TableofContents

GENERAL INFORMATION

� Conference Goals & Objectives

� Board/Staff

� Symposium Volunteers

� Membership Meeting/Agenda

� CISPPROH Awards

� Symposium Sponsors

� Exhibitors

� Research

TECHNICAL INFORMATION

� Announcement

� CISPPROH Resource List

SPEAKERS BIO-SKETCHES

� Professor Isabel Holroyd

� Professor Raymond Dionne

� Professor Sharon Robinson

� Associate Professor Eve Cuny

� Associate Professor Marcelo Valle

� Dr. Bruce Seidberg

� Dr. Denise Young-Brady

� Dr. Carlene Davis

� Dr. Lambert Innis

� Dr. Judith Lieba

� Dr. Kevin Goulbourne

� Dr. Brian James

� Miss Dani Dougan

� Miss Irene Iancu

� Dr. Andrea Daley

� Dr. Arnoldo Ventura

DAILY AGENDA/HANDOUT

� Sunday

� Monday

� Tuesday

SUMMARIES OF PRESENTATIONS

GeneralInformation

� Programme Goals & Objectives

� Board/Staff

� CISPPROH Organogram

� CISPPROH History

� Symposium Volunteers – THANKS!

� Membership Meeting Agenda

� CISPPROH Awards

� Symposium Sponsors

� Exhibitors

� Safety Information

CISPPROH2018–7THINTERNATIONAL

SCIENTIFICSYMPOSIUM

GOALSANDOBJECTIVES

CISPPROH SYMPOSIUM GOALS

1.0 To provide a forum for discussion

and dissemination of cutting edge

research and State-of- the- Art

information on issues of interest to

Pain Management Specialists and

Consultants, Dental & Medical

Practitioners, Researchers,

Academia and Drug Companies.

2.0 To provide an opportunity for

CISPPROH to highlight current

research activities and to promote

evidence-based and best practice

approaches in Pain Management,

Pharmaco-vigilance in the use of

opioids analgesics, Infection

Prevention and Control and ethical

practice of dentistry.

3.0 To provide an opportunity for

dental practitioner to observe and

discuss with vendors new products

and technologies relevant to

dentistry.

4.0 To provide an opportunity to

network with peers, researchers

and venders on common issues and

concerns.

OBJECTIVES OF THE 7TH INTERNATIONAL

SCIENTIFIC SYMPOSIUM

1.0 To learn the latest information on:

� Contemporary trends in pain

management

� Pitfalls and challenges of opioid

analgesics

� Behavioural Management

� Recent Advances in the Diagnosis

and Management of Neuropathic

Pain

� Pain Management and Children

on the Autism Spectrum

Disorders

� Emergency Severity Index (ESI) –

triaging patient management

� Recent advances in Medical

Marijuana

� Risk Management and Informed

Consent

� Inhalation Sedation

� Clinical strategies for managing

endodontic pain

� Dental biofilms and how to

manage dental waterlines

2.0 To understand:

� Best practices in pain

management

� Infection control processes –

quality assurance

� Infection control challenges in a

dental setting

� Best practices for incorporating

the CDC dental infection control

guidelines

� Principle of opioids usage in

managing chronic pain: promise

and pitfall

� Medicolegal and regulatory issues

relating to opioid analgesia

� Principles of risk management.

� Principles of inhalation sedations,

safety and precautions

� Principles of triaging in a medical

emergency

HistoryofCISPPROH

The importance of building research capacities in Oral Health was first highlighted in 1976 at the

Caricom Heads of Government meeting in Castries, St. Lucea by Dr. George Gillespie of the Pan

American Health Organization. Dr. Gillespie found that there were significant gaps in the data in

relation to the state of oral health care throughout the Caribbean region. This, he summarized

was due to the lack of competent dental professionals in health management and public health,

who were capable of conducting basic epidemiological and translational research.

The Heads of Government meeting in that year resolved to establish a body called the Caribbean

Atlantic Regional Dental Association (CARDA) that would guide the respective governments on

Oral Health issues.

Nevertheless, the Caribbean health agenda was driven by several primary health care initiatives,

led by medical doctors in the various Ministries of Health, which were all aimed at improving the

delivery of health care services to the vast majority of citizen of the Region.

Unfortunately, the proposed primary health care system for dental services was never

developed. The conceptual framework for primary Oral and Dental Health services were based

on a pre-World War II construct; this is where Dentists only provided extraction services and

palliative care services, this was not based on any good evidence. In 1985, guided by the

PAHO/WHO, Jamaica conducted its first scientifically sound Decay Missing and Filled Teeth

(DMFT) survey and subsequently implemented the Salt Fluoridation programme, the results of

which were outstanding. This provided scientifically sound (dental public health intervention)

evidence for further country implementation.

DMFT Survey - 1995

Following the implementation of the Salt Fluoridation programme, the Decay, Missing and Filled

Teeth (DMFT) Indices fell to 1.08 from a high of 6.7 (PAHO/WHO 1995). This achievement was

astonishing, as 60% of the 12-year-old cohort was found to be “Caries Free” post salt fluoridation.

