Bispectral index (BIS) monitoring of intravenous sedation for dental treatment.

AIM: To investigate the efficacy of the Bispectral Index monitor (BIS) in monitoring patients receiving intravenous midazolam for dental treatment. BACKGROUND: The BIS monitor has been proposed as an objective form of monitoring the level of consciousness in patients undergoing sedation and anaesthesia. It analyses electroencephalogram wave forms and quantifies this information to produce a numerical value of 0-100. To assess its efficacy,this study investigates if BIS correlates with the Observer's Assessment of Alertness/Sedation scale (OAA/S). METHOD: 50 episodes of intravenous sedation using midazolam were provided for anxious adults. Sedation proceeded in the standard manner but with the addition of BIS monitoring and assessment of the depth of sedation using the OAA/S scoring system.The operator was blinded to the BIS monitor. Information from the BIS monitor and corresponding OAA/S scores were recorded at 5-minute intervals and at clinically significant points, and correlation was tested using Spearman's Rank test.The effect of electromyographic interference (EMG) on the BIS reading was also investigated. RESULTS: A strong positive correlation was found between BIS and OAA/S.The mean range of BIS values recorded during sedation was 81+8.The BIS value was found to be most accurate at the end point of sedation. CONCLUSION: BIS monitoring may be a useful adjunct in monitoring patients receiving sedation for dental treatment using midazolam.

The impact of 0.2% chlorhexidine gel on oral health and the incidence of pneumonia amongst adults with profound complex neurodisability.

AIMS: Investigate the effect of toothbrushing with 0.2% chlorhexidine gel on oral health and pneumonia amongst patients with a neurodisability who are fed via percutaneous endoscopic gastrostomy. METHOD: Forty-nine patients at the Royal Hospital for Neuro-disability were recruited to an observational study. Daily toothbrushing with 0.2% chlorhexidine gel was undertaken for 12 months by trained nursing staff. Plaque and gingival health were assessed every six weeks using the Simplified Debris Index and the Basic Periodontal Examination. The annual incidence and prevalence of episodes of pneumonia experienced by patients whilst using the chlorhexidine gel were compared to rates from the previous year. RESULTS: Plaque levels and the proportion of patients with periodontal pocketing > 3.5 mm significantly reduced, P < .001, with chlorhexidine toothbrushing. Total number of pneumonia episodes (75-67), antibiotics administered (73-64), and radiographs taken (19 to 16) were lower in the year wherein chlorhexidine was employed, and hospitalisations dropped by 31% (16-11), but these reductions were not statistically significant. No adverse events were reported. CONCLUSION: Daily toothbrushing with 0.2% chlorhexidine undertaken by a trained and supported nursing staff was effective in improving oral health but did not significantly affect annual rates of pneumonia amongst patients.

Effect of daily manual toothbrushing with 0.2% chlorhexidine gel on pneumonia-associated pathogens in adults living with profound neuro-disability.

PURPOSE: To investigate the effect of daily toothbrushing with 0.2 % chlorhexidine digluconate (CHX) on the colonization of dental plaque by pathogens associated with pneumonia amongst non-ventilated adults with a neuro-disability. METHODOLOGY: Forty-nine patients living in long-term care were recruited. Daily toothbrushing with 0.2 % CHX gel was conducted for 48 weeks. Plaque accumulation was assessed and microbiological sampling was undertaken every 6 weeks. RESULTS: At any one time point at least 65 % (n=32) of subjects were found to harbour respiratory pathogens. Although there were significant changes in the proportion of individuals colonized over time with Gram-negative bacilli and Pseudomonas aeruginosa, the changes were not sustained. By week 48 there was no significant difference from the levels that had been recorded at baseline. CONCLUSIONS: Bacteria known to be causal in pneumonia are present and colonize the dental plaque of non-ventilated adults with a neuro-disability. Daily toothbrushing with 0.2 % CHX gel did not produce a sustained reduction in intra-oral respiratory pathogen counts after 48 weeks.

Providing dental care for patients with Huntington's disease.

UNLABELLED: This paper describes the genetic condition Huntington's disease and its clinical relevance to dentists. The treatment of two patients with the condition is described: one under general anaesthesia, the other with intravenous sedation. CLINICAL RELEVANCE: Dentists may have patients who develop Huntington's disease in later life, so this paper will help them consider the longer term effects of this disease and help in planning dental care.