SAAD 2025 Poster Exhibition

Dr Helen Adam (Specialist in Special Care Dentistry), Dr Laura McKay (Specialist in Special Care Dentistry)
Wirral Community Health and Care NHS Foundation Trust

Background: Wirral Community Health & Care provides primary care-based dentist-led intravenous sedation for patients ASA1-3.  More complex patients are unsuitable for care in this setting, requiring onward referral to distant services with long wait times.  For these groups, a local theatre-based anaesthetist-led sedation pathway has been piloted, preventing the need for onward referral.   

Methods and results: Patients whose needs could not be met were identified.  Acceptance criteria for the lists were developed, to include ASA3-4 patients and those with challenging cannulation, those requiring multi drug sedation methods and those where midazolam sedation had failed.   Liaison with anaesthetic colleagues allowed some GA theatre lists to convert to anaesthetist-led sedation lists and remote anaesthetic assessment of patients was undertaken.     The sessions successfully prevented the need for GA in some cases, and increased list capacity, by allowing increased cases per list.  However, treatment complexity may be limited eg. single tooth extraction. 

Discussion: Due to complexity, many patients are unsuitable for primary care dentist-led sedation.  In-hospital anaesthetic-led sedation is an appropriate alternative but is not routinely available and sees long waiting lists.  The pilot successfully confirmed local delivery is appropriate, but further work is needed in pathway design and acceptance criteria.  

Chloe Bass (Senior Dental Officer in Oral Surgery), Andrea Aspinall (Specialist Paediatric Dentist) 
Central London Community Healthcare NHS Trust

Within our community dental service, we identified a need for an adolescent intravenous sedation service for patients who fail treatment with inhalation sedation, have significant anxiety, or require complex surgical procedures. The service aims to reduce general anaesthetic referrals, ease hospital pressures, and offer a supportive environment for adolescents with complex needs.

A standard operating procedure was created for 12–16-year-olds and presented to the Clinical Governance and Medicines Management Boards for approval. Supporting materials included adolescent and parent information leaflets, clinical note templates, and a post-operative patient questionnaire.

Referrals are jointly assessed by an Oral Surgeon and Paediatric specialist. EMLA and inhalation sedation assist with cannulation, while distraction tools—music, tablets, and virtual reality headsets—enhance patient comfort.

Initial results from the pilot were positive: eight patients received treatment successfully. Telephone follow-up revealed high satisfaction, with no memory of the procedure, no adverse effects, and all patients very likely to recommend the service to friends and family.

Reflections highlighted the importance of clear communication, appropriate waiting areas, and consistent staffing. Future developments will focus on increasing capacity, improving recovery facilities, and training more dental team members.

Dr Sarah Bux (Speciality Training Registrar in Special Care Dentistry), Dr Bryan Kerr (Consultant in Special Care Dentistry)
Guy's and St Thomas' Foundation Trust

Propofol sedation offers rapid onset, titratability, and short recovery, making it an effective technique in Special Care Dentistry. It enables safe dental care for patients with dental anxiety, medical comorbidities, or previous midazolam sedation failures, while reducing the risks and resource demands associated with general anaesthesia.
This service evaluation reviews the use of intravenous propofol sedation within the Special Care Dentistry department at Guy’s Hospital, focusing on clinical indications, dosing protocols, adverse event reporting, and demographic trends.

Prospective data was collected from 918 sedation episodes between 2014 and 2019. Patient demographics, indications for propofol sedation,  treatment outcomes, sedation levels , operating conditions, adverse events and patient satisfaction were systematically recorded.
Preliminary analysis demonstrates clear trends in referral indications, including severe dental anxiety, medical comorbidities, and previous midazolam sedation failures. Success rates and patient satisfaction were high. Adverse events were infrequent and predominantly minor (e.g., transient desaturation), with no serious complications reported. Dosing varied according to age, weight, and comorbidity profile.

This evaluation highlights the safe and effective use of propofol for dental sedation in a specialist hospital setting and underscores the importance of robust adverse event reporting to optimise practice and inform training for sedation teams.

