SAAD Essay Prizes: Guidelines for Authors

Contribution formats

Essays in all categories are only accepted in digital format and via email. It is a condition of acceptance that they are the work solely of the author stated and that they have not been previously published elsewhere (either in print or electronic format) nor are they under consideration for publication by any other periodical.

Essays should meet the following criteria: they should be original, clearly written, relevant to dentistry, and may be on any subject related to conscious sedation, anxiety control, general anaesthesia or analgesia in dentistry and designed to inform, add to discussion or debate, or entertain. In addition, research papers should have appropriate study methods, valid data and conclusions that are supported by the data.

The authorship of the essay can only be attributed to a single author.

If in any doubt remains about the format or content of a proposed essay please contact us before submission, prizes@saad.org.uk

Generative Artificial Intelligence (AI)

Generative artificial intelligence (AI) may not be used to write your essay. Some examples of generative AI products include ChatGPT, Microsoft CoPilot and Google Bard.

Submission

Essays may only be submitted to SAAD at  prizes@saad.org.uk to arrive and be acknowledged before or on the deadline of 31st March each year.

Authors should note that submitted essays not fully conforming to these ‘Authors Guidelines’, especially in terms of length and manuscript format, will be returned for correction and may well be delayed or subsequently declined.

Length of contributions

Essays should be within the word count for the prize for which they are submitted:

• Drummond-Jackson Prize – 5000
• Undergraduate Essay prize – 3000

Titles must be descriptive of the contents of the article, but should be concise.

Essays should be introduced with a short abstract that should be able to stand alone. The abstract should not contain references or abbreviations, and should be no longer than 200 words. The abstract will not contribute to the word limit of the essay.

Manuscript Format

Manuscripts should be word-processed in Microsoft Word in the native format, single column and double-spaced with a margin of at least 4 cm on the left-hand side. No decorative borders should be used. The font used should be 12 point Calibri. 

The pages should be numbered consecutively with the numbers at the bottom of each page.

The first page of the essay should give only the title of the article, and the author’s name, qualifications and work address (or Dental School address for students), including email address, and the prize for which the essay is submitted.

The layout of the text should be kept as simple as possible. Most formatting codes will be removed and replaced on processing the essay. In particular, do not use the word processor's options to justify text or to hyphenate words. However, do use bold face, italics, subscripts, superscripts etc.

To avoid unnecessary errors, you are strongly advised to use the 'spell-check' and 'grammar-check' functions of your word processor.

Data or tables may be submitted in Microsoft Excel format or embedded in the text of the Word document. 

Figures or images should be submitted as separately attached and clearly labelled files in JPEG format at a high resolution of 300 dpi. Colour illustrations are preferred where possible. If the illustration is of a subject’s face, written consent for its publication must be obtained from the subject and attached with the essay. Should the essay be accepted for publication in the SAAD Digest, illustrations obtained from other sources such as books, or from colleagues, must again be accompanied by appropriate documentation indicating approval for their publication as part of the essay from the copyright holder, or individual concerned.

Units used in the manuscript must conform to the Système Internationale d’Unités (SI).

References

References must be in the Vancouver style, as used in the SAAD Digest (see below) They should be numbered in the order in which they appear in the text. The numbers should be inserted as superscripts each time the author is cited (Robb3-5 reported similar findings). Other references to the paper should be given in the same way after punctuation (Other studies have shown this to be true.4,5 Drummond-Jackson et al.6 demonstrated...)

At the end of the article the full list of references should give the names and initials of all authors unless there are more than six, in which case only the first three should be given followed by et al. The authors' names must be followed by the title

of the article; the title of the journal abbreviated according to Index Medicus and Index to Dental Literature style; year of publication; volume number; and the first and last page numbers in full. Titles of books should be followed by the place of publication, publisher, and the year. If this reference citation style is not followed exactly, especially in relation to punctuation and spacing, the manuscript will be returned without review.