Despite this public health achievement much work was left to be done. The fact is, the caries

prevalence and severity is increasing with age and many of the adolescents and young adults are

not enjoying good oral health. The poor oral health conditions were further exacerbated among

the special needs population where the DMFT was significantly higher than that of the national

average (2.2 in the 12-year-old cohort). A way therefore had to be found to continue evidence

based interventions in not only cohort, but others.

In an effort to address this gap, CISPPROH was established in 2008 having been conceptualized

by Drs. Irving McKenzie and Winston Grey as the vehicle for promoting evidence-based and best

practice approaches to public health policies and intervention in oral health, as the precursor

organization CARDA had failed to live up to its mandate as a policy advisement body to the

governments of the Region. CISPPROH was called the Dental Economic Research Forum (DERF)

in 2008 and we held our first conference with the Atlantic Dental Implant Seminar, an

organization originating out of Clifton, New Jersey USA. The name Caribbean Institute for

Strategic Planning and Research in Oral Health (CISPROH) was adopted in 2009, and was

subsequently changed in order to bolster the organization drive to become a Research Institute

and to further our collaboration with other similar institutions in the Caribbean such as the

Caribbean Oral Health Initiative Network, with which CISPPROH is aligned and the Caribbean

section of the International Association of Dental Researcher (IADR).

Leadership in Public Health

Currently, CISPPROH is the first of its kind in the Region. CISPPROH from a conference perspective

promoted several collaborative initiative with members of the Dental Professions (Jamaica

Association of Public Dental Surgeons), The Policy Makers (the Ministry of Health) and Academia

(the University of Technology, Jamaica) and a few corporate entities.

CISPPROH has from its inception prioritized the following research priorities and has provided

significant training in these areas:

1) Special Health Care Needs: Caring for children on the Autistic Spectrum of disorders.

2) Oral & Pharyngeal Cancer

3) Diabetes and Oral Health

4) Pain management

5) Infection Prevention and Control

6) Antimicrobial resistance

7) Translational Research in Oral Health

Scientific Symposium

The CISPPROH inaugural scientific conference took place in 2012 under the name of the late Dr.

Rosalie Warpeha in who honour the CISPPROH was established. It was at that conference that

CISPPROH honoured six giants in Dental Public Health and Academia. Our honorees were:

1) Hon. Dr. Fenton Ferguson, Minister of Health

2) Dr. Steven Pearlman, Global Dental Director –Special Olympics, Special Smiles programme

3) Dr. Saskia Estupinian-Day - Oral and Dental Health Chief Pan American Health

Organization, USA

4) Dr. Dwight Anthony Lewis – Chairman Dental Council of Jamaica & Inaugural President of

CARDA

5) Adjunct Professor Gary Glassman – Head of Department of Endodontics UTech, Jamaica

6) Adjunct Professor Ramon Baez – Head of Department of Dental Public Health, UTech,

Jamaica

The Inaugural conference showcased many budding researchers, as well as several significant

innovations in dentistry such as 1) ‘Smile Design & digital dentistry’ by Dr. Iva Bloom from the

University of Maryland Baltimore; 2) Optical Tumescence Tomography by Professor Linda Ottis,

also from the University of Maryland, Baltimore.

One of the world’s leading restorative dentist and biomaterial researcher, Professor Len Boksman

from London, Ontario - Canada provided significant insights in the science of dental biomaterial,

while Professor Steve Pearlman shared about the joys of treating Special Needs Children. All of

the lecturers are well published with several citations and significant international

commendations.

The Final Presenter of the conference was the legendary endodontist, adjunct Professor Gary

Glassman, who lectured on the latest in endodontics, inclusive of diagnosis, treatment planning

and management of simple, and complex endodontic cases.

Overall, the CISPPROH 2012 conference was of exceptionally high standards and quality that

resulted in an overwhelming demand for future conferences, dedicated to advancing the science

of dentistry. Since then CISPPROH continue to excel in its commitment to advancing the science

and art of dentistry from an evidence-based perspective.

CISPPROH20187THINTERNATIONAL

SCIENTIFICSYMPOSIUM

SPONSORS

On behalf of all of us, the conference committee is delighted to take a moment to thank our

sponsors who have gone the extra mile to ensure that this year’s Symposium is a success

PRE- CONFERENCE PROGRAMME

Kinder –Krown

College of Oral Health Sciences, UTech, Jamaica

GlaxoSmithKline

EDUCATIONAL PROGRAMME

Listerine

Colgate

LASCO

Kinder –Krown

College of Oral Health Sciences, UTech, Jamaica

SYMPOSIUM BROCHURE

Listerine

CISPPROH AWARDS

OPENING RECEPTION (SUNDAY)