Dr W Bansema (ST7 Anaesthesia), Dr J Wyatt (CT3 Anaesthetics), Dr Giju George (Consultant Anaesthetist)

Royal Liverpool Hospital 

The lack of standardised competencies in education and practice has been commented on in recent literature. We developed an online sedation module covering various Key Capabilities outlined by the Royal College of Anaesthetists 2021 Curriculum and Academy of Medical Royal colleges. Content contained within this module was largely derived from the key standards released by the Royal College of Anaesthetists. Trust based trainees were given access to this module and then surveyed before and after completion, 

The module and survey were completed by 18 trainees within our Trust ranging from CT1 to ST7 as well as clinical fellows. 94% of trainees received training on sedation either fewer than once a year or never. Following completion of the module, all trainees felt comfortable with the safe minimum monitoring level required. Trainees also felt more comfortable with the defining different levels of sedation (with a mean score increase from 6.7 to 9.1). Overall, comfort levels in the provision of sedation increased from a mean score of 6.1 to 8.1. 

This teaching made a demonstrable improvement in trainee confidence levels. 

Dr Haidar Hassan (Clinical Senior Lecturer at Queen Mary University), Mohammed Aziz (Undergraduate in Queen Mary University)
Queen Mary University

This study explores existing literature regarding the safety and efficacy of intravenous sedation in medically compromised patients undergoing oral surgery procedures. The primary outcome is to analyse and compile this information to determine whether intravenous sedation is safe and effective for patients with specific medical conditions or if it poses any risks and complications. A comprehensive search of articles published up to July 2024 was performed using three databases: OVID Medline, PubMed, and Cochrane Library. The Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 guidelines were followed, and the risk of bias was assessed. Only studies regarding intravenous sedation for medically compromised patients undergoing oral surgery procedures were included. The findings indicate that intravenous sedation is generally safe and effective to use in medically compromised patients, with specific considerations and modifications based on individual medical conditions. Intravenous sedation can be safely administered to medically compromised patients for oral surgery procedures with appropriate preoperative assessments and intraoperative monitoring. 

K Holdgate (JDCFT), L Mckay (Specialist in Special Care Dentistry)
Wirral Community Health and Care NHS Foundation Trust

Background: 31-year-old male patient with autism (ASD) and learning disabilities (LD), presented with acute behavioural changes following a respite stay including oro-aversion, refusing food and fluids, and regressed from independent feeding to requiring spoon feeding. Attempt at routine dental examination resulted in severe distress, gagging, and examination abandonment. Given the behavioural deterioration, inability to complete clinical assessment, and interval of over 5 years since previous dental general anaesthesia (GA), multidisciplinary (MDT) intervention was indicated. 

Medical History: ASD, non-verbal communication, wheelchair user, and takes lansoprazole, fluoxetine, and topical psoriasis treatments. Safeguarding concerns arose following respite stay due to dehydration, oro-aversion, and unexplained bruising. 

Management: Following BSSCD guidelines limiting repeat GAs, a coordinated MDT approach was implemented. The patient underwent dental treatment, gastroenterology endoscopy (OGD), CT imaging, and blood investigations under a single GA.

Findings: Dental examination revealed relatively good oral health with carious lesions and a failing restoration. Treatment included restorations and 1 extraction. Endoscope showed benign polyps typical of proton pump inhibitors.

Conclusions: MDT care under GA for patients with complex needs, addresses multiple concerns, minimises patient distress and repeated GAs. 

Discussion

• Early recognition of behavioural changes may indicate underlying issues 
• MDT GAs optimise care delivery - BSSCD guidelines 
• Safeguarding requires coordinated communication across disciplinaries and trusts

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Neha Lalani (StR Special Care Dentistry), Sohir Hayat (Senior Dental Officer), Hamza Hossenally (Specialst)
Whittington Community Dental Services

The Separate Operator-Sedationist (SOS) approach has been advocated as a means of safely delivering dental care in complex cases, where patients present with significant medical comorbidities, physical disabilities, behavioural challenges, or when the procedure is expected to be prolonged or technically demanding (SCDEP, 2017). This case series describes the management of five ASA III patients classified as having severe systemic disease, within Whittington Community Dental Services (CDS), using the SOS approach. 

All patients underwent intravenous sedation, were monitored and recovered within the CDS environment without adverse outcomes. As Whittington CDS serves the wider Northwest London region, this model offers a sustainable and practical alternative to referral for general anaesthesia (GA), especially in areas with limited tertiary care provision. These cases illustrate that, with appropriate patient selection, team-based care, and robust monitoring protocols, high-risk patients can be safely and effectively treated in a community dental setting under IV sedation. Finally it is in keeping with the NHS 10 year plan to move care out of hospital and into community in order to provide continuous, accessible and integrated care.

