Surgical exposure and orthodontic alignment of impacted maxillary canine teeth is often undertaken when young people are aged between 12-15 years.  For patients unable to accept care under local anaesthesia alone, best-practice guidelines endorse conscious sedation as an alternative to general anaesthesia, where appropriate.  There is variation in the extent to which differing behavioural management/support techniques are employed to facilitate care and options available to young people and their parents can vary across the UK and Republic of Ireland. 

Following on from a scoping study which identified patterns in referral and care provision, this current research sets out to explore and begin to understand reasons behind current practice.  A qualitative approach (interviews and focus groups) will be employed to address two key research questions:

Which factors influence behavioural management/support techniques employed by dental professionals to facilitate surgical canine exposures for young people?

What are patient and legal guardian experiences of current care provision?

Ascertaining and exploring opinions and experiences of key stakeholders (dental professionals, patients, legal guardians) will address the above research questions and consider acceptability of differing management/support techniques.  Patient groups and policy-makers are keen to implement young person-centred care to deliver the government’s vision of appropriate and tailored healthcare; with this feeding into health service reforms.  At the heart of this research will be the experiences and opinions of young people, with their voices driving development of interventions designed to bring about equity in access to care.

Qualifying in 2010, Ashleigh undertook posts within the community dental services and oral and maxillofacial surgery prior to working as a dental associate in primary care for a number of years.  During this time Ashleigh developed a keen interest in caring for anxious patients, working within a consultant anaesthetist-led team providing standard and advanced conscious sedation for adult and paediatric dental patients; completing her Diploma in Conscious Sedation at Newcastle University in 2014.

Having been involved in undergraduate teaching on a part-time basis since 2014, Ashleigh transitioned to full time clinical academia in 2017.  Ashleigh is currently undertaking a PhD (part-time) looking at how and why differing behavioural management techniques are employed to support young people receiving surgical dental care.  Ashleigh continues to work within paediatric dentistry providing patient care and clinical teaching to dental and dental therapy undergraduates as well as supporting postgraduate education within the region.

In 2017 Ashleigh became a Fellow of the Higher Education Academy and in 2021 was awarded a Certificate in Advanced Studies in Academic Practice from Newcastle University.  In addition to conscious sedation, Ashleigh’s teaching and research interests include examination and assessment and interprofessional education and working.

Jeena graduated from Liverpool Dental School in 2018. Over the past four years, Jeena has worked in various community dental services across multiple trusts, gaining extensive experience in patient care. Currently, she is training as a Specialty Registrar in Special Care Dentistry at The Royal London Hospital, where she gets to treat a wide range of patients from complex medical histories, the older patient and those with anxieties/phobias who attend the service for dental care. Jeena is particularly passionate about patient comfort, thoroughly enjoys administering IV sedation to help ensure a safe and relaxed dental experience for her patients.

Remimazolam, an ultra–short-acting benzodiazepine, is emerging as a valuable alternative to midazolam for dental conscious sedation. With rapid onset, organ-independent metabolism, and predictable recovery, it allows finer control of the sedation window and reduces risks linked to prolonged recovery, is particularly beneficial for older adults, medically compromised patients, and those with complex procedures or failed midazolam sedation.
This presentation reviews local experience with over 250 remimazolam cases, including 80 cases using an infusion pump for real-time titration. Clinical cases highlight its effectiveness in anxious patients, individuals with learning disabilities, and long procedures requiring maintenance sedation.
Attendees will gain insights into dosing strategies, practical considerations, and future directions such as target-controlled infusion and multi-drug protocols, illustrating how remimazolam can enhance efficiency, offer an option to accept dental procedures, and patient comfort in dental sedation practice.

Jen is a Consultant Health Psychologist based within the Dental Psychology Service at Guy’s and St Thomas’s NHS Trust. Jen’s role as clinical lead is to develop the NHS-based service; providing psychological interventions (including Cognitive Behaviour Therapy) to patients with dental phobia and other dental-related issues including chronic oro-facial pain and orthognathic surgical assessments. She has worked across a range of physical health psychology services within the NHS, holding roles in both community and hospital-based dental services. Jen provides teaching to postgraduate dentists and dental professionals in her role with Kings College London. Jen also sits on the Editorial Board for SAAD Digest.

Geanina Bruj-Milasan is a Clinical Nurse Specialist (CNS) and Trainee Health Psychologist in the Dental Psychology Service at Guy’s & St Thomas’ NHS Foundation Trust. She is in the final stages of completing her Doctorate in Health Psychology, specialising in dental psychology.

Geanina joined the service in 2015 as its first CNS, drawing on her background in psychology, teaching, and dental nursing. Her early clinical work encompassed paediatric dentistry and oral medicine, where she supported patients for whom anxiety, phobia, and emotional challenges were especially prevalent. These experiences strengthened her compassion and commitment to understanding and addressing the psychological impact of dental care.

Since completing training in Cognitive Behavioural Therapy (CBT) for dental phobia and counselling foundations, Geanina has applied these approaches across her clinical work. Her doctoral research has supported service development and advanced the evidence base in the field. She has explored the long-term impact of CBT, the facilitators and barriers to accessing primary care dentistry after CBT, and the impact of sexual abuse on oral health, highlighting the importance of trauma-informed principles. Passionate about research, she is dedicated to translating evidence into practice to improve patient care.