Examples of reference styles (Note: The issue number of a Journal is not cited)

Reference to an article

1.    Molar L R, Fang-Jones Q, Jaw U. Are teeth biting back?. Br Dent J 2006; 200: 144-146.

Reference to a book

2.    Craig D C, Skelly A M. Practical Conscious Sedation. 1st ed. London: Quintessence, 2004.

Reference to a book chapter

3.    Robb N D. Conscious s

Sedation in Dentistry. In Heasman PA (ed) Master Dentistry. Vol. 2; Restorative Dentistry, Paediatric Dentistry and Orthodontics. pp 149-168. Edinburgh: Churchill Livingstone, 2003.

Reference to a report

4.    Re-accreditation and re-certification for the dental profession. London: General Dental Council, 1997.

Reference to a webpage

3. General Dental Council. Scope of practice. 2009. Online information available at www.gdc- uk.org/Newsandpublications/Publications/Publications/ScopeofpracticeApril20 09[1].pdf (accessed April 2012).

The author/principal author is responsible for the accuracy of the reference list. Acknowledgements

These should be grouped in a paragraph at the end of the text before the references. Permission and approval of the wording must be obtained from the person(s) thanked. Where any research project was supported by industry, this should be acknowledged in a covering letter to the Executive Secretary on submission of the essay.

Declaration of interests

Authors must ensure that they declare any possible conflicts of interest in their Essay. This includes matters such as: direct funding from an organisation or company for the research; funding received (or payment in kind) for any related work carried out from an organisation or company that could be linked to the research; consultation or advisory positions held in an organisation or company involved in the research or an organisation involved in similar research; any other situation that could be construed as a conflict of interest.

Ethics

Essays reporting clinical research must include a statement indicating that appropriate Ethical Committee approval has been granted.

SAAD Digest

Any essay submitted for a SAAD Essay prize may be considered for publication in the SAAD Digest.

The SAAD Digest is the Journal of the Society for the Advancement of Anaesthesia in Dentistry and has been published regularly in London UK, since 1970. It has been produced in its current format since 2006. Two editions are published each year. Copies of all editions produced since then are available online at http://www.saad.org.uk/index.php/digest-newsletters

The Digest has become a unique and invaluable international forum for all interested in advancement of knowledge in pain and anxiety control for dentistry.

Copyright

Upon acceptance for publication in SAAD Digest, it is assumed that the author assigns copyright of the essay to the Society for the Advancement of Anaesthesia in Dentistry. Single copies of the published essay for personal study may be made free of charge but multiple copies will require permission of the Editor prior to production.

Reviewed: February 2024

 FOR DENTISTS

SAS SCHEME

REGISTER
The deadline for registering for the SAS scheme is four weeks after attending the SAAD National Course.

INFORMATION REQUIRED
When registering you will need to be able to provide the following information:

• Date you will attend the SAAD National Course
• Intended sedation technique(s)
• Age group of patients (adults, children or both)
• Name of proposed clinical supervisor(s)
• GDC/GMC No. of proposed clinical supervisor(s)
• Qualifications of proposed clinical supervisor(s)
• Dental sedation experience of proposed clinical supervisor(s)
• Sedation services offered by proposed clinical supervisor(s) including approx. no. of dental sedation cases in the last 12 months
• Address of the practice(s) where the clinical supervision will take place
• A brief description of sedation facilities.

APPROVAL
The information about the nominated clinical supervisor(s) and the sedation facility where the supervised clinical practice will take place is submitted for approval to the SAAD Training Board.

SAAD NATIONAL COURSE
Attend the SAAD National Course for the knowledge and skills training.

WRITTEN ASSESSMENT
After attending the SAAD National Course, once supervisor (s) have been approved, a link will be provided to complete the online written assessment in your own time. The assessment is 30 ‘single best answer’ questions.

ASSESSSMENT RESULTS
The results will be emailed immediately. This is followed by a confirmation statement to be signed and returned. On receipt of the signed confirmation a link to access the SAS scheme webpage will be emailed.

SAS SCHEME WEBPAGE
From this page it will be possible to download all of the documents required for completion during the supervised clinical experience.

• Document Submission Checklist
• DOPS form
• Logbook
• Practice Self-Evaluation Checklist (for each location)

Also available is guidance on setting up the SAAD Document Repository (SDR)

SUPERVISED CLINICAL EXPERIENCE
20 IVS and/or 10 IS cases should be documented and signed by the approved clinical supervisor. For ten of the IVS and five of the IS cases the sedation trainee should provide both the treatment and the sedation.