Wan Yee Liang (Dental Core Trainee 1), Jeena Patel (Specialty Trainee in Special Care Dentistry)
Barts Health NHS Trust

Background: Remimazolam is a short-acting benzodiazepine with titratable properties, offering rapid onset and recovery. While infusion pumps have been used to deliver remimazolam in procedural sedation, limited data exists in special care dentistry. This study evaluates its use via infusion pump in special care dental setting, focusing on clinical outcomes, age-specific flow rates, and practical considerations.

Methods: A retrospective review of 80 cases using remimazolam via infusion pump for intravenous sedation cases was conducted. Data included age group (<65, 65-74 and ≥75 years), ASA, BMI, flow rate, bolus, recovery time and sedation outcomes. Success was defined as completion of planned treatment without adverse events. 

Results: Sedation was successful in 72/80 cases. The mean BMI was 27.6, with negligible impact on outcomes. Average flow rates were: <65 – 21.1 mg/hr, 65-74 – 19.45 mg/hr, ≥75 – 15 mg/hr, indicating lower rates for older patients. Average infusion times were 35.1minutes, 29.7minutes and 31.2minutes respectively. The infusion pump allowed real-time adjustments based on cooperation, oxygen saturation and procedure. Mean recovery time was 20.1 minutes. Both single operator-sedationist and separate sedationist models were used. 

Conclusion: Remimazolam via infusion pump offers effective sedation with smooth recoveries. Success was achieved across a wide age range, ASA and BMIs. The infusion model allowed individualised titration, and supports the single operator-sedationist model.

A Maxwell (Dental Core Trainee), D Bhugooa (Senior Dental Officer)
King's College Hospital

Background: Providing dentistry with conscious sedation is common in our department, which, on occasion, is unsuccessful. This may be due to inappropriate planning and requires patients to progress to more restrictive techniques.

Aim: Retrospective review of failed inhalation (IHS)/intravenous (IVS) sedation in CSCD.

Objectives: 

• Identify failed sedations, reason for failure and follow-up.
• Identify ways to reduce failures.
• To compare with cycle 1 (C1) and cycle 2 (C2).

Standards: Data collection 100% of patients who have suffered a failed sedation.

Process: Retrospective data collection between December 2024-May 2025 of failed sedation cases from CSCD.

Results: 30 failed sedations, 87% were IHS. The most common reason was dental anxiety (77.6%). After failure, 76.6% were referred for general anaesthesia (GA); 6.6% repeated IHS; 6.6% local anaesthetic (LA) only; 9.9% went abroad, had IVS or were reviewed. 

Discussion: C1’s actions encouraged trying LA-only first. However, the rate of failed sedations are consistent. Referral for GA has increased by 20-21%. It would be complimentary to this audit to look at those who’ve had treatment with GA before attempting IHS/IVS to see if any were later cooperative for less restrictive options. 

Action plan: 

• Reinforce enquiring about previous sedation experience 
• Ensure staff document failed sedations and reflect

Elise Morgan (Sedation Supervisor), Jeena Patel (Special Care Registrar)
The Royal London Dental Hospital

Introduction: Midazolam is the first-line drug for intravenous sedation (IVS) in dentistry due to its rapid onset, short half-life and anxiolytic properties. However, in some patients midazolam alone may be ineffective, but multidrug IV sedation (for example midazolam and fentanyl) may be contraindicated. This case series explores the combined use of Inhalation Sedation (IHS N₂O/O₂) with IVS midazolam as an alternative approach.

Methods: We present seven cases treated in the Special Care Department of The Royal London Hospital. In four patients IVS midazolam was unsuccessful and the patient subsequently had a combination of IHS N₂O/O₂ and IVS Midazolam. In three patients the approach was selected in the first instance due to the severity of the patient’s anxiety. All cases were unsuitable for sedation with two intravenous drugs. In every case the combined technique was successful. In the four cases where midazolam was given previously, a lower dose of midazolam was required when combined with IHS N₂O/O₂.