College of Oral Health Sciences, UTech, Jamaica

Jamaica Association of Public Dental Surgeons

CISPPROH SILENT AUCTION

CISPPROH CONFERENCE BAG

Listerine

CISPPROH2018-7thANNUAL

INTERNATIONALSCIENTIFIC

SYMPOSIUMEXHIBITORS

LISTERINE

LASCO

COLGATE

MEDICAL & DENTAL SUPPLIES

OPTIUM TRADING LTD

DIMED

CORNWALL MEDICAL & DENTAL SUPPLIES

LAWES INSURANCE BROKERS

TASTE OF THE CARIBBEAN

FACEY COMMODITY

HEART FOUNDATION OF JAMAICA

TechnicalInformation

� CISPPROH 2019 Symposium Announcement

� Infection Prevention and Control Round Table

� CISPPROH Endodontic Conference

� Resource Information

� Symposium Attendees’ List

Speakers’Biosketches

OSAP 2018 SYMPOSIUM FACULTY

� Professor Isabel Holroyd

� Professor Raymond Dionne

� Professor Sharon Robinson

� Associate Professor Eve Cuny

� Associate Professor Marcelo Valle

� Dr. Andrea Daley

� Dr. Arnoldo Ventura

� Dr. Bruce Seidberg

� Dr. Carlene Davis

� Miss Dani Dougan

� Dr. Denise Young-Brady

� Dr. Judith Lieba

� Dr. Lambert Innis

� Miss Irene Iancu

� Dr. Kevin Goulbourne

� Dr Hamlet Nations

� Adjunct Professor Irving McKenzie

� Adjunct Associate Professor Winston Grey

Professor Isabel Holroyd BSc, BDS, FDS – Paed Dent Intercollegiate

Professor Holroyd is currently a Consultant in Paediatric Dentistry, Eastman Dental Hospital,

University College Hospital Foundation Trust, 256 Grays Inn Road, London WC1X 8LD and an

Honorary Lecturer at the University College London, in Certificate courses on Sedation in

Dentistry and Paediatric dentistry. For antecedent she possess a BSC (Hons) 1985 Bio Sci Leic

Univ, BDS 1989 UCLH, FDS (RCSEng) 1993, GDC Specialist list 1999, FDS Paed dent Intercollegiate.

Professor Raymond Dionne DDS, MS –Pharmacology, PHD

Professor Raymond Dionne is a Research Professor in the Department of Pharmacology &

Toxicology in the Brody School of Medicine and Department of Foundational Sciences in the

School of Dental Medicine at East Carolina University. Professor Dionne's research focuses on

novel therapeutic agents and neurohumoral responses to acute pain and surgical stress.

Significant contributions of his work include the use of pre-emptive analgesia and the

pharmacologic basis of pain and anxiety control.

Professor Sharon Gordon DDS, MPH, PHD

Professor Sharon Gordon is the Dean of the ECU School of Dental Medicine, and prior to that

served as the inaugural Associate Dean for Research and Chair of Foundational Sciences at that

institution. She earned a DDS from University of Texas Health Science Center Dental School at

San Antonio and completed a two-year general practice residency at Medical Center Hospital in

San Antonio. She earned a Master of Public Health in Epidemiology in 1997 and PhD in Clinical

Investigation in 2003 from Johns Hopkins University. Dr. Gordon serves as the inaugural Associate

Dean for Research and Chair of Foundational Sciences at the ECU School of Dental Medicine. She

earned a DDS from University of Texas Health Science Center Dental School at San Antonio and

completed a two-year general practice residency at Medical Center Hospital in San Antonio. She

earned a Master of Public Health in Epidemiology in 1997 and PhD in Clinical Investigation in 2003

from Johns Hopkins University. Prof Gordon is well published and is an active researcher.

Associate Professor Marcelo Ignacio Valle Maluenda DDS, MSD-Paediatric Dentistry

Associate Professor Marcelo Maluenda is an accomplished Paediatric dentist and a member of the

International Association of Paediatric dentists. His special interest covers 1) Behavioural management

and Special Oral Health Care Needs Patients, 2) Oral Rehabilitation of the paediatic patient and conscious

sedation. Associate Professor Marcelo is well published and he is an international presenter at the IAPD

symposia.

Dr Bruce H. Seidberg, D.D.S., M.Sc.D., J.D.

.

Dr. Seidberg is a Diplomate of the American Board of Endodontics; he is also a Fellow of the American

College of Legal Medicine, American College of Dentists, American Association of Hospital Dentistry and

the Pierre Fauchard Academy. Dr. Seidberg has lectured about and contributed articles on dental and legal

literature, including a chapter about dental legal issues in the 5th through 7th editions of Legal Medicine,

and a chapter in the 6thedition of Endodontics. He has served two terms on the AAE Board of Directors

and as president of the New York State Association of Endodontists. He is a past president of the American

College of Legal Medicine and is currently secretary of the Onondaga County Dental Society while

maintaining a private practice in Syracuse, N.Y.

Dr Denise Young-Brady DDS Cert in Periodontology

Dr. Denise Young –Brady is a Graduate of Howard University and Nova South Eastern University. An

Analytical, detail-oriented periodontist with extensive training in dental education and employee

development and a dedicated professional. Dr. Brady is a hobbyist event planner/ coordinator, licensed

chaplain by the Church of God Chaplain’s Commission and an ordained minister. Dr. Young Brady was an

Adjunct Professor, Nova Southeastern University Dental Clinic 2000-2002.

Miss Dani Dougan RDA, RDH, BSc

Dani Dougan, DA, RDH, BSc. is the founder of Joyful Scalers and has over 20 years of experience as an

Expanded Function Dental Assistant and over 14 years of experience as a Dental Hygienist. Dani is always

active in the community bringing the importance of oral health to underserved communities by

participating in community health fairs throughout the Washington, DC area.

