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Biomedical subjects

P C Makkes

Publications and source records attributed to P C Makkes.

At least 19 recordsLinked to original sources
PubMed2006

[Nitrous-oxide sedation indispensable in the dental care of anxious people and the mentally impaired].

The long-term occupational exposure to high concentrations of nitrous oxide in health-care workers in a Dutch hospital, with probable adverse effects on their offspring, has triggered a discussion about the benefits and risks of nitrous oxide. In Dutch dentistry, nitrous-oxide sedation is a valuable and indispensable aid in the treatment of patients with challenging behaviour, such as those with mental impairment or in extremely-anxious adults and children. Nitrousoxide sedation can be used without risk to the dental team, provided that measures are taken for sufficient scavenging and room ventilation. A possible ban on nitrous oxide would be a major setback for specialty-care dentistry in the Netherlands.

Anesthesia, Dental↗
PubMed2005

[Guidelines for the treatment of highly anxious dental patients].

Treatment of extreme or pathological forms of dental anxiety requires specific skills. This paper is an attempt to formulate a number of treatment strategies, based on the available literature and effectiveness studies. It is suggested that based upon the assessment information three types of problem areas can be identified, namely, 1. a phobia of specific dental procedures or situations; 2. long overdue requiring acute dental treatment; and 3. intrusive or interfering psychiatric symptoms. In this article these problem situations are reviewed and several appropriate treatment options are discussed.

Anxiety Disorders↗
PubMed2004

[Treatment strategies for anxious adults in general dental practice: guidelines for mild forms of anxiety].

In this article an attempt is made to formulate a number of general clinical guidelines, based on the currently available knowledge and clinical experience within the area of dental anxiety. It is concluded that, in case of mild forms of anxiety, a careful treatment approach of the dental practitioner--which is focused on a style of establishing trust, specific pharmacological support and the teaching of coping strategies--can reduce patients' anxiety level, thereby preventing avoidance behaviour and deterioration of the oral health.

Anxiety Disorders↗
PubMed2001

[Extremely anxious patients: does treatment achieve the desired effect?].

The aim of the present study was to determine the outcome of treatment of several treatment modalities utilized at the Centre for Special Dental Care in Amsterdam, the Netherlands. Outcome was assessed in 341 patients in terms of dental anxiety after treatment (response 65%) and dental attendance one year later (response 74%). After treatment, patients treated with a behavioral management approach had lower dental anxiety scores than patients treated with intravenous sedation. Furthermore, one year after treatment 66.7% of the treated patients indicated to visit a general dental practitioner regularly. It is concluded that treatment was effective. However, it was felt that dental attendance level could be increased by a change in the referral procedure to general dental practitioners. It is recommended that a psychologist is involved in diagnosis and treatment planning in dental fear clinics.

Adolescent↗
PubMed2000

Dental anxiety reduction and dental attendance after treatment in a dental fear clinic: a follow-up study.

OBJECTIVES: The aim of the present study was to assess treatment outcome in terms of dental anxiety reduction at a post-treatment assessment and dental anxiety reduction and dental attendance one year later. Furthermore, it was determined to what extent psychopathological characteristics were related to treatment outcome. METHODS: Questionnaires were sent to 280 patients treated with one of three treatment modes (i.e., behavioral management (BM), nitrous oxide sedation (NOS), and intravenous sedation (IVS)) at a dental fear clinic in The Netherlands. Dental anxiety before (T1) and after (T2) treatment was assessed using the Dental Anxiety Scale (DAS) and the Short version of the Dental Anxiety Inventory (S-DAI); the Symptom Checklist 90 (SCL-90) was used to assess general psychopathology. Dental anxiety was assessed again a year later and patients were questioned about their dental attendance pattern (T3). RESULTS: ANOVA showed that the DAS and S-DAI scores at T2 and T3 were statistically significant lower than the initial scores. In addition, IVS patients showed less anxiety reduction than BM patients at both T2 and T3. Of the 145 patients whose last visit to the clinic was at least one year ago, 62% had visited a GDP at T3. A regression analysis revealed that, beside treatment mode, somatization, number of visits to clinic for dental treatment, and number of months between first and last visit to the clinic predicted dental anxiety at follow-up. CONCLUSIONS: It is concluded that, although a reduction in dental anxiety level was present, a relatively large proportion of patients did not improve, in terms of both dental anxiety and dental attendance.