Conclusions: This limited case series supports the combined use of IHS N₂O/O₂ and IVS midazolam as a safe, effective alternative to midazolam IVS. Patient safety was maintained, with no observed adverse events. This technique enabled these patients to be managed without an onwards referral for General Anaesthetic. Further research into the technique is recommended.Title: A Case Series of Adolescents Treated Under Midozolam and Propofol IV Sedation by the Special Care Dental Team

Elizabeth Morphet (Specialty Trainee in Special Care Dentistry), Emma Critchley (Consultant in Special Care Dentistry)
Lancashire Teaching Hospitals NHS Foundation Trust

Introduction
The LTHTR Special Care Dental department dedicated IV sedation service provides dentist-led midazolam sedation and anaesthetist-led propofol sedation, this is in addition to inhalation sedation which is offered across the department to patients of all ages. Although predominantly an adult service, the service has opened treatment to younger patients over the last year; with a lower age limit of 13 years.

Methods
We review details of the cases treated, demonstrating the successes and highlighting learning points.

Results
Patients aged 12-17* were treated either under dentist-led or under anaesthetist-led sedation. Treatments provided included: management of carious first permanent molars, avoiding a general anaesthetic; surgical removal of a submerged primary molar; Orthodontic extractions that would not otherwise have been feasible; and general dentistry for patients with severe dental anxiety and autism. There were two unsuccessful cases, thought to be due to the patients’ emotional maturities, affecting their ability to accept sedation. Both had treatment provided under general anaesthetic.

Conclusion
Overall, outcomes suggest that this is a valuable service with positive experiences reported by patients, carers and professionals. Suggested improvements relate to communication between the referring and treating teams; including the quality of sedation assessments.

Zahra Nasir (Specialty Registrar in Special Care Dentistry
Marlowes Health and Wellbeing Centre

Introduction: Artificial Intelligence is becoming increasingly prevalent in all aspects of life, including healthcare. Applying AI within dentistry, specifically conscious sedation, has the potential to aid in patient risk assessment.

Aim: Explore the uses of AI in the risk assessment process for conscious sedation. 

Discussion: AI could be used to aid in sedation assessments to predict the risk of having sedation related complications. AI can extract variables such as ASA classification, anxiety, comorbidities and baseline from patient notes. AI will use a machine learning algorithm using data from previous sedation cases and recognise patterns to predict risk, generate a risk score (e.g. a traffic light system), and flag potential high risk cases. This aids the clinician in deciding on the patient’s suitability for conscious sedation in various locations. However, AI presents with significant environmental and ethical challenges, including water and electricity consumption, and use of patient data. This raises important questions about the long term sustainability and cost effectiveness. 

Conclusion: AI has the potential to enhance patient care, safety and support clinicians in decision making using machine learning to analyse patient data and previous sedation cases. However, the sustainability of AI should be carefully considered, particularly its long term cost.

H Patel (ST1 Speial Care Dentistry), R Iles (Consultant Special Care Dentistry), C Boynton (Consultant Special Care Dentistry)
Royal Devon and Exeter Hospital

Background: Adolescents with anxiety, autism spectrum conditions (ASC), and/or learning disabilities may benefit from IV sedation but often struggle with cannulation. Oral or intranasal (IN) midazolam before IV sedation is a well-established technique for adults with learning disabilities, but evidence for its use in12-16-year-olds remains limited.

Aim: To assess IV sedation success rates and efficacy of Oral/IN midazolam for enabling cannulation in 12-16-year-olds with anxiety, ASC, and/or learning disabilities in community dental services.

Methods: Retrospective analysis of all IV sedation episodes in 12-16-year-olds (May 2023-May 2025), including age, medical history, Oral/IN doses, sedation scores and treatment outcomes.

Results: Of 44 IV sedation episodes, 20/44 cases (45%) required pre-procedural midazolam: 8 intranasal, 12 oral. Usage varied by diagnosis: 20% for anxiety alone, 37% for anxiety with ASC, 100% for learning disability. Overall treatment completion success was 93%. Three failures occurred: two from failed cannulation (difficult veins, non-compliance), one from non-compliance in profound learning disability. Distressing behaviours like tearfulness or vocalisations were evident, although amnesia was effective.

Conclusion: Pre-procedural Oral/IN midazolam with IV sedation is safe and effective for most adolescents with anxiety, ASC, or learning disabilities. Its indication increases in those with combined diagnosis. Written consent should acknowledge potential distressing behaviours.

