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SAAD Digest
March 2024
Volume: 40
Issue: 1

Title: An audit of the use of flumazenil for sedation within the Special Care Dentistry Department (CDS Cycle 7) and seven-year comparison
Author(s): H. J. Smith, R. Jaffery 

Abstract: 

Background
Flumazenil is a benzodiazepine antagonist which acts at GABA receptor sites to reverse the sedation effects of midazolam in dental conscious sedation. National Patient Safety Agency Rapid Response Report 2008 identified several cases where patients were being over sedated with midazolam and recommended auditing of flumazenil use as a measure of midazolam oversedation.

Aims
The audit aims to review the number of patients within the Birmingham Community Healthcare NHS Foundation Trust’s Community Dental Service who underwent sedation with midazolam and those who required reversal with flumazenil. It also aims to review the record keeping of the justifications given for flumazenil reversal and to ensure compliance with National Patient Safety Agency’s 2008 recommendations. 

Methods
Data for patients who underwent intravenous / transmucosal sedation with midazolam between January 2023 and June 2023 were taken from the Community Dental Service’s electronic logbook. Clinical records were then reviewed for documentation of justification.

Results
For cycle seven, (0%) no anxious adult patients required reversal with flumazenil, whereas 5.6% of special care patients (n = 5) required reversal. The majority of reversals cited prolonged recovery as the reason for its use.

Conclusion
The findings demonstrate compliance with National Patient Safety Agency’s recommendations, excellent record keeping and justification of flumazenil use.

If you have a query relating to this article please email: digest@saad.org.uk

Articles from Digest 40(1)

 Article title
 Page start
Page end
 Editorial
 2
 2
Peer reviewed papers
Remimazolam compared to midazolam for dental sedation: an umbrella review
 3
 8
A review of the awareness and use of airway assessment techniques in conscious sedation in dentistry
 9
 14
Improving safety and efficiency in special care dentistry through quality improvement of patient information in the Belfast Trust  
 15
 18
Patient experiences and outcomes following intravenous sedation in an oral surgery setting 
 19
 22
An investigation of bispectral index monitoring when providing intravenous sedation for adults with severe cognitive disability 
 23
 27
Are we providing an effective sedation service? An evaluation of a new conscious sedation service in primary special dental care 
 28
 32
An audit of the use of flumazenil for sedation within the Special Care Dentistry Department (CDS Cycle 7) and seven-year comparison 
 33
 36
Unsuccessful conscious sedation on patients with a learning disability and / or autism: a multi-site service evaluation
 37
 41
The effectiveness of dental nurse led Cognitive Behavioural Therapy (CBT) on the dentally anxious patient: a service evaluation
 42
 46
Case reports
Dental treatment for a 15-year-old patient with Nicolaides- Baraitser Syndrome, under intravenous sedation with midazolam: a case report
 47
49 
The use of inhalation sedation to manage delayed eruption of permanent teeth, hypodontia and caries in a child patient 
 50
53
Case report: A paediatric patient with molar incisor hypomineralisation and hypodontia, treated with inhalation and intravenous sedation for extractions of deciduous and permanent molars 
 54
 56
Opinion
 57
 59
Journal Scan
 60
 68
Essay prizes
Dexmedetomidine: pharmacology and use as a sedative agent 
 69
 76
Do children from more deprived backgrounds have a higher chance of becoming dentally anxious?
 77
 80
Symposium 2023
 81
 89
Profile
 90
90 
Forum  92 97 

  

SAAD Digest
March 2024
Volume: 40
Issue: 1

Title: Case report: A paediatric patient with molar incisor hypomineralisation and hypodontia, treated with inhalation and intravenous sedation for extractions of deciduous and permanent molars
Author(s): T. Ng

Abstract: 

A 12-year-old patient was referred into the community dental service by their general dental practitioner following an orthodontic opinion. Clinical and radiographic examination revealed molar incisor hypomineralisation with grossly broken down UR6 and UL6. In addition to hypodontia, the LL5 was not present and a retained LLE was in situ. The patient was advised removal of UL6, UR6, LLE, LRE by the orthodontist. The patient had never received dental treatment and was anxious. The patient successfully completed treatment with inhalation sedation for the removal of LRE and LLE and intravenous sedation for the removal of UR6 and UL6. 