Adolescent↗
PubMed1999

Treatment modalities in a dental fear clinic and the relation with general psychopathology and oral health variables.

OBJECTIVE: To assess differences among highly anxious dental patients assigned to different treatment modes (i.e. behavioural management (BM), nitrous oxide sedation (NOS), intravenous sedation (IVS). Patients were compared with regard to psychological and dental variables before treatment (e.g. number of decayed teeth), and dental variables after treatment (e.g. number of fillings made). DESIGN: Dentists experienced in the treatment of highly anxious patients allocated patients to a treatment mode based upon their clinical judgement. SETTING: Centre for Special Dental Care, Amsterdam, The Netherlands. SUBJECTS: 211 patients from this dental fear clinic. MEASURES: General psychopathology, as measured by the Symptom Checklist 90 (SCL-90), and dental anxiety (DAS, S-DAI, 10-point scale) were measured prior to treatment. From the panoramic radiograph the following pre-treatment dental variables were assessed: number of teeth, number of decayed teeth, number of retained roots, and number of root-filled teeth. After treatment, number of fillings, extractions, endodontically treated elements, number of visits, and treatment duration, were determined from the patients' records. RESULTS: Of the 144 patients who received dental treatment at the clinic, 46.5% was treated using a BM approach, 27.8% with NOS, 22.9% with IVS, and 2.8% under GA. No differences among the treatment groups were found with regard to SCL-90 and dental anxiety. The results showed that patients in the IVS group had statistically significant more decayed teeth than patients in the BM group. Furthermore, more fillings were made in the IVS group than in the BM group. CONCLUSION: Since it appeared possible to treat a large proportion of patients by BM alone, training dentists in the application of psychological methods for the treatment of anxious patients should be stimulated. In addition, future research should seek for variables that, besides oral health, are better able to discriminate between groups of highly anxious patients than measures of dental anxiety and psychopathology.

Adolescent↗
PubMed1998

Pharmacokinetics of propofol during conscious sedation using target-controlled infusion in anxious patients undergoing dental treatment.

Infusion of propofol by a target-controlled infusion (TCI) system is effective in achieving conscious sedation for anxious patients presenting for dental surgery. It is a common clinical observation that anxious patients require more anaesthetic drugs than non-anxious individuals. In study 1 we have defined blood propofol concentrations necessary for conscious sedation in both anxious (n = 23) and non-anxious (n = 18) patients. The pump performance of the TCI system, using Gepts' pharmacokinetic model, was evaluated in these two patient groups. Subsequently, clearance of propofol was compared in the two groups. Mean measured venous serum propofol concentrations obtained between 20 and 35 min after the optimal sedation level was reached were 1.6 (SD 0.2) micrograms ml-1 in the anxious patients compared with 1.7 (0.3) micrograms ml-1 in the control group (study 1) and 1.4 (0.27) micrograms ml-1 in study 2. The pump systematically overpredicted measured propofol concentrations in both groups (study 1). There was no significant difference in propofol clearance between the two groups. In study 2, an optimized set of microconstants was derived which should more accurately predict the pharmacokinetic profile of the anxious population and this set was tested prospectively in another group of 12 anxious dental patients. Bias and precision with the optimized kinetic set were significantly less than the values obtained in study 1. We conclude that there was no significant pharmacokinetic differences between anxious and non-anxious subjects receiving subanaesthetic doses of propofol for conscious sedation.

Adolescent↗
PubMed1998

Patient-controlled versus anesthesiologist-controlled conscious sedation with propofol for dental treatment in anxious patients.

