Your Dental Appointment Explained Information and advice to help you prepare for your appointment in the Day Procedure Unit Causeway Hospital 1
Contents Contents 2 Introduction 3 Information about general anaesthesia and sedation 4 Pain relief 7 Preparing for your appointment 8 Advice for parents and carers 10 Fasting instructions 11 The day procedure appointment: When you arrive 13 The day procedure appointment. In Theatre 15 The day procedure appointment: Recovery 17 After your appointment in the Day Procedure Unit 18 Review arrangements and contact details 20 Your treatment explained 21 2
Introduction Welcome to the Community Dental Services (CDS) Department of the Northern Health and Social Care Trust. Our aim is to deliver high quality dental care for special needs patients who require the provision of dental treatment in a hospital setting. Some patients will need general anaesthesia or sedation to allow their dental treatment to be safely carried out. This type of specialised care is provided in the Day Procedure Unit of Causeway Hospital. Following your assessment today, you will receive a further appointment to attend the Day Procedure Unit. This unit is located to the left of the main hospital entrance. Please take the time to read this booklet, it contains advice on how to prepare for your appointment and what to expect on the day. If you have any questions please contact the dental team on (028) 7034 6297. We would also like to hear from you if you have any comments, compliments or complaints to make about our service. If you require this information in any other format please let us know. 3
Information about General Anaesthesia and Sedation What is sedation? Sedation makes you feel relaxed and less anxious about your treatment but you will remain awake and will be able to talk to the dentist and respond to instructions. The sedation will be given by an anaesthetist. Anaesthetists are specialist doctors who look after you before, during and after surgery. Their role is to ensure that you are sedated and safe throughout surgery and that you wake up comfortably at the end of your operation. Sometimes the sedation may need to become quite deep to allow your treatment to be completed. You will be advised if you may need deep sedation during your assessment appointment. What are the risks and side effects to sedation? Some people may feel sick, vomit, experience dizziness or headaches, memory loss around the appointment or disorientation. In very rare cases some people may be allergic to the sedation or their breathing may slow down. The risks associated with a deep sedation are the same as the risks for a general anaesthetic. Please see the next section on general anaesthetics. 4
What is a general anaesthetic? A general anaesthetic ensures that you are fully asleep and free of pain during a test or operation. It consists of a combination of drugs given either as gas to breathe, or as an injection. General anaesthetics are only given by anaesthetists. Who are anaesthetists? Anaesthetists are specialist doctors who look after you before, during and after surgery. Their role is to ensure that you are asleep and safe throughout surgery and that you wake up comfortably at the end of your operation. How safe is general anaesthesia and are there any risks? Modern anaesthesia is very safe and problems are rare. Risks cannot be removed completely but when a patient is fit and healthy and the operation is a small one, as many dental operations are, the risk is extremely small. 1 Please also remember that it is only after careful consideration of the risks and benefits of your care that you are accepted for treatment under general anaesthesia. Most patients recover quickly after an anaesthetic, but a few may suffer some short-term side effects. These can include headache, sore throat, dizziness, memory loss of the procedure and sickness. Although unpleasant, these side effects will go away quickly and can be helped with medicines. More serious side effects such as having an allergic reaction to the anaesthetic or breathing problems are very rare. 1 The risk of general anaesthesia is estimated as 5 deaths for every million anaesthetics in the UK. Source: You and Your Anaesthetic, Royal College of Anaesthetists. 5
Medication If you regularly take medicines or tablets, it is important to take them as usual before your appointment. The time you take your medicines may need to be changed slightly depending on the time of your appointment. Further advice regarding this is given in the section on fasting, page 11. A small number of drugs taken for some specific illnesses need to be stopped before surgery. You will be advised if the drugs you take are to be stopped. If you have not been advised to stop any medication please continue to take all your routine medications on the day of your treatment. If you are still unsure about when to take your medication, please contact us on (028) 7034 6102. If your doctor has prescribed medication between the assessment and treatment appointments, please contact us on (028) 7034 6102 as soon as possible. On the day of your appointment, please make sure that you give the admitting nurse a list of all medications, tablets, herbal remedies, vitamins or drugs you have taken. Please bring all medicines taken, including inhalers, if used, with you to the hospital. Bring your tablets in their original packaging. 6