Geanina has also played a key role in developing a new dental nursing degree curriculum, particularly in research methods, communication, and special care dentistry.

Veronica (‘Roni’) Munzandi is a Clinical Nurse Specialist and Oral Health Educator in the Dental Psychology Service at Guy’s & St Thomas’ NHS Foundation Trust. She joined the service in 2021 after more than 10 years as a dental nurse, during which she supported BDS students and postgraduate trainees across a range of specialisms. This sparked her lasting interest in supporting patients with dental anxiety and complex health needs.

In her current role, Roni supports and delivers interventions for patients receiving Cognitive Behavioural Therapy (CBT) for dental phobia, drawing on additional training in CBT and person-centred counselling. She works closely with her psychology colleagues to assess patients and devise tailored treatment plans that meet the psychological and medical needs of each individual.

Her practice is trauma-informed, patient-centred, and grounded in compassion. Roni is known for her calm, gentle approach, which helps patients build trust, reduce fear, and re-engage with dental care. Through her expertise and collaborative spirit, she has become an invaluable member of the Dental Psychology Service, exemplifying the impact of integrated psychological support in dental settings.

 To follow. 

Dental anxiety continues to present a significant challenge to patient care, often resulting in avoidance, delayed treatment, and poorer oral health outcomes. Cognitive Behavioural Therapy (CBT) has long been recognised as an evidence-based approach to support patients in overcoming dental phobia and enabling sustainable engagement with treatment. This talk will explore the evolution of psychological management of dental anxiety, focusing on the development of The Toolkit: CBT for Dental Anxiety and our longstanding partnership with the Society for the Advancement of Anaesthesia in Dentistry (SAAD).

The original CBT manual was created in 2008 by the King’s College London (KCL) team, with funding from SAAD, to provide practical behavioural management strategies for use within dental practice. A decade later, following the establishment of the specialist NHS Dental Psychology Service at Guy’s and St Thomas’ NHS Foundation Trust, a new SAAD grant enabled the manual to be comprehensively revised and updated. The result was the publication, in September 2023, of a fully re-written 10-chapter edition reflecting the latest research and current clinical practice in CBT for dental phobia.

The new manual provides detailed guidance on assessment, formulation, skill acquisition, behavioural and cognitive interventions, therapy review and ending, supervision, and service development. It is supported by 31 appendices and a library of patient demonstration videos and photographs used in graded exposure work. Each chapter is accompanied by exercises to consolidate learning, designed for use in supervised training or as part of self-directed study (with professional oversight recommended). The manual is available through SAAD and usually forms part of a face-to-face training course delivered by the authors.

In this presentation, we will reflect on the development of the toolkit, the impact of the collaboration between SAAD and the NHS Dental Psychology Service, and the role of these resources in supporting practice change. We will also consider the broader landscape of behavioural management in dentistry, including the publication of the NHS England dental anxiety management guide (2023). Finally, we will look ahead to the future - exploring opportunities for wider implementation, workforce training, and expanding access to evidence-based psychological care for dentally anxious patients.

By charting this journey - from the first toolkit in 2008 to the most recent manual and national guidance - we aim to illustrate the progress made, the lessons learned, and the continuing opportunities to embed psychological care as a routine part of dentistry.

On qualifying from Guy's Hospital, Claire worked in general and community practice. She then returned to Guys Hospital to complete a Masters in Conservative Dentistry and entered specialist training in Restorative Dentistry. During which time she completed a Diploma in Dental Sedation, and on completion she was appointed locum Restorative Consultant in Special Care at Guys for 9 months.

In 2006 she took up a role as a Consultant in Restorative Dentistry at Barts Health Trust. She helped develop the Oncology service and became Sedation Lead for Dentistry. She introduced training for DCTs in sedation and was Clinical/Educational Supervisor to a number of Special Care Trainee Registrars.

In latter years Claire was appointed Governance lead for Dental/OMFS following a spate of wrong tooth extractions, sparking her interest in Patient Safety which she pursued with a Masters at Imperial College 2018. From there, she became the first Patient Safety Specialist appointed at the Royal London Hospital in 2023 and joined the first cohort of nearly 500 Patient Safety Specialists to undertake NHSE's National Patient Safety Syllabus L3/4 at Loughborough University. Claire sits on the RCS Edinburgh Dental Council and is Deputy Chair for the College's Patient Safety Group, she was also invited to act as Patient Safety Officer for Association of Dental Hospitals.

This presentation focusses on How the landscape for Patient Safety is Changing. It should be of interest to all of us as healthcare workers and patients. Example will be drawn on where appropriate from dentistry and sedation. There will be an initial recap on the scale of the problem posed by patient safety in healthcare and it’s impact on society, along with the importance of contextualising patient safety. The 3Is Insight, Involvement, and Improvement from the Patient Safety Strategy will be explored. Learning from Patient Safety Events, the National Patient Safety Syllabus, Checklists, and engaging with Patients and Staff are considered. There will be an update on the replacement of the Serious Incident Framework to the Patient Safety Incident Response Framework in terms of: compassionate engagement, proportionate high quality investigations, systems based approaches to learning, and supportive oversight and improvement. The changing concept of the Never Event will be reflected on. Finally, the underpinning foundations of Culture and Systems will be mentioned. The closing remarks will attempt to focus on the positive future for Patient Safety.