Dani has served as Adjunct instructor at Fortis College Dental Hygiene Program, fulltime Instructor at

Howard University Dental Hygiene Program, Instructor for Hygiene Associates Radiology and Expanded

Functions for Dental Assistants. She also served as Program Director Dental Hygiene and Dental Assisting

University of Technology, Kingston Jamaica, Program Director Dental Assisting Fortis College Towson, MD.

Dani’s interests include empowering young people to be excited about the profession of dentistry. Also,

empowering her colleagues to reach higher and get outside of their comfort zone. Her personal interests

include singing in the church choir, traveling, shopping and gardening. She is currently pursuing a Masters

in degree in Education with a focus on leadership Concordia University

Associate Professor Evelyn Cuny

Director of Environmental Health and Safety, Associate Professor, and Assistant Dean at University of the

Pacific

Eve Cuny is involved Managing policy, training and education for patient, occupational, environmental

and student health and safety. Develop and maintain risk management program to enhance patient

safety. Maintaining and growing relationships with international partners, and managing student

outreach, exchange and activities internationally.

Outside activities have included serving as a consultant to the ADA Council on Scientific Affairs and expert

reviewer to the Centers for Disease Control and Prevention. Member of the National Occupational

Research Agenda Council, healthcare and social services sector with the National Institute of Occupational

Safety and Health (NIOSH). Current board member

Dr. Kenisha Nelson PhD

Kenisha Nelson is a full-time lecturer in the Faculty of Education and Liberal Studies (FELS) at the University

of Technology, Jamaica where she teaches psychology related courses. She is currently the module

coordinator for Introduction to Psychology and the FELS research coordinator. Kenisha is Commonwealth

Scholar and holds a B.Sc. in psychology with a minor in Human Resource Management from the University

of the West Indies (UWI), Mona, a M.Sc. in Clinical Psychology from Pittsburg State University, Kansas,

and Ph.D. in Psychology with an emphasis in Occupational Health Psychology from Cardiff University. Her

research interests include stress-related working conditions, health and well-being, coping, and help-

seeking behaviors.

Dr. Kevin Goulbourne MBBS, DM (Psych)

Dr. Kevin Goulbourne hails from cool hills of Malvern in St. Elizabeth where he obtained his formative

education at Bethlehem All-Age School. After completing his secondary education at Munro College he

pursued his first medical degree, M.B.B.S. at UWI, Mona and later specialized in the field of Psychiatry in

1999. He has special interest in drug abuse treatment and completed in 2007 Hubert Humphrey

Fellowship in Drug Abuse and Health Services Management at Virginia Commonwealth University,

Richmond, USA. He was involved in the pilot drug treatment court in Jamaica which is a court that

sought to combine drug abuse treatment with judicial oversight. Currently, he serves as board member

of Patricia House, a drug abuse rehabilitation facility in Kingston. He has attended conferences and

training here and overseas in the field of psychiatry. He has done presentations to different audiences

on general medical and mental health topics.

He served as the Regional Psychiatrist in the Western Regional Health Authority from 2000 to 2010 and

later worked for few months as a Consultant Psychiatrist at Bellevue Hospital. He occupied the post of

Medical Director of the Medical Services Branch in the Jamaica Constabulary Force (JCF) until 2018

where he has been involved in an ongoing drive to encourage healthy life style and early intervention in

treating medical conditions through regular screening of members of the JCF. Currently he is the

Director of Mental Health and Substance Abuse Unit in the Ministry of Health.

He is married. In his spare time, he likes to engage in outdoor activities such as football, cricket, cycling

and lawn tennis. He has been assisting in Linstead and Havenhill Baptist Churches’ medical outreach

activities. He has received training in Disaster Mental Health and is a member of Psychosocial Team of

the Jamaica Red Cross. He is a member of the Runaway Bay Tabernacle.

Judith Andrea Leiba , MBBS, DM (Paed), DM (Psych)

Dr Judith Leiba is considered by many as the quintessential child psychiatrist due to her professional

acumen, and the passion she displays as she carries out her day to day professional activities, both in

Government Health Services in Jamaica and in the private sector. For her antecedents, Dr. Leiba is a

graduate of the University of the West Indies (UWI), where she completed both her undergraduate

medical degree (MBBS) and her postgraduate medical qualifications [DM (Paeds) and DM (Psych)]. Dr

Leiba is therefore duly qualified as a Paediatrician and Psychiatrist. She also boasts two fellowships in a)

Pathology and b) Child Health and Youth Psychiatry respectively from UWI.

Dr. Leiba is currently employed to the Ministry of Health as the Director of Child & Adolescent Mental

Health Services for the island of Jamaica since 2006. She has also acted as the National Director for

Mental Health and Substance Abuse for the period 2017 -2018. Prior to 2006, she worked at the

Bustamante Hospital for children in the capacity of a Child and Adolescent Psychiatrist at the Child

Guidance Clinic. Dr. Leiba has worked in various health capacities within the Public Health Services and

private sectors with excellent commendations for her performance, as a corollary she is a devout

Christian and a great health and humanitarian volunteer through the aegis of her church and the

community.

