Brasanyaa Raveendran (Specialty Registrar in Special Care Dentistry, ST2), Beth O'Brien (Dental Officer in Special Care Dentistry), Amar Kaul (Specialist in Special Care Dentistry)
Sussex Community NHS Foundation Trust

The purpose of the service evaluation was to review the intranasal/intravenous (INIV) sedation service for adult patients with learning disabilities set up in 2012. The aims are to improve access to dental care for patients with learning disabilities in Community Dental Services (CDS), as an alternative to General Anaesthesia (GA) or no treatment. Data collection was conducted retrospectively within Sussex Community NHS Foundation Trust (SCFT) from January 2018 until July 2025 (inclusive). The sample size consisted of 59 treatment sessions with a total of 105 patients seen for INIV sedation within this period.

Dental treatment was completed as planned in 90% of patients with learning disabilities and thus avoided the need for GA. The most common reasons for incomplete dental treatment were patients not being compliant, due to sensory stimulation from the dental environment, and cognitive processing issues meaning that explanation or reassurance from the dental team were ineffectual.

The service evaluation highlighted two areas of recommendations to improve the INIV sedation service. The first involved improving patient compliance for INIV sedation by improving adherence to pre-operative advice. The second recommendation explored clear documentation of treatment outcomes following INIV sedation and patient suitability for INIV treatment in the future.

Dr Haidar Hassan (Clinical Senior Lecturer/Students Experience Lead/Modules Lead), Mohammed Aziz, Esther Lin, Jinan Alghawi (BDS, MSc), Inês Novo Pereira (BDS, MSc), Rawand Shado (BDS)
Oral Surgery Department, The Royal London Hospital

Background/Aim: Medically compromised patients (ASA II-IV) face barriers to dental care and intravenous conscious sedation represents a potential access strategy. However, safety and efficacy data specific to this population have not been systematically synthesised. This review aimed to determine the rate of adverse events and procedural completion for intravenous conscious sedation in medically compromised patients undergoing dental and oral-surgical procedures.

Methods: MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and Scopus were searched up to 9 October 2025. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool for randomised controlled trials and ROBINS-I for non-randomised studies. Meta-analysis used the Freeman-Tukey double arcsine transformation with DerSimonian-Laird random-effects models. Certainty of evidence was assessed using GRADE.

Results: Twenty-one studies met inclusion criteria. The pooled rate of unplanned hospital admission or emergency escalation was 0.10%. Procedural completion was 99.3%. SpO₂ <90% occurred in 1.2%. Hypotension was recorded in 3.8% and bradycardia in 8.6%, predominantly in dexmedetomidine protocols. No sedation-attributable deaths were reported.

Conclusions: Intravenous conscious sedation is safe and effective in medically compromised dental patients when delivered with supplemental oxygen, appropriate monitoring and evidence-based agent selection. Extreme heterogeneity in adverse event definitions limits certainty for most secondary outcomes.

Dr Tarun Singh Nagpal (Specialist oral surgeon / locum consultant), Dr Amanveer Singh Benning (Clinical Fellow OMFS/ Associate Dentist/ Medical Student), Dr Ashana Gupta (Specialist Oral Surgeon)
Private practice and Practice Plus Group

Over the past two decades, conscious sedation in dentistry has undergone substantial change, driven by advances in patient safety, clinical governance, technology and education. This poster compares contemporary practice with the standards and approaches described in the 2006 SAAD Digest, highlighting how dental sedation has evolved.

Key developments include enhanced patient monitoring through the introduction of capnography, updated national guidance and training standards, digital consent and record keeping, simulation-based education, and increased awareness of human factors in improving patient safety. Emerging innovations, including artificial intelligence, point-of-care ultrasound and novel sedative agents, are also explored for their potential impact on future practice.

A visual comparison of sedation practice in 2006 and 2026 provides an accessible overview of the major milestones that have shaped modern conscious sedation. The poster concludes by considering future directions for dental sedation and encourages reflection on how continued innovation can further improve patient care, safety and clinical outcomes.

Habiba Gohur¹
Charles Fasoranti²
Elizabeth Morphet³ BDS MFDS PGCert(TLHP) PGDip(DPH) DSCD
Emma Critchley⁴ BDS MFDS RCSEd MSC(Rest) PGCertMed DSCD MSCD RCSEd
1. Dental Core Trainee 2
2. Dental Core Trainee 1
3. Specialty trainee in Special care Dentistry, Lancashire Teaching Hospitals NHS Foundation Trust
4. Consultant in Special Care Dentistry, Lancashire Teaching Hospitals NHS Foundation Trust

Introduction

Two years ago, the Special Care dentistry intravenous midazolam sedation service at LTHTR began treating patients with a lower age limit of 14 years. The success of the service at one year was evaluated; results demonstrated consistency and positive patient outcomes; avoiding unnecessary general anaesthetics, allowing completion of Orthodontic extractions and the provision of routine dentistry in severely anxious teens. The lower age limit has since been reduced to 12 years for physiologically and emotionally suitable patients.