UNLABELLED: In a randomized, cross-over study, we prospectively compared the efficacy and quality of two methods to achieve conscious sedation with propofol in 11 unpremedicated, anxious dental patients. Each patient underwent two dental procedures, one that was conducted under target-controlled infusion (TCI) by the anesthesiologist (ACS), and the other that used patient-controlled sedation (PCS). The initial target concentration in the ACS mode was 2.5 microg/mL, which was manipulated in both directions until the desired clinical end point was achieved. In the PCS mode, a 4-mg bolus of propofol (10 mg/mL) was delivered at each activation of the machine, infused over 7 s without a lockout interval. The anxious dental patients could induce and maintain conscious sedation with the PCS settings. The mean (range) venous blood propofol concentrations were not significantly different with either mode: ACS 1.8 (0.8-2.7) microg/mL and PCS 1.2 (0.2-2.5) microg/mL. The level of patient satisfaction, quality of sedation, and treatability were not different for either mode of sedation. The intensity of amnesia for intraoperative events was related to the blood concentrations achieved. In the ACS mode, one patient became unresponsive (sedation level 4) immediately after the start of sedation. No adverse cardiorespiratory effects resulted from either mode of propofol sedation. Five patients expressed a strong preference for PCS, and three would prefer ACS in the future. The results of the present study suggest that with these PCS settings, a satisfactory level of conscious sedation and a high level of patient satisfaction was achieved. IMPLICATIONS: In a randomized, cross-over study, the blood propofol concentrations necessary to achieve conscious sedation in anxious dental patients using a target-controlled infusion conducted by the anesthesiologist versus patient-controlled sedation were not different. With the patient-controlled sedation settings, a satisfactory level of conscious sedation and a high level of patient satisfaction were achieved.

Adult↗
PubMed1998

[Treatment of anxious patients in special dental care centers. From local initiatives to organized dentistry].

OBJECTIVE: Since the eighties, dental treatment of extremely anxious adult patients became possible in centres for special dental care. In 1996 regulations were formulated about dental treatment for extremely anxious dental patients in these centres. The aim of the present study is to determine how dental treatment of these patients was organised before the regulations were formulated. DESIGN: Descriptive study. SETTING: Twelve centres for special dental care where the largest numbers of anxious patients were treated. METHODS: Semi-structured interviews were held with dentists working in these centres. RESULTS: The results indicate that not (yet) everywhere dentists work according to the regulations. In addition, questionnaires to determine the dental anxiety level and the indications for the different treatment modalities differed between the centres. CONCLUSION: The majority of the centres do not have the capacity to treat the number of patients seeking treatment. It is recommended that research should determine the efficacy of treatment in the centres and should assess which treatment modality is most appropriate for which patient.

Adult↗
PubMed1997

Computer controlled infusion of propofol for conscious sedation in dental treatment.

OBJECTIVE: To assess a drug delivery system that can rapidly achieve and maintain a constant blood concentration of Propofol (2,6 di-isopropyl phenol) which, in subanaesthetic doses, is an effective intravenous sedative for treating anxious or handicapped patients in dentistry. DESIGN: The clinical use of a computer controlled infusion system to induce and maintain conscious sedation with propofol was prospectively studied. Based on a 3-compartment pharmacokinetic model, the system calculates the initial bolus dose and infusion rates to achieve a user-selected target blood concentration. SETTING: Amsterdam Center for Special Dental Care. SUBJECTS: 89 patients attending for dental treatment. RESULTS: Treatment could be performed within 2 minutes after the onset of the infusion. The median therapeutic target blood propofol concentration was 2.5 micrograms/ml and the median recovery time was 9 minutes. Transient oversedation (38 procedures) could easily be treated by decreasing the target concentration. No adverse cardiorespiratory effects resulted from propofol sedation. Venous blood propofol concentrations were measured in 25 anxious patients. The kinetic data set used in this study underestimated the distribution and elimination of propofol in our patients. CONCLUSIONS: Computer controlled infusion of propofol can provide satisfactory and safe conscious sedation in dental patients.

Adolescent↗
PubMed1996

[Treatment for dental anxiety. Evaluation of treatment of patients with anxiety].

This article presents the results of a study among 332 extremely anxious persons who applied for treatment at SBT, a Dutch special dental care clinic, between July 1990 and December 1991. It was found that 85% of these persons actually started treatment. Two and a half years later it appeared that 39% of them still received regular treatment, whereas 34% had completed treatment. Twelve percent stopped visiting before treatment was completed. Furthermore, results showed that dental anxiety was reduced after treatment. However, 36% of the patients still avoided appointments with a dentist. It is concluded that for most of the dentally anxious patients specialized care and oral health are no guarantee for regular dental attendance in the long term.

