A Care Pathway for Children Unable to Accept Dental Care within the General Dental Services Involving the Use of Inhalation Sedation and General Anaesthesia

2015 ◽  
Vol 4 (2) ◽  
pp. 29-34 ◽  
Author(s):  
Allyson R Shepherd ◽  
Halimah Ali
Keyword(s):  
General Anaesthesia ◽  
Dental Care ◽  
Dental Treatment ◽  
Care Pathway ◽  
Treatment Modalities ◽  
General Anaesthetic ◽  
Dental Services ◽  
Inhalation Sedation ◽  
Dental Practitioners ◽  
The Right

Dental treatment is the commonest reason for a child to be in hospital in the UK. This is a shocking statistic for a preventable disease. How can we reduce the high numbers of dental general anaesthetics? It is essential that dental treatment under general anaesthesia (GA) is fully justifiable, ensuring that the right patients receive the right treatment. Guidance for general dental practitioners on when to refer a child for a dental GA is discussed. Treatment planning for this dentally high-risk group of children requires a holistic approach. It is complex and requires an experienced and competent clinical team, including dental care professionals with additional postgraduate qualifications. Often, alternative treatments are successful and a GA can be avoided. An audit of 85 patients referred for GA with Oldham Community Dental Service demonstrated 35% of patients accepted treatment with local anaesthesia only, 25% required inhalation sedation and only 25% were actually referred on for GA. Treatment for this group of patients must include the availability and provision of appropriate alternative treatment modalities, with the right staff and facilities, including those for dental general anaesthetic sessions. Ongoing follow-up within the general dental services is essential for this group of patients.

Paediatric dental treatment under inhalation sedation by a therapist in secondary care: An audit

Dental Update ◽  
2020 ◽  
Vol 47 (11) ◽  
pp. 960-962
Author(s):  
Elara Palmer ◽  
Sarah-Jayne Campbell ◽  
Lee Foo
Keyword(s):  
General Anaesthesia ◽  
Secondary Care ◽  
Dental Treatment ◽  
Positive Impact ◽  
Waiting Lists ◽  
General Anaesthetic ◽  
Future Health ◽  
Health And Wellbeing ◽  
Inhalation Sedation ◽  
Dental Therapist

We investigated the success of paediatric dental treatment under inhalation sedation (IHS) with nitrous oxide completed by a dental therapist, as an alternative to general anaesthesia (GA) in secondary care. We found that 94% of had treatment successfully completed under IHS by a therapist. These patients were assessed as being suitable for IHS and were referred to the therapist via a new patient clinic. The success of therapists treating paediatric patients with IHS could help reduce pressure on GA waiting lists. As well as being a safer treatment option, this method allows effective conservative treatment to be completed and thereby reducing the number of extractions required, which is a major benefit to patients' future health and wellbeing. CPD/Clinical Relevance: This study shows the success of treatment under inhalation sedation by a dental therapist. Appropriate referral to therapists has the potential to reduce the need for procedures under general anaesthesia. This has the affect of reducing the strain on our general anaesthetic waiting lists, as well as having a positive impact on the health and wellbeing of our patients with IHS being considered the safer option.

scholarly journals The Impact of Dementia on Oral Health and Dental Care, Part 2: Approaching and Planning Treatment

2020 ◽  
Vol 9 (2) ◽  
pp. 31-37 ◽  
Author(s):  
Andrew Geddis-Regan ◽  
Kathryn Kerr ◽  
Charlotte Curl
Keyword(s):  
Dental Care ◽  
Dental Treatment ◽  
Treatment Modalities ◽  
Health And Social Care ◽  
Dental Practitioners ◽  
Planning Treatment ◽  
Diagnosis Of Dementia ◽  
Secondary Care Setting ◽  
Specialist Practice ◽  
The Impact

Dementia has been described as the biggest health and social care challenge of this century; its impact on dental care cannot be ignored. Dementia affects cognitive ability and decision making, so it is important that oral healthcare professionals are conversant with current mental capacity legislation and issues that may be raised when treatment planning for patients living with the condition. This second article in the series considers the impact of dementia on dental care provision and covers a range of issues which are relevant to both general and specialist practice. These include assessment of capacity, use of different treatment modalities, such as sedation and general anaesthesia, and the factors that may be relevant when deciding to offer treatment or to refer to a secondary care setting for dental treatment. Advanced care planning is detailed to support general dental practitioners considering the longer-term wishes of their patients with an early diagnosis of dementia.

scholarly journals A dental care pathway for children with inherited bleeding disorders

