Sir, I have carefully read the original article by Dr Kupietzki, (BDJ2004, 196: 133) a respected clinician and teacher, and the subsequent correspondence.
I feel that conscious sedation is of little if any value in the treatment of uncooperative or precooperative children since it relies upon the ability of the practitioner to communicate with the child.
Its main value is to assist the child who wishes to have treatment but who is unable to overcome his/her anxiety.
The trained, experienced paediatric dentist will generally be able to overcome such anxieties without recourse to sedation. That is not to say that it has no place in the armamentarium of the less experienced practitioner.
One of the authors of the subsequent articles on this paper (BDJ2004, 196: 138), G. Manley responds: B. Scheer's comments on the use of conscious sedation are curious. He informs us that conscious sedation relies on the ability of the practitioner to communicate with the child, and therefore is of little value in some cases.
He also informs us that the trained experienced paediatric dentist will be able to overcome children's anxieties 'without recourse to sedation'.
Presumably such a practitioner would need to communicate with the child as part of their strategy in order to achieve success.
Even in the event of providing treatment under general anaesthesia communication with the child is a necessary and essential part of care.
The use of inhalation conscious sedation does of course rely on a degree of compliance from the child and is extremely valuable in the management of the anxious child and also the uncooperative child. It is essential that the technique is carried out with good behaviour management, and to achieve success in the treatment of the uncooperative or precooperative child, its use may require time, patience, additional expertise and skill.
I feel confident that there are many practitioners in the UK who have had success in treating anxious and or uncooperative children using conscious sedation techniques.
I would also suggest that many might hold the view that the use of effective conscious sedation requires training and experience additional to behaviour management rather than being a prop for the inexperienced.
