and three manuals, and continues to do clinical research. He has been in a private general practice in Seattle since 1967.

DAVID DONALDSON is presently licensed by the College of Dental Surgeons of British Columbia to practice dentistry. He obtained his dental degree at St. Andrews University in Scotland in 1965. In 1969 he completed his Fellowship in Dental Surgery through the Royal College of Surgeons in Edinburgh and was granted his Masters degree in Prosthodontics by Dundee University in 1971.

He moved to the University of British Columbia in 1970 to take up the position of Director of Pain and Anxiety Control in the Faculty of Dentistry. Since then he has held many academic and administrative positions including Assistant Dean, Director of Clinics, Chairman of the Curriculum Committee, member of the University Senate and head of three departments:  Oral Maxillo Facial Surgery, Oral Surgical and Medical Science and, presently, the Department of Oral Biological and Medical Sciences. His private practice involves chronic head and neck pain clinics at UBC and his own clinic on Vancouver Island.

His teaching and research interests have mainly been in anesthesia and pain control and, in 1985, he successfully completed the examinations for the Fellowship in the American Dental Society of Anesthesia. In 1994 he was appointed as a Diplomat of the American Academy of Pain Management, in 2000, was elected as a Fellow of the American Academy of Dentistry, and in 2001 elected as a Fellow in the Academy of Oral Facial Pain Dr Donaldson has served as Chairman of the Canadian Dental Association Council on Education, President of the Association of the Canadian Faculties of Dentistry and President of the International Federation of Dental Education Associations. He Chaired the Canadian Dental Association Task Force on the Future of Dental Education in Canada, which reported in 1999.In the year 2000 he was awarded the Certificate of Merit by the Canadian Dental Association His scientific publications and presentations are extensive and he has co-authored several textbooks. He has presented over one-hundred continuing education courses, both national and international for dentists, dental hygienists and physicians.

MARK DONALDSON received his BSc (Pharm.) from the University of British Columbia and his Doctorate in Clinical Pharmacy from the University of Washington. He completed a clinical residency at Vancouver General Hospital and is the current Director of Pharmaceutical Services at the Kalispell Regional Medical Center near his home in Whitefish, Montana. He is an affiliate faculty member of the Department of Pharmacy at the University of Montana in Missoula, and a clinical assistant professor in the School of Dentistry at the Oregon Health Sciences University.

Dr. Donaldson is a continuing education speaker for the University of Washington, Washington State University, Oregon Health Sciences University, the Duke School of Medicine and the University of British Columbia. He has a special interest in dental pharmacology and has lectured internationally on a number of related topics for both dental and medical practitioners. He spent three years in Japan focusing on cross-cultural communication and internationalization, and he has two of the cutest children in the world.

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University of Washington is an ADA CERP Recognized Provider.	The University of Washington is an ACDE member.
ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.
University of Washington designates this activity for 7, 14, or 21 continuing education credits.