Methods

Details of cases of 12–17-year-old patients treated under dentist-led IV midazolam sedation in the last year were reviewed. Any adverse outcomes were reflected on and overall patterns compared to the previous evaluation, considering the suggested outcomes following initial presentation.

Results

A total of 11 patients were treated over 1-year. Patients were assessed equally between the adult Special Care and Paediatric teams. Doses of midazolam were consistent, ranging from 4-9mg. Courses of treatment were mostly completed over 1 visit. Patient and parent feedback has been encouraging.

Conclusion

The service continues to evolve, becoming more widely accepted and utilised appropriately as its benefits are demonstrated. We hope that our outcomes will support the development of IV sedation services for younger patients elsewhere.

Dr Tarun Singh Nagpal (Specialist oral surgeon / locum consultant), Dr Amanveer Singh Benning (Clinical Fellow OMFS/ Associate Dentist/ Medical Student), Dr Ashana Gupta (Specialist Oral Surgeon)
Private practice and Practice Plus Group

Conscious sedation in dentistry is increasingly used to manage anxiety and facilitate complex procedures. The safe administration of sedative agents requires a thorough understanding of potential drug interactions, which can significantly alter the efficacy and safety profile of sedation.

This practical guide aims to provide a concise overview of the most relevant drug interactions encountered in conscious sedation. It highlights key interacting medications across several common categories, including cytochrome P450 3A4 (CYP3A4) inhibitors, opioids, selective serotonin reuptake inhibitors (SSRIs), glucagon-like peptide-1 (GLP-1) agonists, cannabis, and benzodiazepines.

The most frequently encountered interacting medications within each category are identified, along with their potential clinical implications. Emphasis is placed on pharmacokinetic and pharmacodynamic considerations that may increase the risk of prolonged sedation, respiratory depression, haemodynamic instability, or reduced drug efficacy.

A traffic-light interaction chart is presented to support rapid risk assessment at the chairside.

This tool categorises interactions as green (low risk), amber (moderate risk), or red (high risk) to guide clinical decision-making and promote patient safety.

This overview aims to enhance the confidence of dental clinicians in managing patients receiving conscious sedation in the context of polypharmacy.

Rayan Musa (Academic Clinical Fellow and DCT2 in Special Care Dentistry), Janka Fazekas (DCT1), Simran Mann, Specialty Dentist, Fatimah Alsayer, Consultant and Honorary Clinical Associate Professor in Special Care Dentistry
Royal National ENT and Eastman Dental Hospital, University College Hospitals

Abstract: 

Dental services providing Intravenous sedation should carryout regular audits of practice evaluating compliance with national guidelines. The aim of this audit includes the evaluation of compliance across multiple staff groups focusing on:

1.    Sedation assessment, written consent (2 stage), and the provision of patient information leaflet prior to the appointment

2.    Sedation Log including pre-operative, peri-operative, surgical safety checklist and fulfilment of discharge criteria

Methods

A retrospective audit based on data collected from electronic health records. The proforma used was derived from national record keeping and sedation standards. A sample of 40 cases in Special Care Dentistry and Oral Surgery were reviewed (n=40) and compared to previous audit results (n=40).

Results

Although overall good compliance across standards, gaps were identified in key areas including:

·      Consent verification digitally

·      Surgical safety checklist including pre and post operative checks

·      Avatar clinical illustration documentation of cannula site insertion / removal

Conclusion

This audit demonstrated achievement of core clinical sedation standards, but identified deficiencies in electronic documentation, especially following implementation of a new digital step. Results of this audit and action plans shared with the wider teams including reinforcing record keeping, delivering targeted digital training, and providing in surgery tip sheets for digital step.

Lucy Malcolm (Specialty Dentist OMFS)
Forth Valley Royal Hospital, NHS Forth Valley

A valuable treatment modality within OMFS Forth Valley is IV Sedation (IVS). There are strict requirements every patient and escort must follow and comply with in order to deliver safe care. Assessment of patient perception demonstrated 100% of patients asked, believed they had followed pretreatment instructions correctly. However, clinicians confirmed only 61% of those questioned had complied with all pretreatment requirements.

This project was established aiming to improve patient compliance, reduce wasted appointments and ensure appropriate safe care.

The project focused on the development of a tool which would be easily accessed by every patient, pre-appointment. This was a collaborative process with Forth Valley College, who filmed/edited the video as part of their film and production college course. Both teams benefited, with the department gaining a professional video and local students practicing new career skills in a real-world environment.

The video is now available for IVS patients to watch and is included in the physical patient information leaflet given to all patients during their assessment.

Moving forward the questionnaire will be repeated. Ideally demonstrating an improvement in compliance, bettering patient flow through the service using a sustainable tool.