2025-I Editorial
2025 has arrived, brimming with endless possibilities for collaboration, practical innovations, and a renewed focus on high- quality, effective anxiety management and sedation. As I sit at my desk less than a month into the year, listening to the radio and reflecting on political shifts across the Atlantic and the launch of DeepSeek, I’m reminded that the course of this year will be shaped by both the anticipated and the unexpected. There are many exciting changes on the horizon, with items awaiting discussion at my first Board of Trustees meeting as President. Yet, as I listen to interviews with Davos attendees, one commonality stands out: we must adapt and innovate, guided by experience, evidence, and expertise, with patient care always at the centre.
For those of us in clinical dentistry and patient care, the trajectory of sedation and anxiety management continues on a clear, positive path. The SAAD Digest remains a vital platform for showcasing these innovations: where curiosity in patient care and imagination, underpinned by scientific understanding, are truly exemplified. This issue’s AI-generated cover, inspired by remimazolam, marks our second biannual Digest and stands as a testament to Nigel Robb and the Editorial Board’s relentless pursuit of engagement with members and readers in a timely, relevant format.
Since acquiring its licence four years ago, remimazolam has proven to be an excellent example of how experience, evidence, and expertise can enhance patient care and improve clinical outcomes for some of our most vulnerable patients. In this issue, Mili Doshi, MBE, and the team at the Royal Hospital for Neuro-disability have provided valuable evidence from 33 patients with acquired and inherited brain injuries. This is a significant contribution, coupled with the case series and reports from the Special Care Dentistry team at the Royal London Dental Hospital. It is heartening to see remimazolam emerging as a tool that delivers excellent patient care for some of the most vulnerable in our society. Lord Darzi’s Independent Investigation of the National Health Service (NHS) in England emphasised the need to ‘tilt towards technology’ to drive productivity and transform care.1 His call to empower staff and improve patient outcomes resonates in the pilot study undertaken by the paediatric dentistry team at Guy’s and St Thomas’ NHS Foundation Trust. It highlights how technology can safely mitigate the increased risks of dental care under general anaesthesia for paediatric patients with high body mass index (BMI). Alarmingly, one in eight children aged two to ten in England are obese, a statistic that is more prevalent in deprived areas, alongside dental caries.2 The innovative approach discussed in this article has successfully reduced patient waiting times, alleviated the burden of care on families, and kept patient care at the centre for this growing patient group. I hope other readers of the Digest will find this pilot study insightful as electronic noting systems continue to be integrated across the UK.
Those who attended the recent SAAD webinar on ‘Intravenous sedation with remimazolam’ may have noticed our motto, Dolore vincto timore victo which translates loosely as ’Abolish pain to conquer fear’. In 2025, the importance of preventing dental anxiety to combat dental disease remains as relevant as ever. This theme was acknowledged at a recent Office of the Chief Dental Officer meeting, where the prevention of dental disease was high on the agenda. The articles by the Oral and Maxillofacial Surgery team at Cardiff University Dental Hospital and Salaried Dental Services at the Royal Devon University Healthcare NHS Foundation Trust highlight how dental anxiety continues to be a leading cause of secondary and tertiary care referrals. Where dental anxiety and phobia are present, resultant avoidance behaviours or increased psych- ogenic non-epileptic seizures may escalate dental needs and shift care from primary and community services to acute trusts.
The Digest also includes a review linking pre- operative anxiety to poorer post-operative outcomes. To mitigate this, our colleagues in Australia commend pharmacological and cognitive behavioural therapy (CBT) options to reduce immediate and long-term anxiety respectively. This mirrors the UK’s Clinical standards for dental anxiety management and ties into a cause close to my heart as a paediatric dentist.3 Kier Starmer and Wes Streeting have repeatedly highlighted the urgent need to improve paediatric oral health. All too frequently, I witness how a child’s experience of pain only serves to reinforce a fear that was once unfounded. Breaking the cycle of parental dental anxiety, reduced parental engagement with oral care, and unmet paediatric dental need is crucial for improving oral health in the UK. To achieve this, high-quality training in sedation and anxiety management is essential. It is inspiring to see a growing number of articles, book reviews, abstracts, posters, and case reports from younger colleagues across the country, all supported by experienced sedation and anxiety management teams.
For those interested in exploring CBT further, I highly recommend Cognitive Behaviour Therapy of Dental Anxiety: A Manual for the Dental Team, which was supported by a grant from SAAD. This evidenced-based 10-chapter book pulls together relevant knowledge and expertise in the dental anxiety field. Additionally, for dental teams utilising visiting sedationists, I commend the article by Laleh Sharifian, SAAD Trustee, and Raj Rattan, which highlights key considerations when engaging peripatetic sedation services.4
The Digest would not be possible without the tireless efforts of the whole Editorial Board. Countless volunteered hours go into reviewing articles for the Journal Scan and overseeing the publication. The Journal Scan has become an increasingly diverse section of the Digest, reflecting the global rise in awareness around anxiety management, sedation and anaesthesia.
As part of your SAAD membership, complimentary access to the Digest-related CPD is provided as a membership benefit. This part of membership is an easily discernible advantage of being a SAAD member however there are many significant initiatives and less published projects concurrently being undertaken by the Board of Trustees to drive our work forward. As this is my opportunity to guest write the Editorial as in-coming president, I would like to thank past Board members for their efforts in establishing the many SAAD schemes and accomplishments featured in this Digest. They provide a firm, trusted foundation on which to build. To the current Trustees and co-opted members of the Board, thank you in advance for the important work being undertaken now, which will come to fruition for all our benefit. Their tenacity, innovation and expertise are an unparalleled force. SAAD’s newsletters, events and upcoming editions will undoubtedly keep all members updated on the exciting times ahead. In the meantime, I invite you to enjoy this issue’s exploration of evidence for change, or, as the organisers at Davos have termed it, ‘Imagination in Action.’
Yi Kwan Loo, President
References
1. Independent investigation of the NHS in England. London: Department of Health and Social Care, November 2024. Online information available at https://www.gov.uk/government/publications/independent-investigation-of- the-nhs-in-england/summary-letter-from-lord-darzi-to-the-secretar y-of-state-for-health-and-social-carehttps://www.gov.uk/government/publications/independent-investigation-of- the-nhs-in-england/summary-letter-from-lord-darzi-to-the-secretar y-of-state-for-health-and-social-care (accessed January 2025)
2. One in eight toddler and primary school aged children obese, September 2024. Online information available at https://www.england.nhs.uk/2024/09/one-in-eight-toddlers-and-primary-school-aged-children-obese/ (accessed January 2025)
3. Clinical standards for dental anxiety management. NHS England, January 2023. Online information available at https://www.england.nhs.uk/long-read/clinical-guide-for-dental-anxiety-management/ https://www.england.nhs.uk/long-read/clinical-guide-for-dental-anxiety-management/ (accessed January 2025)
4. Sharifian L, Rattan R. A sedationist calls: intravenous sedation in general dental practice. The Dentist 2024; 28-32. Online information available at https://www.the-dentist.co.uk/content/news/a-sedationist-calls-intravenous-sedation-in-general-dental-practice/ (accessed January 2025)