Unsuitable currency

Sir, I write in support of the letter from Dr Alex Crawford (BDJ 2008; 204: 629) underlying the importance of sedation in preventing phobia in dentistry. Dr Crawford was focussing on inhalation sedation but I believe his point is also valid for IV sedation. The DH report in 2003¹ (p 20) states that the prevention of phobia is a clear indication for the use of conscious sedation.

Unfortunately, once a patient has become phobic the use of standard sedation techniques may not be successful. A consultant anaesthetist once referred to this as the 'midazolam bouncing off the patient'. Most practitioners of IV sedation using midazolam will understand this comment. In this situation, more advanced sedation techniques are often required. In some cases a GA will be necessary. This is precisely what we are trying to avoid.

The UDA is not a suitable currency for the dental treatment of high needs patients. It is even more unsuitable for patients who require sedation. The new contract has restricted the availability of sedation in the NHS. The practitioner is credited with no UDAs for sedation. Furthermore, in my experience, a referral to a nearby teaching hospital produces a standard letter which states that: 'This hospital does not offer sedation for routine restorative treatment' and the return of the referral letter.

This means that more phobic patients may be produced. Such patients often require extensive treatment and their oral health deteriorates as they cannot access the appropriate care. Attempts to treat without sedation exacerbate the situation and make a GA more likely.

The only way forward for sedation in NHS dentistry is to use a more suitable currency than the UDA.