Introduction

Sir, the Society for the Advancement of Anaesthesia in Dentistry (SAAD) notes the comments from the Chairman of the DSTG regarding the provision of conscious sedation for NHS patients (BDJ2008;  204: 51).

Since the new GDS contract was introduced in 2006 there has been a 'two-tier' system in operation with regard to pain and anxiety control for dental patients in England. This has resulted in many NHS patients being denied the benefits of sedation for their treatment. PCTs now control which practices control sedation, so it is no longer possible for all GDPs to offer this service. This restriction affects children who need nitrous oxide/oxygen inhalation sedation (relative analgesia), adults who cannot tolerate treatment due to anxiety or phobia and patients who require a prolonged or threatening procedure such as minor oral surgery or multiple crown preparation. Referral to a specialist practice is not the solution as patients will then be treated by a different dentist in whom s/he may have less confidence.

Neither will the introduction of 'Dentists with a Special Interest in Conscious Sedation' (DwSIs)¹ solve this problem. These sedationists are appointed by PCTs to provide alternative sedation techniques, not the basic techniques which are appropriate for the vast majority of patients and should be available as part of general dental services.

Dentists are not allowed to provide sedation privately as part of an NHS course of treatment. Lifting this restriction would go some way to resolving the problem. Similar restrictions do not, of course, apply to private patients who are able to receive the benefits of anxiety-free dentistry without government interference.

It appears that conscious sedation was overlooked when the new dental contract was introduced. SAAD urges the BDA to investigate this anomaly and negotiate for reform of the contract to enable basic conscious sedation techniques to be practised more widely for the benefit of all patients. Practitioners are encouraged to tackle their PCTs energetically over this matter.

SAAD would be pleased to receive comments directly from practitioners.

Reference

1. Department of Health/Faculty of General Dental Practice. Guidelines for the appointment of Dentists with a Special Interest in Conscious Sedation. December 2007.

1. SAAD