CISPPROHCONFERENCEAGENDA

Dental Surgeon Agenda Day 1- October 28, 2018

7:30am: Registration

8:00am: Opening Ceremony

Keynote Presentations: (Scientific Session # 1) Chair –Dr. Irving McKenzie

9:00 Keynote Speaker: Pain Management Professor Raymond Dionne

9:40 Opioid addiction and the Health Care Professionals Professor Sharon Gordon

10:30 Risk Management and Informed Consent Dr Bruce Seidberg

10:35-11:00 BREAK

11:00 Inhalation Sedation Anaesthesia – Part 1 Prof. Isabel Holroyd

12: 10 Health Tourism –Opportunities and Risks, Dr. Hamlet Nation

is it worth it?

1:00pm LUNCH

Scientific Session # 2: Chair – Dr. Eugenia Hines

2:00pm Individualizing Care to Optimize Positive Professor Sharon Gordon

Outcomes for Patients with Chronic Orofacial Pain

3:00pm: Cognitive Behavioural Therapy for Pain Dr Kenisha Nelson Management

4:00pm Recent advances in Medical Marijuana EPICAN

DENTAL HYGIENISTS, TECHNICIAN & DENTAL NURSE/ THERAPISTS Agenda Day 1 –

October 28, 2018

7:30am: Registration

8:00am: Opening ceremony

9:00 Keynote Speaker Dr. Denise Brady, Periodontologist Tools, technology and guidelines for Perio-Implant Care

Scientific Session # 1: Issues in Pain Management Chair – Miss Shulan Allen

10:00 Behavioural Aspects of Pain Management Asst. Professor Marcelo Valle

11:00 Individualizing dental hygiene care to optimize good outcomes for Patients with chronic

Orofacial pain.

11:35am BREAK

Scientific Session # 2: Recent Advances in Dental Pain Management Chair – Miss Julene Allen

12:00pm Assessing Complications and addiction Dr. Andrea Daly

in Pain Management

1:00pm LUNCH

Scientific Session # 3 Session Chair: Ms. Merkeisha Williams

2:00pm Inhalation Sedation for Dental Hygienists Prof Holroyd and Therapists

3:15pm Listerine roundtable

3: 30pm Tooth Bleaching; Recent Advances and Application Ms. Dani Dougan

4:40 End of Day 1

DENTAL ASSISTANTS AGENDA DAY 1- October 28, 2018

7:30am Registration

8:00am Opening Ceremony

Scientific Session #1: Radiology Certification Course Session Chair: Mrs. Stacy Ann Pryce-

Brown

9:00 Keynote Speaker # 1 Biophysical consideration for diagnostic

Radiography

10:00 Radiology update: Part 1 Miss Dani Dougan

11:35am BREAK

Scientific Session # 2: Recent Advances in Session Chair: Mrs. Teika Linguard-Wolfe

Dental Pain Management

12:00am Keynote Speaker: Dr. Sharon Robinson

Preparing and assisting in handling Medical Emergency in the Dental Office

1:00pm LUNCH

Scientific Session # 3

2:00pm Medicolegal consideration for Dr. Bruce Seidberg

Dental records /documentation

3:00pm Dental Assistants and Special Asst. Professor Marcelo Valle

Health Care Needs Patient

Management

4:20 End of Day 1

Dental Surgeon Agenda Day 2 – October 29, 2018

7:30am Registration

Session Chair #3: Dr Rena Francis

8:15am: Opening Remarks

Keynote presentations

8:30 Pain Management beyond Opioid Analgesics Professor Sharon Gordon

9:35 Recent Advances in the Diagnosis and Professor Raymond Dionne

Management of Neuropathic Pain

10:40 BREAK

11:00 Inhalation Sedation Professor Isabelle Holroyd

01:00 Lunch

Session Chair # 4: Dr. Hilary Jones

02:00 Pain Management and Children on the Professor Marcelo Valle

Autism Spectrum Disorders

Scientific Session # 5 Session Chair: Dr. Daley

3:30 Clinical strategies for managing endodontic pain Dr. Bruce Seidburg

DENTAL HYGIENISTS & DENTAL NURSE/ THERAPISTS Agenda Day 2 – Oct. 29,

2018

7:30am Registration

Scientific Session # 1 Session Chair: Mrs. Sherell Bingling

8:05am Opening Remarks: Chair

8:15am The Role of Oral Health Care Professionals Associate Professor Eve Cuny

(Dental Hygienists, Therapists, and Assistants in maintaining good oral health and general health.

Scientific Session # 2 Session Chair: Nickeisha Reid-Thompson

9:20am: Understanding the Link between Oral Health Ms. Irene Iancu

and Systemic Health

10:00am Break

10:30am Promoting Excellence in Dental Hygiene Dani Dougan

Practice; Patient Centred Care

11:00am Infection Prevention and Control (Part 1) Associate Professor Eve Cuny

Scientific Session #3: Session Chair:

12:05pm Chronic Obstructive Pulmonary Diseases Dr. Carlene Davis-McKenzie

Scientific Session # 4: Session Chair: Dr. Claudia Leon

1:00 pm LUNCH

2:00 Comprehensive Treatment Decisions Based Dr. Denise Brady

on accurate Diagnosis, Radiographic interpretation, and classification of Periodontal disease

