SAAD Digest

AIMS: To review the literature, to investigate whether there was aconsensus on what encompasses over-sedation, and to determine the guidance employed for the administration of flumazenil. METHODS: A literature search was performed following which a self-designed questionnaire was emailed to 14 sedation leads within UK Dental Hospitals. RESULTS: 10 documents in the literature review met the inclusion criteria. In their definitions of over-sedation, loss of consciousness and respiratory depression were the main terms used; but a variety of terms were also seen, indicating a lack of agreement...

Allergic cross-reactivity between propofol and food is frequently considered as a risk factor for perioperative allergic hypersensitivity reactions and anaphylaxis during dental anaesthesia and sedation. Better understanding of of this cross-reactivity is important to providing safe care. There are, however, conflicting assumptions about anaphylactic reactions to propofol in patients reporting allergy to certain type of the food. Egg and/or soya allergy are often cited as contraindications to propofol administration but the evidence remains unclear...

AIM: To evaluate current level of safety under the care of an escort following intravenous sedation, post-sedation arrangements and to identify potential risk levels. BACKGROUND: Information and post-sedation arrangements are important to patients'safety following surgery but although there is a general consensus over what is recommended for patients and their escorts, there is little, if any, literature on the escorts' awareness of sedation and accordance to post-sedation arrangement and recommendations...

Sedation is frequently desired to facilitate dental procedures in uncooperative paediatric patients. Oromucosal Midazolam sedation is a popular choice among paediatric dentists world wide due to its many advantages such as ease of administration, good efficacy, presence of reversal agents and a wide margin of safety. On the other hand, many investigators have reported that midazolam sedation may not be successful for carrying out all types of dental procedures. This may be attributed to diverse nature of various treatment plans coupled with the extent of behavioural changes in the child and operator's experience...

AIM: To review the current teaching of the use and administration of local anaesthesia in United Kingdom dental schools, along with their local guidelines and protocols. METHODS: A qualitative and quantitative questionnaire was sent to sixteen UK dental schools to probe the methods of local anaesthetic teaching within each school. RESULTS: 14 of the 16 schools replied and the responses show a variety of practices being taught in the dental schools...

An understanding of mental capacity is fundamental to the process of obtaining valid consent. This article looks at the processes of both consent and capacity assessment, and highlights the importance of fully informed consent following recent changes in the law.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

Endodontic therapy is often of concern to patients, frequently due either to the expectation, or experience of pain. Managing this pain before, throughout and after a procedure is not only beneficial to a patient but reflects upon their dentist. To achieve effective pain relief different methods of pain control, including a pharmacological plan and the use of anaesthetics, must be individually tailored for each patient alongside an appropriate diagnosis and treatment plan.

Dental anxiety is well documented within dental literature, and is a condition with which dentists and dental care professionals alike will be familiar. Its consequences may extend beyond dental implications alone, but can also have the potential to affect a patient's quality of life. It is important that as a dental profession we are aware of the methods which can be used to manage various forms of dental anxiety, and to refer to specialist services as appropriate. This paper focusses on detailing both the evidence-based behavioural and pharmacological strategies that may be employed for both dentally anxious adults and children...

Identifying the causes of dental anxiety by taking a history and carrying out investigations for patients attending for any type of dental procedure, can be time consuming. Common causative factors of dental anxiety can be previous adverse dental experiences, age, temperament or socioeconomic factors. These factors can lead to patients falling into a cycle of dental avoidance and greater treatment need with attendance for symptomatic relief only. Treatment using pharmacological methods such as conscious sedation or general anaesthesia can help overcome these obstacles, however, although a successful treatment outcome may result, how is the patient to gain trust and overcome their anxiety or fear, if they do not learn from the experience? In 1967 Nathan Friedman described a method he termed 'Iatrosedation' consisting of two components, the interview and the clinical encounter...

INTRODUCTION: Dental anxiety is an important factor in influencing patients' decisions to access treatment. It is crucial dental care professionals understand its causative factors in order to prevent and manage it, particularly as dentally anxious patients often have poor oral health. This report is of an elective study that tried to ascertain whether children with signs of dental neglect suffered greater dental anxiety, as existing research suggests that anxiety can stem from previous experiences...

This audit aimed to identify the prevalence of, and reasons for failed intravenous conscious sedation in an adult oral surgery department, to develop recommendations to reduce such failures and to identify any cost implications. Data were collected prospectively for three months for all intravenous sedation appointments in the Oral Surgery department. Data were collected for 109 sedation appointments of which 83 were successful (76%). The failure rate (24%) was higher than the acceptable departmental failure rate (10%), and included reasons for failure that should have been avoided by a thorough patient assessment prior to treatment...

OBJECTIVE: This research explores the attitudes of medical professionals towards fasting patients prior to the use of conscious sedation. MATERIALS AND METHODS: Questionnaires were completed by a total of 113 dentists, anaesthetists and dental nurses in order to identify current practices and opinions concerning the employment of pre-operative fasting in the context of conscious sedation in dentistry. RESULTS: Seventy-eight (69%) respondents did not recommend fasting, compared with 35 (31%) who did...

Post-operative pain is a common occurrence within dentistry. The causative factors are not solely dependent on the procedure but a part is also played by the patient's ability to self-cope as well as their level of anxiety. This article discusses the effectiveness of analgesia available for prescription by general dental practitioners based on systematic reviews in the literature, with particular reference to third molar removal. In addition, other methods that can help reduce pain in the post-operative period are addressed, including the types of local anaesthetic used for the procedure and psychological aspects of patient care...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

UNLABELLED: Advanced conscious sedation techniques for dental procedures include continuous propofol infusion and combinations of midazolam and fentanyl. A course based on the Independent Expert Group on Training & Standards for Sedation in Dentistry (IEGTSSD) training syllabus was set up in 2012 to provide training in these techniques. Training involved: self-directed study modules; attendance at didactic teaching day; presentation by candidates of knowledge; medical emergency simulated training; written examination; supervised cases; and submission of case logbook...

No abstract text is available yet for this article.