If you have a query relating to this article please email: digest@saad.org.uk

Articles from Digest 40(1)

 Article title
 Page start
Page end
 Editorial
 2
 2
Peer reviewed papers
Remimazolam compared to midazolam for dental sedation: an umbrella review
 3
 8
A review of the awareness and use of airway assessment techniques in conscious sedation in dentistry
 9
 14
Improving safety and efficiency in special care dentistry through quality improvement of patient information in the Belfast Trust  
 15
 18
Patient experiences and outcomes following intravenous sedation in an oral surgery setting 
 19
 22
An investigation of bispectral index monitoring when providing intravenous sedation for adults with severe cognitive disability 
 23
 27
Are we providing an effective sedation service? An evaluation of a new conscious sedation service in primary special dental care 
 28
 32
An audit of the use of flumazenil for sedation within the Special Care Dentistry Department (CDS Cycle 7) and seven-year comparison 
 33
 36
Unsuccessful conscious sedation on patients with a learning disability and / or autism: a multi-site service evaluation
 37
 41
The effectiveness of dental nurse led Cognitive Behavioural Therapy (CBT) on the dentally anxious patient: a service evaluation
 42
 46
Case reports
Dental treatment for a 15-year-old patient with Nicolaides- Baraitser Syndrome, under intravenous sedation with midazolam: a case report
 47
49 
The use of inhalation sedation to manage delayed eruption of permanent teeth, hypodontia and caries in a child patient 
 50
53
Case report: A paediatric patient with molar incisor hypomineralisation and hypodontia, treated with inhalation and intravenous sedation for extractions of deciduous and permanent molars 
 54
 56
Opinion
 57
 59
Journal Scan
 60
 68
Essay prizes
Dexmedetomidine: pharmacology and use as a sedative agent 
 69
 76
Do children from more deprived backgrounds have a higher chance of becoming dentally anxious?
 77
 80
Symposium 2023
 81
 89
Profile
 90
90 
Forum  92 97 

SAAD Digest
March 2024
Volume: 40
Issue: 1

Title: The effectiveness of dental nurse led Cognitive Behavioural Therapy (CBT) on the dentally anxious patient: a service evaluation
Author(s): K. Kauser, S. Naidu, R. Jaffery 

Abstract: 

Introduction
Dental Cognitive Behaviour Therapy (dental CBT) is a talking therapy for adults and children aimed to reduce a patient’s anxiety specifically related to dentistry. The Modified Dental Anxiety Score (MDAS) allows an objective measurement of the patient’s level of anxiety pre and post CBT.

Aims
The objective was to assess the effectiveness of the CBT service within Birmingham Community Healthcare NHS Foundation Trust (BCHC) Community Dental Services (CDS). The aims were to assess the number of patients with a pre- and post-CBT MDAS recorded, the success of CBT and the anxiety management modalities used to facilitate treatment.

Methods
A retrospective analysis of internal CBT referrals between January 2018 to December 2022.

Results
135 referrals were identified. 56% had a pre-MDAS score, of these 85% were between 20 to 25, indicating high anxiety (>19). Post-CBT MDAS scores reduced to between 5 to 14 for 85% of patients (indicating low / moderate anxiety). After having CBT 45% of patients had dental treatment with local anaesthetic (LA) alone and 35% with inhalation sedation (IHS).

Conclusions
CBT is effective in the treatment of dental anxiety and therefore allows patients to receive treatment from their general dental practitioners (GDP) and step down from general anaesthetic (GA) / intravenous sedation (IVS).