ACCESS THE SAAD DOCUMENT REPOSITORY (SDR)
This enables SAS scheme documents to be uploaded, via a secure section of the SAAD website, and submitted for approval. All documents must be submitted within 12 months of attending the SAAD National Course.

APPROVAL AND CERTIFICATION
Successful practitioners will receive a SAAD certificate confirming ‘SAAD Assessed Sedationist’ status which will enable you to practise independently.

For more information and to register see: https://www.saad.org.uk/index.php/new-to-sedation/sas-scheme

 FOR DENTAL NURSES

SASN SCHEME

REGISTER
The deadline for registering for the SASN scheme is four weeks after attending the SAAD National Course.

INFORMATION REQUIRED
When registering you will need to be able to provide the following information:

• Date you attended the SAAD National Course
• Intended sedation technique(s)
• Age group of patients (adults, children or both)
• Name of proposed clinical supervisor(s)
• GDC/GMC No. of proposed clinical supervisor(s)
• Qualifications of proposed clinical supervisor(s)
• Dental sedation experience of proposed clinical supervisor(s)
• Dental sedation services offered by proposed clinical supervisor(s) including approx. no. of dental sedation cases in the last 12 months
• Address of the practice(s) where the clinical supervision will take place
• A brief description of sedation facilities.

APPROVAL
The information about the nominated clinical supervisor(s) and the sedation facility where the supervised clinical practice will take place is submitted for approval to the SAAD Training Board.

SAAD NATIONAL COURSE
Attend the SAAD National Course for the knowledge and skills training

SASN SCHEME WEBPAGE
From this page it will be possible to download all of the documents required for completion during the supervised clinical experience.

• Document submission checklist
• DOPS forms
• Practice profile (for each location)

Also available is guidance on setting up the SAAD Document Repository (SDR)

SUPERVISED CLINICAL EXPERIENCE
20 IVS and/or 10 IHS cases should be documented and signed by the approved clinical supervisor.

ACCESS THE SAAD DOCUMENT REPOSITORY (SDR)
This enables SASN scheme documents to be uploaded, via a secure section of the SAAD website, and submitted for approval.

SUBMIT DOCUMENTS FOR APROVAL
All documents should be submitted to be approved within 12 months of attending the SAAD National Course.

ONLINE WRITTEN ASSESSMENT
After the submitted documents have been approved, a link will be provided to complete the online written assessment in your own time. The assessment is 30 ‘single best answer’ questions.

ASSESSSMENT RESULTS
The results will be emailed immediately. This is followed by a confirmation statement to be signed and returned. On receipt of the signed confirmation a certificate will be posted.

APPROVAL AND CERTIFICATION
Successful practitioners will receive a SAAD certificate and badge confirming ‘SAAD Assessed Sedation Nurse’ status which will enable you to assist with the provision of dental sedation as the second suitable trained person.

For more information and to register see: https://www.saad.org.uk/index.php/new-to-sedation/sasn-scheme 

 FOR DENTAL HYGIENISTS & THERAPISTS

SASH/T SCHEME

REGISTER
The deadline for registering for the SASH/T scheme is a week before the weekend of the SAAD National Course.

INFORMATION REQUIRED
When registering you will need to be able to provide the following information:

• Age group of patients (adults, children or both)
• Name of proposed clinical supervisor(s)
• GDC/GMC No. of proposed clinical supervisor(s)
• Qualifications of proposed clinical supervisor(s)
• Dental sedation experience of proposed clinical supervisor(s)
• Sedation services offered by proposed clinical supervisor(s) including approx. no. of dental sedation cases in the last 12 months
• Address of the practice(s) where the clinical supervision will take place
• A brief description of sedation facilities.

APPROVAL
The information about the nominated clinical supervisor(s) and the sedation facility where the supervised clinical practice will take place is submitted for approval to the SAAD Training Board.

SAAD NATIONAL COURSE
Attend the SAAD National Course for the knowledge and skills training

WRITTEN ASSESSMENT
After attending the SAAD National Course, once supervisor(s) have been approved, a link will be provided to complete the online written assessment in your own time. The assessment is 30 ‘single best answer’ questions.

