The future of sedation in primary care?

Key Points

• The use of conscious sedation techniques for the management of the patient with dental anxiety showed considerable variation within a group of dental practitioners working in primary care.

• The majority felt there was a need for sedation in their own practice.

• Very few in the study group had received postgraduate training in sedation techniques.

• Sedation training must improve if conscious sedation is to become the principle alternative to general anaesthesia in dental practice.

Abstract

Objectives Firstly to determine the current provision of sedation in primary dental care in an area of Scotland without local secondary care support and secondly, to investigate dental practitioners' desire for formal postgraduate training in sedation techniques.

Design A prospective postal questionnaire-based study.

Setting Grampian Primary Care NHS Trust, UK, 2001.

Subjects Questionnaires were sent to all NHS dental practitioners and community dental service clinicians [N=194] employed through Grampian Primary Care NHS Trust, Scotland during March-April 2001. The questionnaires sought details about personal status and the use and perceived need for conscious sedation techniques in practice in addition to the stated desire for postgraduate training in sedation techniques.

Results One hundred and thirty-six questionnaires were returned (70%). 49% of respondents reported current sedation use, with intravenous sedation the favoured technique (82%), followed by oral sedation (33%) and inhalation sedation (19%). Seventy four per cent of participants considered that there was a need for sedation in their own practice and 68% were interested in further postgraduate training in sedation techniques.

Conclusion Nearly three-quarters of practitioners who responded felt that there was a need for sedation in their own practice, although less than half were able to offer sedation to their patients. Nearly 70% of practitioners felt there was a need for postgraduate training in sedation techniques.

Main

The way forward for dental sedation and primary care? J. Foley Br Dent J 2002; 193: 161–164

Comment

As the profile of dental sedation rises and education for its provision increases, there is no doubt that primary care will be responsible for the majority of the conscious sedation done in dentistry. This paper therefore is both fascinating and timely in its publication since it looks specifically at dental sedation in relation to the primary care setting. The author very sensibly chose an area of the North East of Scotland which has no local secondary care support and dental practitioners in this area are able to give an insight into where they feel both resources and education should be directed. It may have been interesting to compare this group of practitioners with a group with easy secondary care support and compare the two.

One hundred and ninety four questionnaires were sent out to general dental practitioners and community dental practitioners asking about the perceived need for conscious sedation techniques in their practices and the desire for postgraduate training in sedation techniques.

They had a 70% response with 49% of the respondents currently using some form of sedation in their practice, 82% of these used intravenous sedation, 74% felt there was a need for sedation in primary care. There were some slightly worrying cases revealed in the results with lapses in emergency equipment including one case where pulse oximetry did not seem to be routine. The results in general are very positive with nearly half of the respondents using sedation regularly although it could be argued that with many of them only doing up to two patients a week competence could be an issue. In their defence 68% of those who responded expressed an interest in continuing professional education in this area and this is encouraging in the light of the General Dental Council's recent statutory CPD scheme.

As the dental population moves away from a reliance on general anaesthesia for anxious patients it is encouraging to see a group of primary care clinicians who are both interested in using these techniques and in learning more about them.