If you have a query relating to this article please email: digest@saad.org.uk

Articles from Digest 40(1)

 Article title
 Page start
Page end
 Editorial
 2
 2
Peer reviewed papers
Remimazolam compared to midazolam for dental sedation: an umbrella review
 3
 8
A review of the awareness and use of airway assessment techniques in conscious sedation in dentistry
 9
 14
Improving safety and efficiency in special care dentistry through quality improvement of patient information in the Belfast Trust  
 15
 18
Patient experiences and outcomes following intravenous sedation in an oral surgery setting 
 19
 22
An investigation of bispectral index monitoring when providing intravenous sedation for adults with severe cognitive disability 
 23
 27
Are we providing an effective sedation service? An evaluation of a new conscious sedation service in primary special dental care 
 28
 32
An audit of the use of flumazenil for sedation within the Special Care Dentistry Department (CDS Cycle 7) and seven-year comparison 
 33
 36
Unsuccessful conscious sedation on patients with a learning disability and / or autism: a multi-site service evaluation
 37
 41
The effectiveness of dental nurse led Cognitive Behavioural Therapy (CBT) on the dentally anxious patient: a service evaluation
 42
 46
Case reports
Dental treatment for a 15-year-old patient with Nicolaides- Baraitser Syndrome, under intravenous sedation with midazolam: a case report
 47
49 
The use of inhalation sedation to manage delayed eruption of permanent teeth, hypodontia and caries in a child patient 
 50
53
Case report: A paediatric patient with molar incisor hypomineralisation and hypodontia, treated with inhalation and intravenous sedation for extractions of deciduous and permanent molars 
 54
 56
Opinion
 57
 59
Journal Scan
 60
 68
Essay prizes
Dexmedetomidine: pharmacology and use as a sedative agent 
 69
 76
Do children from more deprived backgrounds have a higher chance of becoming dentally anxious?
 77
 80
Symposium 2023
 81
 89
Profile
 90
90 
Forum  92 97 

  

SAAD Digest
March 2024
Volume: 40
Issue: 1

Title: Dental treatment for a 15-year-old patient with Nicolaides-Baraitser Syndrome, under intravenous sedation with midazolam: a case report
Author(s): J. Coomar 

Abstract: 

A 15-year-old male with Nicolaides-Baraitser Syndrome (NCBRS), presented for a routine examination complaining of lower left tooth pain. NCBRS is a very rare genetic condition caused by mutations in the SMRCA2 gene, affecting chromatin remodelling where patients can exhibit delayed eruption of permanent teeth, spaced dentition and hypodontia.1 He also has a severe learning disability, heart murmur, ADHD, psoriasis, asthma (mild), scoliosis and limited speech.

He exhibited severe crowding, an anterior open bite, multiple retained deciduous teeth, a fractured upper left central incisor and a grossly carious upper right deciduous second molar. An orthodontic opinion was sought and the extraction of all deciduous teeth was advised. After discussing treatment options with his parent, intravenous sedation was chosen due to the patient’s challenging co-operation for extractions. The treatment was completed over three appointments under intravenous sedation, with an operative score of three and a general anaesthetic was avoided.

If you have a query relating to this article please email: digest@saad.org.uk

Articles from Digest 40(1)

 Article title
 Page start
Page end
 Editorial
 2
 2
Peer reviewed papers
Remimazolam compared to midazolam for dental sedation: an umbrella review
 3
 8
A review of the awareness and use of airway assessment techniques in conscious sedation in dentistry
 9
 14
Improving safety and efficiency in special care dentistry through quality improvement of patient information in the Belfast Trust  
 15
 18
Patient experiences and outcomes following intravenous sedation in an oral surgery setting 
 19
 22
An investigation of bispectral index monitoring when providing intravenous sedation for adults with severe cognitive disability 
 23
 27
Are we providing an effective sedation service? An evaluation of a new conscious sedation service in primary special dental care 
 28
 32
An audit of the use of flumazenil for sedation within the Special Care Dentistry Department (CDS Cycle 7) and seven-year comparison 
 33
 36
Unsuccessful conscious sedation on patients with a learning disability and / or autism: a multi-site service evaluation
 37
 41
The effectiveness of dental nurse led Cognitive Behavioural Therapy (CBT) on the dentally anxious patient: a service evaluation
 42
 46
Case reports
Dental treatment for a 15-year-old patient with Nicolaides- Baraitser Syndrome, under intravenous sedation with midazolam: a case report
 47
49 
The use of inhalation sedation to manage delayed eruption of permanent teeth, hypodontia and caries in a child patient 
 50
53
Case report: A paediatric patient with molar incisor hypomineralisation and hypodontia, treated with inhalation and intravenous sedation for extractions of deciduous and permanent molars 
 54
 56
Opinion
 57
 59
Journal Scan
 60
 68
Essay prizes
Dexmedetomidine: pharmacology and use as a sedative agent 
 69
 76
Do children from more deprived backgrounds have a higher chance of becoming dentally anxious?
 77
 80
Symposium 2023
 81
 89
Profile
 90
90 
Forum  92 97 