ASSESSSMENT RESULTS
The results will be emailed immediately. This is followed by a confirmation statement to be signed and returned. On receipt of the signed confirmation a link to access the SASH/T scheme webpage will be emailed.

SASH/T SCHEME WEBPAGE
From this page it will be possible to download all of the documents required for completion during the supervised clinical experience.

• Document Submission Checklist
• DOPS form
• Logbook
• Practice Self-Evaluation Checklist

Also available is guidance on setting up the SAAD Document Repository (SDR)

SUPERVISED CLINICAL EXPERIENCE
Ten IS cases should be documented and signed by the approved clinical supervisor. For five of these cases the sedation trainee should provide both the treatment and the sedation.

ACCESS THE SAAD DOCUMENT REPOSITORY (SDR)
This enables SASH/T scheme documents to be uploaded, via a secure section of the SAAD website, and submitted for approval. All documents must be submitted within twelve months of attending the SAAD National Course.

APPROVAL AND CERTIFICATION
Successful practitioners will receive a SAAD certificate and badge confirming ‘SAAD Assessed Sedation hygienist/therapist’ status which will enable you to practise independently.

For more information and to register see: https://www.saad.org.uk/index.php/new-to-sedation/dental-hygienists-therapists

Please click on the tables and figures to enlarge

The effect of remimazolam on a Parkinson’s patient

S. Madaan*¹ BDS (Lond), MFDS RCS (Ed), General dentist with a special interest in restorative and surgical dentistry, St Johns Dental Practice, Oxford, OX1 2LH.
A. Harris² BDS (Lond), DPDS, General dentist, visiting sedationist and SAAD accredited mentor, London, The Dentist Salisbury, SP1 2LH.
*Correspondence to: Dr Sita Madaan
Email: drsitamadaan@gmail.com
Madaan S, Harris A. The effect of remimazolam on a Parkinson’s patient. SAAD Dig. 2024: 40(II): 124-127 

Case Summary

A 63-year-old lady who is 5 ft 4 in and weighs 66 kg was diagnosed with Parkinson’s disease in 2016. Sedation with remimazolam was used with the aim of alleviating the patient’s fears so that we could remove her poor prognosis teeth and perform socket preservation in the upper left quadrant with the view to placing dental implants in the future. We found that using remimazolam enhanced her involuntary movements due to Parkinson’s disease, with each dose administered.

Patient details
Gender: Female
Age at start of treatment: 62 

Pre-treatment assessment

The patient presented with a left-sided swelling of the buccal space relating to two upper retained roots, not affecting the eye, and a toothache of two weeks. The patient stopped caring about her dental health after she was diagnosed with Parkinson’s disease in 2016 and started to neglect her dentition. She has started to feel self-conscious of her teeth but is extremely nervous of the dentist and has only presented because she had been suffering with pain for two weeks and had developed an abscess relating to some retained roots.

Relevant medical history

The patient is an ASA II. She was diagnosed with Parkinson’s disease in 2016. The patient also suffers from epilepsy and has been diagnosed as having grand mal seizures, although she had experienced a petit mal seizure in the last year. She has also been diagnosed with hypothyroidism. Overall, the patient is mobile, but says she is stiff in the morning and ok with stairs.

Medications

• Co-careldopa 50mg: primarily used to manage the symptoms of Parkinson's disease, however, it does not slow down the disease or prevent it from worsening
• Ropinirole 100mg a day: used to treat the symptoms of Parkinson's disease and restless legs syndrome - it can improve symptoms like shaking (tremors), slowness and stiffness
• Epilim 4mg bd: for epilepsy
• Levothyroxine 100µg od
• The patient also has a codeine allergy.

Previous sedation history

The patient has never been sedated before and has a BMI of 25. Her alcohol intake is 18 units per week with no history of taking benzodiazepines or recreational drugs. Her pre-operative blood pressure was 120/78.

Dental history

Irregular attender, has not attended for over 10 years.

Clinical examination

The patient had some trismus, not relating to dental infection. Several fractured teeth were seen with heavy evidence of parafunction and her muscles of mastication were tender because of this. There was evidence of heavy palatal erosion due to dietary acids, which the patient was unaware of. Calculus, plaque, and gingivitis were present throughout the mouth.