Pain relief before your appointment To help reduce pain after dental treatment it is advised that you take some paracetamol before attending the Day Procedure Unit. You should take the correct dose for your age at 7.00am for morning appointments, or 12.00 noon for afternoon appointments. See the Table below. The paracetamol should be taken with a small glass of water. Do not take anything to eat with this. Dose chart for paracetamol AGE STRENGTH DOSE 3-4 120mg in 5ml 1 x 5ml spoonful paediatric oral suspension 5-8 120mg in 5ml 2 x 5ml spoonful paediatric oral suspension 9-12 250mg in 5ml 2 x 5ml spoonful oral suspension 13-18 500mg 1 to 2 x 500mg tablets with a sip of water Adults 500mg 2 x 500mg tablets with a sip of water 7
Preparing for your appointment Children must come to their appointment with their parent / guardian. Adult patients must attend with another adult who can stay with them for 24 hours after treatment. Patients who attend without an accompanying adult will be refused treatment. Hygiene Please make sure you have a bath or shower on the night before or the morning of your appointment. Clothing Please dress in loose fitting clothing, for example a track-suit, so that you are comfortable while in theatre and recovery. Pyjamas are not necessary. We recommend that you bring a change of clothing. Make-up Do not put on make-up before coming into hospital. Please remove nail varnish. Books / toys To help pass the time you may wish to bring a book / magazine with you to the Day Procedure Unit. Valuables Do not bring any valuables or jewellery, as there is no safe area in which to keep them. 8
Alcohol / smoking / recreational drugs Please do not smoke, drink alcohol or take recreational drugs for at least two weeks before your appointment. Oral care before your appointment This means cleaning your teeth well and using a mouth wash every day. Try to take extra care with your oral hygiene before you attend for your treatment; this will greatly improve the overall result of your treatment and help with healing. Cancelling your appointment If you have been sick or are concerned that you will not be fit for the procedure, please contact the dental team for advice on (028) 7034 6297. If you are unable to attend your appointment for any reason, please telephone the Day Procedure Unit on (028) 7034 6102 to cancel your appointment. A new appointment will be posted out to you. Please try to give us as much notice as possible if you need to cancel your appointment. 9
Advice for parents / carers of children attending the Day Procedure Unit Accompanying your child If you are a parent or are responsible for a child, you must come to the appointment with them. What should I tell my child about the anaesthetic? This will depend on the age of your child and how much you think they can understand. It may be enough to explain that some of their teeth are bad and need to be fixed before they cause pain or to treat their toothache. You can explain that the doctor will give them some medicine which will make them go to sleep while their teeth are being fixed. Afterwards they will wake up. Older children may want to know more. Do encourage your child to talk about the operation. Books, games and stories can help. 10
Fasting Instructions It is important that your stomach is as empty as possible to prevent vomiting during and after the operation. To fast properly you must follow the instructions below: 1. When your appointment for treatment is in the morning The night before your appointment: Have a light supper before going to bed, for example milk and toast. Do not have anything to eat or milky / fizzy drinks after this. On the day of your appointment: Take your routine morning medications and your paracetamol at 7.00 am. Small drinks of water / diluted juice or tea / coffee with small amounts of milk (up to 1 tablespoon) are allowed up to 2 hours before your appointment. No other fluids / drinks are to be taken. 11
2. When your appointment for treatment is in the afternoon In the morning of your appointment: Take your routine medications at the normal time unless specifically advised otherwise by the dentist or anaesthetist. Take a light breakfast, for example milk and toast, in the morning of your appointment. You must be finished eating your breakfast by 8.00 am. Do not have anything to eat or milky / fizzy drinks after this. Small drinks of water / diluted juice or tea / coffee with small amounts of milk (up to 1 tablespoon) are allowed up to 2 hours before your appointment. No other fluids / drinks are to be taken Take your paracetamol at 12.00 noon. For your own safety, if you have not fasted as advised, the procedure may need to be postponed or cancelled. 12
The day procedure appointment Stage one - when you arrive Please report to reception which is inside the Day Procedure Unit Entrance. A nurse will take you for a pre-operative check before your operation. The nurse will ask you some questions, ensure that you are fit and well, and that you have fasted. The dentist will examine your teeth and make sure that you are happy to go ahead with the planned treatment. This is known as giving your consent. The anaesthetist will also come to see you. Why do I need to see an anaesthetist before the anaesthetic / sedation? The anaesthetist will assess your general health and discuss the anaesthetic with you. If the anaesthetist has any concerns about whether you are fit for treatment in the Day Procedure Unit, your appointment may need to be postponed. The anaesthetist will also decide whether you need to take some medicine to help you relax before your procedure. When you are ready for your operation, you will be taken to the theatre by the nursing staff. Your parent or accompanying adult may stay with you during these assessments, while you are being brought to theatre and until you are asleep or sedated, if you wish. 13