3:05pm From Research Writing to Publication: Dr. Arnoldo Ventura Tips and Techniques for Successful Scientific Writing

DENTAL TECHNOLOGISTS Agenda Day 2 – October 29, 2018

7:30am Registration

8:15am Welcome Remarks Mr. Andrew Williamson

Scientific Session # 1 - Session Chair: Mr. Williamson

8:30am Go digital: incorporating innovative TBD

digital techniques into today’s Dental

laboratory

9:35m Snoring & sleep apnoea – mandibular TBD

advancements appliances; a role for the

laboratory

10:30 BREAK

11:00 Combined Session on Infection Prevention Associate Professor Eve Cuny

and Control (Part 1)

Scientific Session # 2 Session Chair: Miss Simonette Wright

12:05am Fabrication protocol for double structure TBD

implant retained removable prosthetics

1:00 pm LUNCH

Scientific Session # 3 Session Chair:

2:00pm Patient-dentist-laboratory communication Associate Professor

and clinical protocols including indications, Winston Grey

contraindications, preparation requirements,

cementation and bonding requirements

3:05pm Workplace Hazardous Materials Information Adjunct Professor Irving

System (WHMIS) McKenzie

DENTAL ASSISTANTS Agenda Day 2 – October 29, 2018

7:30am Registration

8:15am Welcome Remarks

Scientific Session # 4

8:30am Radiology Part 2: Ms. Dani Dougan RDH

9:35m Recognizing Abuse and Neglect in the Clinical setting Dr. Judith Lieba

10:30 BREAK

11:00 Infection Prevention and Control (Part 1) Associate Professor Eve Cuny

Scientific Session # 5 Session Chair: Vivett Parchment

12:05am Inhalation Sedation for Dental Assistants Prof Isabel Holroyd

1:00 pm LUNCH

Scientific Session # 6 Session Chair: Vivett Parchment

2:00pm ERGONOMICS and Four Handed Dentistry Eve Cuny

3:05pm

Dental Surgeon Agenda Day 3 – October 30, 2018

7:30am Registration

Scientific Session # 1 Session Chair: Dr Shawnette Finegan

8:05 Recent Advances in Infection Prevention Associate Professor Eve Cuny

and Control in Dentistry

10:05 BREAK

10: 30 Emergency Severity Index (ESI) – triaging patient Dr Lambert Innis

management

11:30 Psychiatric and Psychological Challenges in Dr K. Goulbourne

Pain Management

12:30 LUNCH

1:30 Rosalee Warpeha Lecture: Dr Brian James

Clinical Decision Making in the Need and Demand for Sedation/General Anaesthesia in Medicine or

Dentistry

RESEARCH FORUM

2:30 pm

• Presentation by Stacianne Tennant – Health Literacy in Antenatal clients.

• Presentation by Dr. Su Yin Htun

• Scientific presentation “on the legislative and regulatory challenges to dental

• Public Health outreaches in Jamaica.”

• Presentation by Dr Rena Francis on Neuromuscular discomfort in Oral Health

Professionals.

• Presentation by Shane Mathews, Dental Student

5:10 pm Awards Presentation and Closing Ceremony

DENTAL ASSISTANTS, TECHNICIANS, DENTAL HYGIENISTS & DENTAL NURSE/

THERAPISTS Agenda Day 3 – October 30, 2018

7:30am Registration

Session 1 Chair: Samantha Rhule

8:30am Keynote Speaker: Dr. Marcelo Valle

Topic: Updates on Local Anaesthetics agents and Vasoconstrictors, clinical

considerations and Patient Care Planning

Session 2 Chair: Shana-Kay Simons

9:05 -10:05 Menarche and Menopause: exploring oral Dr. Olivia McDonald

& systemic implications in women’s health

10:05 -10:25 BREAKS

Session 3 Chair: Miss Stacianne Tennant

10:25am Caries Prevention Plan Irene Iancu

12:05pm Risk Management, Patients’ Consent Bruce Seidberg

and legal obligations

1:00 LUNCH

Session 4 Chair: Miss Julene Allen

2:00 Infection Prevention and Control (Part II) – Waterline - Eve Cuny

Spore testing, Waste Management, Dental

Research Forum: Undergraduate Student Research Competition (Participation and

Presentation)

3:00pm Research paper presentation

5:10 pm Awards Presentation and Closing Ceremony

Conscious Sedation the UK perspective

Inhalation Sedation

Lecture summary and handout for CISPPROH 2018

I. Holroyd 2018

Indications and evidence for paediatric sedation.

Children may require dental treatment for a variety of reasons, e.g. dental caries, anomalies, oral

pathology. Paediatric dentistry aims to treat children efficiently and encourage a positive attitude

toward dental care in the long term.

Dental treatment is invasive and can be difficult. Behaviour management problems (BMP)

maybe a barrier and linked to dental fear. A Swedish study reported 10.5% children with BMP in

a population of 4-11 year olds Klingberg et al Comm Dent and Oral Epidem 1994.

In order to treat children non-pharmacological techniques of behaviour management, such as

modelling, desensitization, tell show do techniques maybe used. However, for more challenging

treatments pharmacological techniques such as inhalation sedation (in the UK suitable for all

ages), intravenous sedation techniques (single drug midazolam 12- 16 years only in primary

care) or general anaesthesia maybe applicable.