Bitewings and an OPG were taken for a full assessment of the patient’s dentition which showed:

LR7 is fractured and requires vitality testing and then cuspal coverage.

LR6 is a root filled tooth which has been prepared for a crown and will require a new crown.

LR5 is fractured with deep caries and has been recommended for extraction.

LL5 retained root recommended for extraction.

UR6 is a root fragment and requires extraction.

UR2-UL2 are fractured. Wear and exposed dentine can be seen clinically.

UL4 is a metal post crown with a questionable long-term prognosis.

UL6 and UL7 are root filled retained roots with signs of periapical pathology around UL7.

UL8 LL8 are unerupted.

There is mild generalized horizontal bone loss with vertical bone loss around the UL6 retained root.

Pre-treatment photographs

Diagnostic summary

1. Mild periodontitis (Stage 2 Grade A), which is active at present, with poor oral hygiene due to demotivation to look after oral health since onset of Parkinson’s disease.
2. Buccal caries on the lower premolars.
3. Retained roots which will require extraction. Multiple fractured teeth requiring cuspal coverage.
4. Palatal wear of the upper anteriors and fractured upper and lower incisors due to erosion, attrition and tooth position.
5. Post-extraction spaces which will require fixed, long-term space replacement to keep the bone stimulated and prevent bone loss from occurring in these areas.

Aims and objectives of treatment

1. Stabilisation of oral hygiene and gingival inflammation
2. Strengthening of enamel to reduce the risk of future decay and prevent tooth wear with high fluoride toothpaste
3. Elimination of any causes of disease, and to bring about a state of health, function and self-confidence
4. Alleviation of dental anxiety using treatment under IV sedation.

Treatment plan

1. Prevention advice: oral hygiene to be reinforced with emphasis on motivating the patient to introduce interdental cleaning into her regime. To discuss use of plaque disclosing tablets to aid removal of biofilm. Duraphat toothpaste to be prescribed to strengthen enamel against decay and prevent further tooth surface loss, which is of multifactorial origin (attrition and erosion)
2. Oral hygiene stabilisation with hygienist and periodontist involvement
3. Extraction of poor prognosis teeth and socket preservation in the upper left region as the patient would like to consider fixed space replacement, in the form of dental implants, if her oral hygiene permits this in the future. The patent is aware of the risks associated with dental implants including peri-implantitis. This phase of treatment will be carried out under IV sedation using remimazolam, due to the better sedative profile than that of the current drugs, including rapid onset and offset of sedation and a predictable duration of action
4. Caries stabilisation of lower premolars which require filling cervically
5. Fractured teeth to have cuspal coverage restorations and post crown to be monitored
6. Fractured anterior teeth and palatal exposed dentine to be repaired
7. Patient is also a heavy bruxist and will need some form of protection at the end of treatment. 

Treatment undertaken

• The initial presentation was as a new patient at an emergency appointment in February 2023 during which an assessment was carried out, a periapical radiograph (PA) was taken and referral for full mouth Orthopantomogram (OPG) made. Antibiotics were prescribed to prevent the further spread of infection and the patient was advised to return for a full mouth detailed clinical examination. Even though there were no signs of septicaemia or cellulitis, the patient’s reduced co-operation and compromised oral hygiene until this point was taken into consideration as a risk factor for further spread of infection.
• The patient then saw the periodontist and had multiple sessions with the hygienist every three weeks where disclosing tablets were used to aid oral hygiene instruction.
• She expressed her concerns about undergoing dental treatment and explained that she was nervous. We discussed the possibility of sedation, and she filled out an Indicator of Sedation Need form. Her pre-operative sedation score was 21 indicating a very high Modified Dental Anxiety Scale (MDAS) score. Given her underlying medical health and considering the treatment complexity this gave a score of ‘very high need’ for sedation.
• We elected to use remimazolam due to its superior properties over midazolam such as rapid induction, rapid recovery, and less respiratory depression.¹ The patient then attended in May 2023 for extraction of all retained roots, UR5, UL6, UL7, LR5, LL5 and socket preservation in the upper left quadrant (ULQ). At this stage the drug was in its infancy for use in general dental practice sedation cases, as remimazolam was approved for use in dentistry in the UK in January 2023.