2014 ◽  
Vol 1 (3) ◽  
pp. 3-6 ◽  
Author(s):  
Franchesca Fong ◽  
Janet Davies ◽  
Janice Fearne ◽  
John Pasi
Keyword(s):  
Dental Care ◽  
Dental Treatment ◽  
Care Pathway ◽  
Bleeding Disorders ◽  
Invasive Treatment ◽  
Dental Services ◽  
Consultation Process ◽  
Active Involvement ◽  
Dental Hospital ◽  
Paediatric Dentist

Abstract Royal London Hospital is a major referral centre for children with inherited bleeding disorders (IBD). Dental caries and periodontal disease can be prevented, which is especially important in these children to avoid invasive treatment. For this reason a care pathway has been established, focusing on appropriate prevention advice and treatment A Paediatric Dental Specialist attends the monthly Paediatric Haematology clinics. Children are screened for untreated dental decay and preventive dental advice is given verbally along with a patient information leaflet. At the clinic, a letter is sent out to the patient’s general dental practitioner (GDP). Nonregistered patients are directed to NHS Choices website to find a local NHS GDP. Liaison of GDPs with both haematology and hospital paediatric dental services is actively encouraged to support the provision of dental care within the primary care setting, particularly routine preventive care. Depending on the severity of the bleeding diathesis and the degree of invasive dental treatment required, the GDP may undertake simple treatment or, in more complex cases, may arrange a referral to the Royal London Dental Hospital. A consultation process takes place between paediatric dentist, paediatric haematologist and specialist nurse to determine the most appropriate haematological cover for each patient. This will depend on the severity of the bleeding disorder, the complexity of dental treatment and the need for local anaesthesia. The date of the dental visits and the haemostatic cover are requested via the electronic patient record so that it is accessible to all clinicians involved in their care without the need to retrieve their paper notes. This pathway encourages active involvement of the patients’ GDP and allows the patient to be treated as safely as possible in a timely manner. The care pathway has helped to formalise dental treatment for children with IBD and to improve every health care professional’s understanding of their role in this care.

scholarly journals Dental implant care and trouble among dependent patients based on the questionnaire survey among Japanese dental practitioners

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yuji Sato ◽  
Shigeto Koyama ◽  
Chikahiro Ohkubo ◽  
Shin Ogura ◽  
Ryutaro Kamijo ◽  
...  
Keyword(s):  
Elderly People ◽  
Dental Care ◽  
Questionnaire Survey ◽  
Japanese Society ◽  
Dental Treatment ◽  
Actual State ◽  
Treatment Type ◽  
Dental Practitioners ◽  
Care Problems ◽  
Implant Treatment

Abstract Background Self-care and professional care of implants may prove difficult for elderly people who require nursing care. However, the actual state of care and problems remains unknown. In this study, we investigated the actual state of implant problems in elderly people living in their own home or in a nursing home who received visiting dental treatment. Methods We mailed questionnaire survey forms to 2339 representatives or specialists who were members of the Japanese Society of Oral Implantology, the Japanese Society of Gerodontology or the Japan Prosthodontic Society. We narrowed down the respondents to those who provided visiting dental treatment, and analyzed the actual state of implants observed during visiting dental treatment (type, care, problems, countermeasures, etc.). Results Of the 924 dentists who responded to the questionnaire survey, 291 (22%) provided visiting dental treatment. While the majority of implant types encountered in the previous 12 months were root-form implants, there were still a certain number of blade and subperiosteal implants. Daily implant care involved mostly cleaning with a toothbrush + auxiliary tools. The most frequent implant problems encountered in the past were difficulty in cleaning and peri-implantitis. Medication and antiphlogistic treatment were most frequently adopted as countermeasures to implant problems, followed by observation. When we classified the results into those for the dentists who provided implant treatment and those for the dentists who did not, we found that many of the dentists who did not provide implant treatment opted for observation or medication, while those who provided implant treatment also implemented removal of superstructure, retightening of screws, repair and so forth. Conclusions We found that many of the implant troubles encountered by dentists who provided visiting dental care were difficulty in cleaning or peri-implantitis, and that the actions taken against these troubles varied depending on the experience of the dentist performing the implant treatment. Our study also revealed that dentists who provide visiting dental care need to acquire knowledge and skills of implant treatment, to have actions prepared in case they encounter such cases, or to closely coordinate with dentists who specialize in implants.