In the UK the definition of ‘Conscious Sedation’ is widely agreed and represents a technique

where verbal contact is maintained throughout, with a wide margin of safety and loss

consciousness unlikely – Minimal or Moderate sedation.

In considering treating children, it must be understood they have a different:

• Anatomy – large heads, small mandibles, larynx anatomy

• Physiology – heart rate, BP, O2 consumption

• Behaviour, psychology- developmental stage

And in choosing the technique the procedure complexity, medical history – contra/indications,

coping ability/anxiety scale, training / operator skills, environment and facilities available; all

need consideration. Is there a scale to assess sedation need? IOSN; nil for paeds yet....Coulthard

P et al, BDJ 2011

Evidence?

The Cochrane Collaboration ‘Sedation of anxious children undergoing dental treatment

2005/updated 2006 L.Matharu, P.F. Ashley

This study found evidence for a variety of techniques but no definitive conclusions evidence for

oral sedation and inhalation sedation.

Various other systematic reviews:

• Lyratzopolous and Blain 2004 - nitrous oxide can be safe and effective for

paediatric sedation J of Pub H Med 2004

• McIntosh, Ashley and Lourenco-Matharu 2015 – intravenous midazolam safe

and effective Cochrane collaboration

• Papineni, Lourenco-Matharu, Ashley 2014- oral midazolam safe and effective

Cochrane collaboration

All weak evidence.

Standards and Guidelines in use in the UK

Dentists, dental therapists and hygienists have the competencies to provide inhalation sedation in

the general practice and hospital setting. The General Dental Council is the regulator; however,

the surgical colleges provide detail of standards for training. The main documents for the UK are

Intercollegiate Advisory Committee for Sedation in Dentistry – (IACSD) Standards for

Conscious Sedation in the Provision of Dental Care 2015 and Scottish Dental Clinical

Effectiveness programme- Conscious Sedation in Dentistry 2017.

IACSD-Published April 22nd, 2015

All aspects of training, syllabuses defined for dentists, therapists, hygienists and nurses. Training

should now be through a University or postgraduate training scheme (Deaneries). In house style

training must now be IACSD accredited.

The Standards define:

Preassessment, consent, recording; audit; CPD; resuscitation skills; patient information; practice

checklists.

For therapists and hygienists- Therapists and hygienists cannot prescribe nitrous oxide and

oxygen but can use it following a prescription from the dentist. The dentist does not need to be

on the hospital premises so long as the therapist/hygienist has an accurate prescription and is

appropriately supported. As an independent sedationist the therapist/hygienist must administer

the technique and apply knowledge competently.

Inhalation Sedation

A basic technique, suitable for all delivering subanaesthetic concentrations of nitrous oxide/

oxygen from dedicated machines through a nasal mask. Nitrous oxide was first administered for

a dental extraction by Horace Wells in 1844.

The advantages are that nitrous oxide has a rapid onset and recovery with a controlled duration

of sedation, the machines allow a titrated dose, hypoxia is prevented due to the levels of oxygen

and there are no special patient arrangements. However not all patients will accept a nasal mask,

pre-cooperative children, it is not profound for difficult procedures and the machines incur cost.

European Academy of Paediatric Dentistry guidelines 2007, define usage for dental anxiety,

special needs, moderate treatment needs, emergency care of trauma.

Nitrous oxide properties

Sweet odour/Non-irritant/ heavier than air. Carried simple solution. Low tissue solubility, with a

low blood gas partition coefficient, crosses blood brain barrier quickly and has a high MAC

value -104% so is a weak anaesthetic. It has a poor solubility, is carried in simple solution

unchanged and has no excretion products being exhaled unchanged through the lungs. It has a

CNS action acting on glutamate receptors in neurotransmission.

Nitrous oxide Safety

Nitrous oxide sedation in literature is considered a very safe form of sedation, with no reported

fatalities when used alone in dental setting.

Collado et al 2007 systematic review using 50% N2O/O2 of 140 trials could find only one

adverse event attributable to N2O alone- risk factor 3/10,000 to patients Exp Opin Drug Safety

2007.

Galeotti et al 2016 nitrous oxide sedation paediatric dental patients (n=472, 688 sedations)

success 86.3%, adverse effects 2.5% most commonly nausea and vomiting Biomed Res Int 2016.

Adverse events reported generally nausea/vomiting during treatment – incidence cited at 1% and

linked with fasting Galleoti A et al Biomed Res Int 2016.

American Academy of Paediatric Dentistry notes nitrous oxide to have a superior safety profile

when used within recommendations noting negative outcomes only when used above 50% or as

an anaesthetic in major surgery Council on clinical affairs 2005, revised 2013.

Post op diffusion hypoxia cause of side effects? but research suggests this is largely theoretical,

but good practice to give oxygen at the end of treatment.

Unusual Adverse events

Zeir 2010 reported 3 cases of children under 24 months having seizures during nitrous oxide

sedation for painful medical procedures. One child had history seizures, sedation used 60-70%

N2O – authors note nitrous oxide not contraindicated in epilepsy and has reduced stress in

affected patients Zeir JL and Doescher JS Journal of Child Neurology 2010.