Treatment findings

A total of 17.5 mg of remimazolam was administered over the course of 1 hour 15 mins. An initial 5 mg dose was administered. With every subsequent 2.5 mg increment given the patient demonstrated jerky movements and signs of un-cooperation. Her legs started to jerk, and her jaw would clamp down which would impede the procedure but then she would settle down. A brief timeline of events is as follows:

11.54: Rapid induction of remimazolam (5 mg over 2 mins)

11.58: The patient did not like the administration of local anaesthetic

12.06: 2.5 mg administered, patient became unco-operative and was very jerky during the upper left quadrant extractions

12.28: 2.5 mg administered. The patient reported ‘this is a great experience’.

12.32: 2.5 mg administered. Bone grafting of the upper left quadrant.

12.36: The patient was much more relaxed.

12.42: Sutures placed and collagen plug.

12.53: Patient is relaxed during further suturing

13.00: 2.5 mg administered, patient is unco-operative again

13.10: Patient is more aware of what is going on

13.13: 2.5 mg administered

13.20: Patient did not like local anaesthetic (LA)

13.35: Patient was co-operative for extractions

13.49: Patient settled down and was more co-operative but was aware of treatment

13.55: Remaining lower surgical extraction was completed

14.00: Procedure finished

Long term treatment and future considerations

 In future, we could consider giving a reduced dose over a longer administration period. However, reducing the duration of the drug use would make it unsuitable for long surgical types of procedures. It is worth considering that now that she has been reintroduced to dental work after several years, she may have a lower sedation score in future and may not need treatment under sedation going forward. Her next phase of treatment would be restorative and only when we come to implant placement may she feel a need to revisit the idea of sedation.

We could consider trying to manage her pre-operative anxiety using other relaxation techniques such as deep relaxation with diaphragmatic breathing or hypnotherapy². We could also consider the use of midazolam as there are case reports to support the use of this drug to ease the symptoms of Parkinson’s disease.²

At present the patient is still mid-restorative phase due to a fall and subsequent hip injury, causing a delay in the completion of her treatment. The anterior restorative work which has been carried out so far was unremarkable and was undertaken under local anaesthetic with ease.

Discussion and reflection about case presented

As remimazolam was only approved for use in dentistry in UK in January 2023, the seditionist had limited experience of practical cases with this drug. In hindsight, she could have started with a lower induction dose and could have given lower top-up doses, as the patient swung from being co-operative to unco-operative immediately after top-up increments.

On a follow up phone call the next day, the patient reported that the sedation was ‘fabulous’, she didn’t remember anything about the treatment apart from the tail end of the appointment and the patient was much more co-operative at this point. She felt normal upon leaving the practice and was delighted with the outcome.

Oral surgery can be difficult in patients with chorea-like dyskinesia (involuntary movements) which is common in those on long-term levodopa medication for Parkinson's disease,³ and we know of no conclusive evidence to indicate whether conscious sedation with midazolam is effective in such cases. However, there are case reports of a patient in whom levodopa-induced chorea-like dyskinesia disappeared when midazolam was given intravenously for conscious sedation, so this drug could be preferred in such patients.³

References

1. Kim K M. Remimazolam: Pharmacological Characteristics and Clinical Applications in Anaesthesiology. Anesth Pain Med (Seoul) 2022; 17: 1–11.

2. Wang R, Huang X, Wang Y, Akbari M. Non-pharmacologic approaches in preoperative anxiety: a comprehensive review. Front Public Health 2022, 10: 852673.

3. Shibuya M, Hojo T, Hase Y, Fujisawa T. Conscious sedation with midazolam intravenously for a patient with Parkinson's disease and unpredictable chorea- like dyskinesia. Br J Oral Maxillofac Surg 2018; 56: 546-548. 

Please click on the tables and figures to enlarge

A synopsis of articles of interest from the last twelve months to inspire further reading 

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Reviewer’s evaluation, opinion and points of interest

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Reviewer’s evaluation, opinion and points of interest