Hiba Salman (DCT2 CDS)
South Tyneside and Sunderland NHS Foundation Trust

Aim: This audit aimed to investigate whether clinicians included all recommended aspects in patient notes, as per the Conscious Sedation guidelines by the Scottish Dental Clinical Effectiveness Programme, specifically relating to assessment appointments for inhalation sedation.

Method: This two-cycle audit involved selecting patients booked for sedation and looking retrospectively at the assessment notes. These were inspected for the aspects recommended by the guidelines to be included. The recommendations for change were emailed to all clinicians in the department with a 6-month interval between cycles.

Results: Medical history, dental history and the treatment plan were recorded at 100% in both cycles. Areas which improved included ASA recording from 0% to 13%, sedation/general anaesthetic history to 91%, fasting instructions to 22% and information leaflet provision to 65%. Social history, justification and consent decreased in compliance by a maximum of 13%. Anxiety level recording was unaffected at 83%.

Conclusion: This project highlights the importance of record keeping auditing, as otherwise the compliance rate of 0% for ASA recording would not have been identified. Reflection for future cycles could include exploration of other methods of implementing change to lead to a larger and more sustained improvement.

Dr Jess Taylor (Dedicated sedationist and associate dentist)
Magenta Sedation

The poster will be an account of the experiences of the author in setting up a peripatetic dental sedation service in Hertfordshire, during 2024 to 2025.  

It will feature background information about the author and the circumstances which led to deciding to start the business.  It will move on to the planning and preparations that went into being ready to launch the business.  It will move into a month by month account of the progress of the promotion and building of the business.   It will detail the successes and mistakes made over the year.   It will round off with some tables illustrating how the business has grown, and plans for the future.

The tone of the poster will not be academic, as it will be a personal account of the time, effort, and tears that went into creating and promoting the business.   The author hopes it will be an honest account that will inspire other dental sedationists to make the leap to running their own business.  Although hopefully not in Hertfordshire, just at the moment. 

Sirinie Wanigaratne (Specialty Dentist)
Royal London Dental Hospital

Glucagon-like peptide-1 receptor agonists have become central in managing type 2 diabetes and obesity due to their effects on glycaemic control, satiety, and delayed gastric emptying. The increasing use of these agents, alongside sodium-glucose co-transporter 2 inhibitors (e.g. dapagliflozin, empagliflozin), presents new perioperative challenges. GLP-1 receptor agonists delay gastric emptying, potentially increasing the risk of pulmonary aspiration during general anaesthesia or conscious sedation. SGLT2 inhibitors may precipitate diabetic ketoacidosis during prolonged fasting or physiological stress.

Methodology: A structured literature search was conducted using PubMed and NICE Evidence. Search terms included “GLP-1 receptor agonists”, “SGLT2 inhibitors”, and “sedation”. Relevant clinical guidance was reviewed to evaluate perioperative recommendations for managing these drug classes.

Conclusion: For minimal to moderate sedation, single-agent protocols titrated to preserve airway reflexes are generally considered low risk. However, multi-drug or deep sedation and general anaesthesia may require additional precautions, including fasting protocols and medication adjustments. GLP-1 receptor agonists typically do not require withholding, whereas SGLT2 inhibitors should be omitted the day before and day of the procedure, with resumption once oral intake is restored. Tailored guidance for dental sedation is needed.

Alexandra Ward (Dental Therapist)
Peninsula Dental Social Enterprise

Many children are too anxious to receive dental treatment in a routine dental setting and may benefit from conscious sedation. However, as many practices do not offer this service, an external referral is often required, contributing to significant wait times in community dental services and hospital units. To address this challenge, Peninsula Dental Social Enterprise launched a dental therapist-led inhalation sedation service in June 2024. This initiative enables dental therapists to practise to their full scope, including under direct access and with inhalation sedation, within the primary care setting. The aim is to improve access to timely dental care, reduce disease progression, and ease pressure on secondary care services. Since the launch, the wait time for an inhalation sedation assessment within Peninsula is just eight weeks, compared to 72 weeks in community services. The service has grown from one session per month to a weekly clinic, accepting 21 patients and successfully restoring 15 to clinical oral health. The service has been well received by patients with 100% of users scoring the service as very good. This approach demonstrates a scalable solution, effectively utilising the dental therapist workforce and highlighting their value within the NHS and primary care setting.