Dental care for the bariatric patient

Dental Update ◽  
2021 ◽  
Vol 48 (4) ◽  
pp. 302-306
Author(s):  
Jessica Hamilton ◽  
Mary Gittins ◽  
Andrew Geddis-Regan ◽  
Graham Walton
Keyword(s):  
General Anaesthesia ◽  
Dental Care ◽  
Clinical Relevance ◽  
Conscious Sedation ◽  
Dental Treatment ◽  
Careful Consideration ◽  
Equitable Access ◽  
Bariatric Patient ◽  
Access To Dental Care ◽  
Obese Population

As the overweight and obese population increases, one must be mindful of the implications on the delivery of dental care to this group. Appropriate facilities must be available, which may warrant structural and equipment adaptations to clinical and non-clinical areas. The complexity of dental treatment planning and delivery may be compounded by medical comorbidities, and careful consideration must be given to the suitability and safety of conscious sedation and general anaesthesia in order to facilitate treatment. This article aims to discuss how safe provision and equitable access to dental care can be achieved for the bariatric population. CPD/Clinical Relevance: This article aims to discuss the challenges posed by the increase in the overweight and obese population and considerations to be taken for provision of safe and equitable bariatric dental care.

scholarly journals The “business” of dentistry: Consumers’ (patients’) criteria in the selection and evaluation of dental services

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0253517
Author(s):  
Laura Gray ◽  
Lisa McNeill ◽  
Weiming Yi ◽  
Anastasia Zvonereva ◽  
Paul Brunton ◽  
...  
Keyword(s):  
Dental Treatment ◽  
Treatment Options ◽  
Clinical Effectiveness ◽  
Healthcare Services ◽  
Geographic Region ◽  
Online Questionnaire ◽  
Chi Square ◽  
Dental Services ◽  
Dental Practitioners ◽  
Chi Square Analysis

The dimensions of patient-centred care include not only clinical effectiveness and patient safety, but, importantly, the preferences of patients as consumers of healthcare services. A total of 249 participants were included in the study, with a balanced population proportional representation by age, gender, ethnicity and geographic region of New Zealand. An online questionnaire was used to identify participants’ decision-making process, and what factors and barriers for participants to seek dental treatment. Cross-tabulations, Spearman correlation analysis and Pearson Chi-Square analysis were used for the statistical analyses. Three most common reasons for visit were check-up (77%), clean (57%) and relief of pain 36%). A desire to treat a perceived problem was the most common encouraging factor to seek dental care. Cost was the most common barrier to seeking dental services. The majority of participants attended a private practice (84%), with convenience of location and referral from professionals the most likely to influence their choice. Participants felt the most important trait a dental practitioner could demonstrate was to discuss treatment options with them before any treatment. Dental check-up, teeth cleaning and relief of pain were the most common reasons for patients to choose dental services. Cost and ethnicity of the consumers had a significant impact on how dental services were perceived and sought. Dental practitioners may need to reorientate how they express value of oral health practice, not just in regard to communication with patients, but also with government funding agencies.

scholarly journals Penggunaan sedasi inhalasi N 2 O-O 2 pada penatalaksanaan marsupialisasi ranula rongga mulut anak anxiety patient

2008 ◽  
Vol 7 (2) ◽  
pp. 78
Author(s):  
Harun Achmad ◽  
Dini Safitri ◽  
Kirana Lina Gunawan
Keyword(s):  
Dental Care ◽  
Side Effect ◽  
Dental Treatment ◽  
Minimal Side Effect ◽  
Inhalation Sedation ◽  
Anxiety Patient ◽  
Frog Stomach ◽  
Short Time ◽  
Anxiety And Fear ◽  
Selection Of

Inhalation sedation becomes the main choice in the dental treatment of children whoovercome have any kind of the fearness, concerned with pain in the treatment of theirteeth. Inhalation sedation with N2O-Ocauses sedation situation that accompanies byanalgesia to the conscious patients by inhaling the mixture of oxide nitrogen (N2O)with oxygen (O), that was known as psychosedation or concious sedation technique.Ranula is a mucocel that developed at the base of the mouth, unilateral, bluish, andthe shape like frog stomach. On this paper, will be esplained about N2O-O2inhalationsedation technique that concider the condition for the patient, using short time andcan be recovered immediately. A 9 year old girl diagnosed by ranula sublingualis onthe cavity of the mouth was very anxiety and fear in this treatment. The ranula treatedwith marsupialitation and was supervised by inhalation sedation of N2O-O2 in theSpecial Dental Care Hasan Sadikin Hospital Bandung. The result showed thatinhalation sedation with N2O-O2 was very very useful to reduce anxiety and fear tocertain patients with minimal side-effect. So it was very important to a dentist to knowthe selection of the patient, equipment and the technique of inhalation sedationadequately

scholarly journals A Framework for Equity Access to Primary Dental Care

2020 ◽  
Vol 25 (9) ◽  
pp. 3669-3676
Author(s):  
Denise Silveira Antunes ◽  
Sudeshni Naidoo ◽  
Neil Myburgh ◽  
Juliana Balbinot Hilgert ◽  
Paul Douglas Fisher ◽  
...  
Keyword(s):  
Dental Care ◽  
Dental Treatment ◽  
Waiting Times ◽  
Face Validity ◽  
Oral Disease ◽  
Care Practice ◽  
Dental Services ◽  
Dental Staff ◽  
Dental Rehabilitation ◽  
Oral Disease Prevention