Adolescent↗
PubMed1996

[Local anesthesia in dentistry. Additional techniques].

Patients with insufficient coping abilities can yet be dentally treated by practising several additional techniques. Behaviour management should always be the starting point of all dental treatment strategies. In the end the administration of well selected drugs should lead, via anxiolysis, sedation or general anaesthesia, to a painfree and optimal treatable patient.

Anesthesia, Dental↗
PubMed1992

Attendance pattern of anxiety-treated dental patients: a pilot study.

Ex-patients of a dental fear clinic were found to have significantly reduced, yet still high, dental anxiety scores in comparison with the pre-intervention scores. In spite of the intervention about one quarter of the ex-patients did not visit a dentist regularly. A positive relationship was found between dental anxiety, measured with Corah's DAS, and "dislike of drilling". A short duration of (self-reported) psychophysiologic anxiety reactions appeared to be associated with the intention to ask for treatment, e.g. if a cavity were present. However, regular dental attendance was not correlated with dental anxiety scores.

Adult↗
PubMed1992

A comparison of the effects of propofol and nitrous oxide on the electroencephalogram in epileptic patients during conscious sedation for dental procedures.

The influence of sedative doses of propofol or nitrous oxide on the electroencephalogram was studied in 11 mentally handicapped patients with treated epilepsy undergoing dental procedures. At one session, propofol was titrated to achieve conscious sedation. The mean (+/- SD) dose requirements were 5.5 +/- 1.1 mg.kg-1.h-1. In six patients, the electroencephalogram was unchanged during propofol administration. In three patients, there was a decrease in epileptic activity, and in two patients, paroxysmal discharges disappeared. At another session, nitrous oxide was administered by nasal mask. The mean (+/- SD) concentration of nitrous oxide needed was 43.6% +/- 4.8%. The electroencephalogram did not change in nine patients, whereas in two patients epileptic activity decreased. There were no clinical epileptoid or other adverse manifestations during any treatment or up to 48 h thereafter. The results of the present study suggest that propofol or nitrous oxide can be administered in subanesthetic doses for conscious sedation in mentally handicapped patients with treated epilepsy.

Adolescent↗
PubMed1991

[Nitrous oxide as a sedative in dental treatment].

In the Netherlands nitrous oxide is also used as a sedative to improve the quality of dental treatment of emotionally disturbed patients. During the inhalation of low concentrations of nitrous oxide (20%-40%) in oxygen a patiënt can relax more easily, comes to a different mood and is more able to cooperate with the dental team. As a result, efficacy and quality of the dental treatment come to a higher level. Apart from the technical improvements, there is a notable improvement in the whole dental situation and the subsequent emotional comfort of the patiënt.

Affective Symptoms↗
PubMed1990

Value of the teeth.

A random sample of 542 respondents answered questions concerning the value assigned to the teeth, dental attendance pattern, oral health status, and dental anxiety. Non-linear multivariate analysis showed the data regarding value attached to the teeth to contain two dimensions, of which the second one was deleted due to extreme answer patterns (skewed distributions) on the pertinent variables. Repetition of the analysis, including a plot of the respondents, made it possible to discern four subsamples, characterized by specific answer patterns. In the discussion attention was given firstly to the separate variables estimating the value attached to the teeth, and next to the four subsamples, taking into consideration the dental attendance pattern, oral health status, and dental anxiety. It was concluded that the multivariate approach reveals that the respondents are of a rather high heterogeneity.

Adult↗
PubMed1990

[Anesthesiological support for special dental care].

Many mentally and/or physically handicapped and anxious dental patients do not receive adequate dental treatment because effective ways of supportive treatment are insufficiently known and/or available to dentists. The pharmacologically induced treatment methods: oral sedation, inhalation sedation, intravenous sedation and general anesthesia are discussed. Centres of Special Dental Care are strongly recommended in order to accept the challenge to search for, study and apply those treatment possibilities which are appropriate to these specific patients. Thereby the standard of dental care which could be achieved would be comparable to that for normal patients.

Anesthesia, Dental↗