Babl 2015 reported single case of laryngospasm of 16 month-old using full face mask in A&E

70% nitrous oxide was patient in deep sedation - unconscious? Drug reaction postulated to vary

between patients Babl FE et al Annals of Emerg Med 2015.

Patient Safety

In primary care IS is suitable for ASA I or II patients. It is safe for use in patients with

cardiovascular or cerebrovascular disease due to added oxygen, non-irritant to bronchial mucosa

and useful for patients with neuromuscular disorders and special needs. It is suitable for patients

with endocrine, hepatic disorders and there are no reported allergies to nitrous oxide itself.

Relative contraindications are noted however, the common cold, nasal blockage, sinusitis,

middle ear infections and psychiatric disorders. Absolute contraindications recorded are

pregnancy, where elective dental procedures not advised; chronic obstructive pulmonary disease-

depression of hypoxemic drive and cystic fibrosis. Cancer treatment-Bleomycin, Bisulfan

chemotherapy; raised intraocular pressure (intraocular gas/ treatment detached retina), retinal

surgery, tympanic membrane middle ear surgery.

Where a patient is noted to have medical considerations the patient’s medical team should be

consulted as appropriate before considering invasive treatment.

Pollution

Nitrous oxide is a greenhouse gas and has toxic effects on staff in chronic long-term

occupational exposure in unscavenged environments. Maximum safe concentration in health care

environment not determined. British Health and Safety Guidelines established a workplace

exposure limit 1994 - 100ppm for an eight-hour exposure TWA in 24 hours. Various countries

set exposure limits between 25-100ppm. Different Countries have legislation in place for

workplace materials hazardous to health (COSHH in the UK) and employers must comply.

Scavenging systems mandatory, active and passive systems in place understood to eliminate

significant risk to personnel by removing accidental pollution.

Studies regarding staff exposure:

Exposure of nurses significantly lower than operator/sedationist Girdler NM et al Int J Paediatr

Dent 1998. Exposure is increased if operator very close to the patient breathing zone.

Recommendations to reduce surgery pollution include:

• General ventilation -fans, windows, check air ventilation systems.

• Active scavenging system- vacuum pump/ central suction apparatus (set at flow 45l/min

NOISH).

• Technique/rubber dam with high volume suction.

• Various equipment providers can advise.

Equipment

E.g. MDM Quantiflex or McKesson machines, all have standard safety features. These are - BSI

70% N2O cut off, proportional delivery of O2/N2O, N2O cut out in O2 failure, Emergency O2

override, Air Intake valve, Colour coded cylinders non-interchangeable pipelines and pin index

system; Bodok Seals.

Clinical monitoring only is required; pulse oximeters are not required (IACSD 2015).

Technique

Following full patient dental assessment and suitability for sedation, medical history and relevant

information gathering, written consent parent/legal guardian, verbal and written instructions,

parental escort under 16s. For therapists and hygienists, the Dentist will have provided the

appropriate prescription and consent, but therapists and hygienists are expected to apply

their knowledge and seek advice if required, liaising with the referring dentist.

On treating the patient-

• Quiet relaxed surgery

• Settle patient

• Select mask

• Connect delivery pipes and set flow 100% O2 approx 6l/min-establish volume

• Check nosepiece for leaks

• Introduce nitrous oxide - suggest incremental technique up to approx 30% N2O : 70%

O2 Roberts GJ Dent Update 1990

When adequately sedated the patient should be:

• Awake and relaxed

• Responsive to verbal instruction

• Able to maintain an open mouth

• Experiencing subjective symptoms

• Patient should be treated flat with chin up to allow patent airway

• Spontaneous movements decrease

• Blink rate decreases

• Glazed fixed eye signs

• Able to respond to a command

Use of suitable behaviour management techniques, should also be applied. Semihypnotic

suggestion.

20-40% N2O generally ideal, 50-70% results in increase detachment, dizziness and decrease in

laryngeal/pharyngeal reflexes. Appropriate local anaesthesia is required. Encourage nasal

breathing throughout and discourage chatting.

Oversedation?

Early signs/symptoms:

Signs and symptoms of comfort and relaxation disappear:

Anxiety, distressed look/dizziness/mild headache

Management: Reduce N2O 5-10%

Assess and continue.

Late signs/symptoms: Check level of sedation? More than 50% N2O?

Extreme anxiety/crying/vomiting/ severe headache

Management: Stop N2O, O2 flush, give 100% O2; Reassess treatment plan

At the end of a treatment session:

Give 100% O2 for 2-5 minutes – prevent (theoretical?) diffusion hypoxia/scavenge expired N2O,

allow breathing of ambient air for 5 minutes. Check- headache, nausea or dizziness?

• Patient should be coherent, able to walk steadily

• Remember N2O will be entirely expelled via the lungs in 18-20 minutes

• Complete recovery in waiting room 10 minutes

• Patient should have escort if under 16 years

• Post op activity eg school at discretion

• Give post-operative instructions, both for IS and for treatment completed e.g.

warnings re LA, post extn.

Please note this is a lecture summary document only for information purposes for

CISPPROH delegates from the 2018 conference. I Holroyd 2018