Abstract The objective of this study was to demonstrate face validity with a novel resource allocation framework designed to maximize equity into dental booking systems. The study was carried out in 2014. Eleven experts in primary dental care practice in Southern Brazil participated, using a three-round consensus group technique. First, the experts reached consensus on the items to be included in a 5-level diagnostic scale. They identified 21 clinical conditions and categorized them according to the oral health intervention required. Then, they described workload and activity standards for dental staff to carry out health promotion, oral disease prevention, dental treatment, dental rehabilitation, and urgent dental care. Finally, they agreed upon a set of wait times for primary dental care, establishing maximum waits from 2 to 365 days, according to the diagnostic classification. The framework demonstrated potential ability to promote more equitable access to primary dental services, since equal diagnostic classifications share the same waiting times for the dental care they require.

Sedation or General Anaesthetic for Special Care Patients?

2020 ◽  
Vol 9 (2) ◽  
pp. 56-61
Author(s):  
Carole A Boyle ◽  
Helen Lane
Keyword(s):  
Decision Making ◽  
General Anaesthesia ◽  
Dental Care ◽  
Conscious Sedation ◽  
Decision Making Process ◽  
General Anaesthetic ◽  
Complex Needs ◽  
Factors Influencing ◽  
Anxious Patient ◽  
General Dental Practitioner

When faced with an anxious patient with complex needs who requires dental care, it can be difficult to decide on the most appropriate method to manage their pain and anxiety. There are a range of conscious sedation techniques that may be used, and on some occasions, general anaesthesia may be required. This paper describes the methods available and the factors influencing the decision-making process. The general dental practitioner (GDP) may not be able to offer care in their setting, but knowing more about the decision-making process and the information required to make that decision can help them guide patients and their families.

scholarly journals Acceptability of intravenous propofol sedation for adolescent dental care

2019 ◽  
Vol 21 (3) ◽  
pp. 295-302
Author(s):  
C. Dixon ◽  
A. Aspinall ◽  
S. Rolfe ◽  
C. Stevens
Keyword(s):  
General Anaesthesia ◽  
Thematic Analysis ◽  
Dental Care ◽  
Patient Reported Outcomes ◽  
Dental Treatment ◽  
Anaesthetic Agent ◽  
Patient Acceptability ◽  
Propofol Sedation ◽  
Patient Reported ◽  
Adolescent Patients

Abstract Purpose Propofol is an intravenous anaesthetic agent commonly utilised in general anaesthesia, however in sub-anaesthetic concentrations can be utilised to provide sedation through automated dosing of target-controlled infusion (TCI). TCI has been shown to provide accurate and stable predicted plasma and effect-site concentrations of propofol. A four-part mixed-method prospective study was undertaken to evaluate the safety and patient acceptability of intravenous propofol sedation in adolescent patients requiring dental care. There is a paucity in the literature on patient-reported outcomes and patient safety in the management of adolescent patients for dental treatment. Methods Demographics were recorded including age, gender, ASA Classification and Children’s Fear Survey Schedule—Dental Subscale (CFSS-DS) completed pre-operatively. Behaviour ratings of the Frankl and Houpt scales were recorded followed by post-operative questionnaire and telephone consultation. Consultation was completed following the procedure to determine patient satisfaction, memory of the procedure and any reported side effects of treatment. Qualitative thematic analysis was utilised. Results 55 patients were recruited for the study, of which 49 (mean age 14.67 years) completed the sedation study and were treated safely with no post-operative complications. The mean lowest oxygen saturation was 98.12% SpO2 (SD 2.6). Thematic analysis demonstrated positive patient-reported outcomes to IV sedation. Conclusion Propofol TCI sedation is an effective treatment modality for the management of dentally anxious adolescents as a safe alternative to general anaesthesia, allowing the opportunity for increased provision of treatment per visit on those patients with a high dental need. Further randomised controlled trials comparing propofol TCI to other pharmacological managements are required.

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