Advice for Parents / Carers You may stay with your child / person in your care throughout their assessments and until they are asleep or sedated in theatre. You can help to calm and reassure your child / person in your care by talking gently to them and holding their hand. In theatre, as the anaesthetic or sedation begins to take effect, you may notice the patient starting to wriggle. This is normal and can be eased again by reassuring your child / person in your care. Once the patient is asleep or sedated, you will be asked to return to the waiting area. Please use the facilities within the hospital while you are waiting but remember to let a member of staff know where you are going so that you can be contacted. You will be given advice on how long the procedure should last so that you know when to return to the Day Procedure Unit. 14
The Day Procedure Appointment Stage two - in theatre. How will I be given the general anaesthetic? You will be given an anaesthetic gas to breathe, or an injection. If you are having anaesthetic gas, this takes a minute or two to work. The anaesthetist generally places a mask gently over your mouth and nose to give the anaesthetic gas. If you are having an anaesthetic by injection, medicated cream will be put on your hand and arm about 40 minutes before surgery by the admitting nurse. This makes the skin go numb so that the injection will not be painful. How will I be given the sedation? The sedative drug is normally given by injection into the back of the hand or arm by the anaesthetist. Special cream is used to make the skin numb before the injection is given. This takes about 40 minutes to work. Once the skin is numb, the anaesthetist will be able to give you the sedation. Because the skin is numb you will feel very little pain. What happens next? Once asleep or sedated, the anaesthetist will look after you during your operation, ensuring that you are safe and comfortable. You will remain asleep or sedated until your dental treatment has been completed. 15
Will I be in pain? You will be given pain relief and sometimes a local anaesthetic (freeze) while you are asleep or sedated to help make you as comfortable as possible after surgery. The numbness from the local anaesthetic will wear off while you are recovering after your treatment. Please be careful not to bite / burn your lip while you are numb. It is best to wait until the numbness has worn off before you eat. Sometimes more pain relief drugs may be needed. These may be given while you are in recovery. 16
The Day Procedure Appointment Stage three - recovery What happens after my treatment is finished? You will be brought from theatre to the Recovery Ward where you will be looked after by trained nurses. When you are awake your parent or accompanying adult will be allowed to sit with you. Once you are comfortable you will be offered something to eat and drink, such as toast and tea / juice. If you had teeth taken out, the dentist will check your mouth to ensure that bleeding has stopped and will give you advice on the care of your mouth. Discharge You must remain in the Day Procedure Unit until you are sufficiently recovered. The nurse will assess you and decide when you are well enough to leave the hospital. You will then be discharged into the care of a responsible adult / parent and allowed to return home. On rare occasions, patients may need to be admitted to the ward to allow full recovery. Travelling home A parent or a person with parental responsibility must go home with their child. Adult patients must be discharged into the care of another responsible adult. You must not return home on public transport after having a general anaesthetic or sedation. Try to arrange another way, for example a taxi or a lift with a friend or relative. 17
After your appointment in the Day Procedure Unit It is normal for you to feel a little strange after having a general anaesthetic or sedation. You may even experience some brief loss of memory of your treatment. You will be given written advice on caring for your mouth after having a tooth out. When you have been discharged: 1. You must return home after treatment and stay with a responsible adult for 24 hours. 2. For the next 24 hours you are advised: DO NOT drive/operate machinery; climb ladders/scaffolding; be responsible for looking after others; make important decisions; take part in sports activities; or drink alcohol/take drugs or smoke. BUT DO stay at home, rest and take light meals. 18
Pain relief after your treatment You can take paracetamol if you need to, every six hours but no more than four times in 24 hours. Please wait for four to six hours after your treatment before taking the first dose. If you have been given additional pain relief in recovery, please ask staff when you can take the next dose of paracetamol. Please take the correct dose for your age, see page 7 for details. If the pain gets worse or the wound continues to bleed you should contact your own dentist. Out of hours, please contact the relief of pain clinic on 028 25663510. Sickness If you vomit, take fluids only. If the vomiting does not stop contact your own family doctor or doctor on call. Returning to work, school or day centre It is advisable to rest at home the day after having a general anaesthetic or sedation. Some people may become distressed if their routine is changed. If this applies to you or someone in your care, please discuss this with the dentist or anaesthetist. 19