  

SAAD Digest
March 2024
Volume: 40
Issue: 1

Title: The use of inhalation sedation to manage delayed eruption of permanent teeth, hypodontia and caries in a child patient
Author(s): A. Heewa, A.K. Lamba, H. Syed,  R. Kaur, R. Whatling

Abstract: 

A ten-year-old medically healthy male, was referred to The Royal London Hospital’s Paediatric Dental Department due to delayed eruption of upper central incisors. Clinical and radiographic examination confirmed the diagnosis of carious first permanent molars, hypodontia of the LR5 and delayed eruption of multiple permanent teeth.

Following attendance at a joint orthodontic paediatric clinic, three first permanent molars (UR6, UL6 and LL6) were extracted, whilst the remaining lower right first permanent molar (LR6) was fissure sealed. Soft tissue exposure was advised and performed on seven unerupted permanent teeth (UR1, UL1, UL3, UL4, UL5, LL4 and LL5). Successful treatment appointments have been achieved with inhalation sedation. Inhalation sedation as an adjunct to chairside treatment under local anaesthetic has allowed treatment to be completed, without the need for general anaesthetic.

If you have a query relating to this article please email: digest@saad.org.uk

Articles from Digest 40(1)

 Article title
 Page start
Page end
 Editorial
 2
 2
Peer reviewed papers
Remimazolam compared to midazolam for dental sedation: an umbrella review
 3
 8
A review of the awareness and use of airway assessment techniques in conscious sedation in dentistry
 9
 14
Improving safety and efficiency in special care dentistry through quality improvement of patient information in the Belfast Trust  
 15
 18
Patient experiences and outcomes following intravenous sedation in an oral surgery setting 
 19
 22
An investigation of bispectral index monitoring when providing intravenous sedation for adults with severe cognitive disability 
 23
 27
Are we providing an effective sedation service? An evaluation of a new conscious sedation service in primary special dental care 
 28
 32
An audit of the use of flumazenil for sedation within the Special Care Dentistry Department (CDS Cycle 7) and seven-year comparison 
 33
 36
Unsuccessful conscious sedation on patients with a learning disability and / or autism: a multi-site service evaluation
 37
 41
The effectiveness of dental nurse led Cognitive Behavioural Therapy (CBT) on the dentally anxious patient: a service evaluation
 42
 46
Case reports
Dental treatment for a 15-year-old patient with Nicolaides- Baraitser Syndrome, under intravenous sedation with midazolam: a case report
 47
49 
The use of inhalation sedation to manage delayed eruption of permanent teeth, hypodontia and caries in a child patient 
 50
53
Case report: A paediatric patient with molar incisor hypomineralisation and hypodontia, treated with inhalation and intravenous sedation for extractions of deciduous and permanent molars 
 54
 56
Opinion
 57
 59
Journal Scan
 60
 68
Essay prizes
Dexmedetomidine: pharmacology and use as a sedative agent 
 69
 76
Do children from more deprived backgrounds have a higher chance of becoming dentally anxious?
 77
 80
Symposium 2023
 81
 89
Profile
 90
90 
Forum  92 97 

More Articles …