The use of general anaesthesia in special care dentistry: A clinical guideline from the British Society for Disability and Oral Health.

Background: General anaesthesia (GA) may be required to support the care of those seen in Special Care Dentistry (SCD) services for various reasons, such as enabling extensive dental care for people with severe learning disabilities or severe dental phobia. Guidance is needed for teams delivering SCD using GA due to the potential risks, implications, and costs of using GA to deliver dental care.

Aim: To present evidence-based recommendations, where possible, for teams involved in providing GA for dental care for adults within SCD services.

Sedation or General Anaesthetic for Special Care Patients?

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.

A Review of the use of Flumazenil for the Reversal of Midazolam Conscious Sedation in Dentistry.

The practice of midazolam conscious sedation is well established in dentistry. The drug flumazenil is a specific benzodiazepine antagonist and is an essential requirement in settings where midazolam is used. A literature review has been carried out, examining the available information regarding flumazenil’s safety, administration, potential complications and the regulatory documentation which governs its use.

Dementia and Dentistry.

Dementia is increasing in prevalence: by 2025 it is estimated that there will be over a million people in the UK with this diagnosis. The condition is likely to affect us all as healthcare providers, whether in our patients, our relatives or ourselves. This article gives an overview of dementia: causes, treatment, how it affects people and provides advice on how to manage patients with dementia who require dental care.

Dysphagia and dentistry.

Dysphagia is defined as a 'difficulty in swallowing' and is commonly found in the general population, particularly in the elderly. This article gives an overview of the more frequently encountered swallowing disorders and provides advice on how to manage the dysphagic patient in the dental surgery. Clinical Relevance: By identifying patients with dysphagia and being aware of the potential problems that the clinician may experience when treating them, the risk of aspiration, choking and healthcare-acquired upper respiratory tract infections may be reduced.

Sedation for patients with movement disorders.

Unlabelled: The general features of the movement disorders are outlined and the effects of inhalational sedation with nitrous oxide and oxygen and intravenous sedation, using midazolam, are described.Two case reports of patients with cerebral palsy treated in a community care setting are presented, and the advantages of intravenous and inhalational sedation are explained.

Clinical Relevance: Inhalational sedation (IS) with nitrous oxide and intravenous sedation (IVS) with midazolam can be useful aids to reduce unwanted movements in patients with movement disorders during dental treatment.

Sickle cell disease, dentistry and conscious sedation.

Unlabelled: The features of sickle cell disease (SCD) are described. Two case reports of patients treated in a Dental Institute are presented and the dental management of patients with SCD discussed. Since infection is one of the major risk factors for sickle cell crisis, the prevention of oral disease and infection is vital for this group of patients and there is no contra-indication to the delivery of dental treatment under local anaesthetic with inhalational sedation if required in the primary care setting.

Neurofibromatosis-1 and the provision of dental care.

Unlabelled: The general features of Neurofibromatosis-1 are outlined and the oral and maxillofacial features described. Two case reports of patients treated in the Department of Sedation and Special Care Dentistry at King's College London Dental Institute are presented, and the dental management of patients with Neurofibromatosis discussed.

Clinical Relevance: Neurofibromatosis-1 is a neurocutaneous genetic disease with a prevalence of one in 4000-5000.

The effects of dental anxiety and irregular attendance on referral for dental treatment under sedation within the National Health Service in London.

Objective: To investigate whether the relationship between dental anxiety and referral for treatment under sedation is explained by attendance patterns and oral health.

Methods: Structural Equation Modeling was used on the covariance matrix of the covariates to test hypothesized inter-relationships. Subsequently, we modeled the probability of referral for treatment under sedation with a multiple logistic regression taking into account inter-relationships between the independent variables.

Sedation or general anaesthesia for treating anxious children.

Data Sources: Relevant literature was selected following searches using the following: Cochrane Central Register of Controlled Trials, Medline, Embase (OVID), System for Information on Grey Literature in Europe, Latin American and Caribbean Health Sciences Literature, ISI Web of Science; and searches were made by hand of: Journal of the American Academy of Pediatric Dentistry, Anaesthesia, British Dental Journal, British Journal of Anaesthesia, Dental Update, International Journal of Paediatric Dentistry, Journal of American Dental Association, Journal of Dentistry for Children and Pediatric Dentistry.

Study Selection: Reports were selected if they described randomised controlled clinical trials (RCT) of sedative agents compared with general anaesthesia in children and adolescents aged up to 18 years who were having dental treatment: complex surgical procedures and pseudo-randomised trials were excluded. There were no language restrictions.

Potential interactions with herbal medications and midazolam.

Unlabelled: In the management of patients who require intravenous sedation with midazolam care must be taken if the patient is taking herbal drugs. There is a potential for harmful drug interactions between herbal drugs and midazolam.Assessment of which herbal drugs a patient is taking should be part of the treatment planning stage so interactions can be avoided or anticipated.

Providing dental care for patients with Huntington's disease.

Unlabelled: This paper describes the genetic condition Huntington's disease and its clinical relevance to dentists. The treatment of two patients with the condition is described: one under general anaesthesia, the other with intravenous sedation.

Clinical Relevance: Dentists may have patients who develop Huntington's disease in later life, so this paper will help them consider the longer term effects of this disease and help in planning dental care.

Angio-oedema in dentistry: management of two cases using C1 esterase inhibitor.

Unlabelled: Angio-oedema is a rare condition; it may be a hereditary or acquired form. It results from biochemical defects which cause excessive activation of the complement cascade and result in deep swellings in the skin and alimentary tract, called angio-oedema. These swellings are painful rather than itchy and not associated with urticaria, which helps to differentiate angio-oedema from allergic reactions.

Epilepsy and oral care.

Epilepsy is a common symptom of an underlying neurological disorder. The seizures can take a variety of forms. Both the condition and its medical management can affect oral health.