Review arrangements If you need a review appointment this will be explained before you leave the Day Procedure Unit. After treatment make sure that you attend your dentist regularly. Contact details: Dental Clinic Outpatients 1 Causeway Hospital 4 Newbridge Road Coleraine BT52 1HS Telephone numbers Causeway Hospital 028 7032 7032 Day Procedure Unit 028 7034 6102 Dental Clinic Outpatients 028 7034 6297 Pre-anaesthetic clinic 028 7034 6101 E mail CDS.Causeway@northerntrust.hscni.net If no one is available to take your call please leave a message on the answer machine with your contact details. Someone from the dental team will return your call as soon as possible. 20
Your treatment explained The type of dental treatment normally provided under general anaesthesia or sedation are: Fillings Extractions X-rays Scaling (cleaning) Root treatment on front teeth Complicated or cosmetic treatments such as crowns, bridges, tooth bleaching or root treatment in premolar / molar teeth are generally not offered unless there is a good clinical reason to provide this type of care. Dental treatment provided under general anaesthesia or sedation, by its very nature, is more invasive than care provided under local anaesthetic alone. While every effort is made to make the experience as pleasant as possible, you should expect some discomfort and soft tissue trauma. Although the treatments provided are routine, as with any procedure there are risks and benefits. FILLINGS: Benefits: When your tooth is decayed, the diseased part of your tooth can be removed and the tooth shape restored by the placement of a filling. This type of treatment will treat pain and prevent the tooth deteriorating. It will also improve the appearance and function of the tooth. Risks: Initially, the tooth may become sensitive but generally this will subside. However, fillings can fail, particularly when a filling is deep. The tooth can become painful and need further treatment. 21
EXTRACTIONS Benefits: When a tooth is very decayed, abscessed or mobile through gum disease or infection, it will often need to be pulled. Tooth extractions are normally very straight forward and this type of treatment provides a very predictable result that is the bad tooth will be removed and after healing there will be no pain. Once an adult tooth has been removed another one will not grow in its space, however other teeth in the area of the removed tooth can drift forward and close the gap. Sometimes extraction is the only option for a very bad tooth. Risks: Like any surgery, the socket may bleed or get infected. There may be bruising and swelling around the extraction site and on the face. Teeth, roots and bone can break. Rarely, a tooth can be very difficult to remove and you will need to return to get the treatment completed. The removal of certain teeth carries additional risks, such as nerve damage (lower molars) or creating a tiny opening between the mouth and the sinus (upper molars). Thankfully these types of risks are rare. X-RAYS Benefits: X-rays (radiographs) are needed to help diagnose dental disease, plan extractions or to help in providing certain treatments such as root canal work. It allows the dentist to make a more informed decision about your treatment. Risks: To get a dental radiograph you need to expose the patient to a very small dose of radiation each small film is similar to the additional dose you would receive on a typical flight to Spain! Any dose of radiation can in theory cause damaging changes in cells but the risk is exceptionally small. 22
SCALING Benefits: Scaling the teeth will remove plaque, tartar (calculus) and help treat gum problems. Risks: Scaling teeth can cause them to be sensitive and sore for a while. Without good daily oral care post treatment by the patient, plaque and tartar will return. ROOT TREATMENT Benefits: Root treatment allows a tooth to be saved that would otherwise need extracted. It should only be carried out in a mouth with good levels of oral hygiene. It involves removing the diseased pulp of the tooth and replacing it with a root filling. Risks: Root treatment is the most unpredictable area of routine dentistry. The treatment often involves more than one visit and can result in a flare up of symptoms. Treatment can fail for a number of reasons. If the treatment fails you may need to return to get the tooth removed. 23
SUMMARY The information in this booklet is provided to help you make the right choices for you. You may decide that you do not want treatment. No treatment is always an option to consider, however, dental disease will continue unless you get treatment. Please also remember that the treatment provided is safe. Every effort will be made to provide the best treatment for you. Our aim is to discharge you back to your dentist as dentally fit. Once you have had your treatment you must take great care with your daily oral hygiene, reduce the amount and frequency or sugary foods and drinks you take and visit your dentist regularly. Email: info@northerntrust.hscni.net Website: www.northerntrust.hscni.net This document is available, on request, in accessible formats, including Braille, CD, audio cassette and minority languages. NT/PCCOPS/ 02/12/6153 1k CCD 24