Day Case IV Sedation
Before considering dental treatment under conscious sedation all the alternative methods of anxiety management should be attempted. However, the provision of adequate anxiety control is an integral part of the practice of dentistry. The General Dental Council has indicated that this is both a right for the patient and a duty of the dentist.
All patients deserve appropriate anxiety control for any dental procedure; in order to be appropriate the methods used must be considered for the individual patient having a specific treatment. At the Carholme Dental Practice conscious sedation is provided for the nervous patient. Conscious sedation is defined as maintaining verbal contact with the patient at all times during the procedure and the patient’s protective reflexes are maintained (whereas in general anaesthesia these are lost).
Principles of Good Sedation Practice
Good sedation practice requires practitioners to consider a range of non-pharmacological and pharmacological methods of anxiety management in treatment planning for individual patients. It is essential that conscious sedation be provided to the highest possible standards.
Recording of blood pressure is part of the assessment process for all patients having intravenous sedation, unless lack of patient compliance renders pre-sedation measurement impossible.
Facilities at the Carholme Dental Practice
Treatment and recovery areas are large enough to enable adequate access for the dental and medical care team. All equipment and drugs recommended for treating medical emergencies and sedation-related complications are immediately available. The equipment is constantly maintained and serviced every 6 months.
The clinic has a purpose built recovery room and is staffed by a team of qualified recovery nurses.
All sedation surgeries are equipped with necessary monitoring equipment as recommended by the Royal College of Anaesthetists. Such machines are maintained according to manufacturers’ guidance with regular, documented servicing.
Are you a Candidate for Day Case Sedation Dentistry?
If you have any of the following – the answer could be yes:
- Fear of dental treatment
- History of traumatic dental experiences
- Difficulty getting numb
- Very sensitive gag reflex or difficulty opening
- Extremely sensitive teeth
- Medical conditions potentially aggravated by stress
- Special needs
- Often make and then cancel dental appointments
Many people are fearful of dental treatment, which is often based on a past experience of something unpleasant happening at the dentist.
- You may have little or no memory of the experience.
- You may not remember any sounds or smells.
Patients with any of the following conditions are NOT SUITABLE as day cases.
- Living alone with no responsible adult to look after the patient after leaving the clinic.
- No responsible adult to accompany the patient home.
- No access to a hospital.
A thorough medical, dental and social history is taken to ensure that the conscious sedation technique chosen is the most appropriate to enable treatment to be carried out for each individual.
Non-English speakers without an interpreter cannot be treated
- Myocardial infarction in the last twelve months
- Patients with severe cardiac symptoms
Patients who have required Steroids for prolonged periods in the last 6 months.
Children under 3 years of age or under 15KGs
Known DRUG ADDICTS or ALCOHOLICS.
Previous Anaesthetic History:
Any complications in patient’s previous anaesthetic history, including any close relatives.
- A patient who has had more than one major convulsion within previous 6 months
- A patient who is controlled with medication is suitable for day case.
- MAO inhibitors
Most patients do not require routine pre-operative investigations, however, there are exceptions:
- Sickle Cell Test
- Other Tests – to be decided by the dentist after assessing the patients.
Intravenous sedation at Carholme Dental Practice is commonly achieved by the injection of a single drug. In addition, there are a number of other techniques. These include the use of combinations of sedative drugs and/or inhalation sedation.
Intravenous access by way of a cannula is always maintained until discharge.
The usual technique for intravenous sedation is the use of a titrated dose of midazolam. Sedation using single intravenous drugs, intravenous drugs in combination with inhalation sedation, or infusion of short-acting agents is also used in certain circumstances in order to achieve comfortable sedation.
It is particularly emphasized that sedation using single intravenous drugs, intravenous drugs in combination with inhalation sedation, or infusion of short-acting agents is always restricted to a fully trained and experienced medical practitioner and team working in an appropriate environment.