Digest evolves, but the problems of access to dental care worsen. Almost a quarter of the way through the 21st century, what progress since SAAD was founded?
Welcome to SAAD Digest 40(1). This year marks an exciting milestone for SAAD Digest. We are moving to two issues per year: March and September. The Editorial Board have decided to make this change as a result of the continuing submission of large numbers of high-quality papers of interest to our readers. As I write this editorial, we already have ten papers submitted for Digest 40(2). You will notice a few other changes as you read through this edition.
If you have a query relating to this article please email: digest@saad.org.uk
Title: Remimazolam compared to midazolam for dental sedation: an umbrella review Author(s): G. Shaw, K. Taylor
Abstract: Remimazolam is a newly approved benzodiazepine drug used for intravenous sedation. Its efficacy and safety compared to the standard sedative drug, midazolam, have not been studied extensively, particularly in the dental setting. This study aims to compare the outcomes of remimazolam and midazolam for single-drug intravenous sedation and to discuss its potential use in dentistry.
A search was conducted across six electronic databases for systematic reviews comparing the efficacy and safety of remimazolam and midazolam. Five systematic reviews were included from a total of 542 studies. The findings indicated that remimazolam may offer significant advantages over midazolam, including faster onset, higher procedure success rates, reduced need for rescue sedatives, shorter recovery time, improved cognitive recovery, and fewer instances of hypoxia. However, there were no significant findings regarding procedure completion or required sedation dosage.
Overall, the evidence suggests that remimazolam has statistically significant benefits over midazolam for intravenous sedation. However, more clinical trials are needed to determine its suitability and clinical significance in dental practice. Further research is required to fully understand the potential advantages of remimazolam in the dental setting.
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Title: Do children from more deprived backgrounds have a higher chance of becoming dentally anxious? Author(s): L. J. Irving
Abstract:
There is certainly no shortage of literature surrounding the incidence of dental anxiety, the causes of dental anxiety and management strategies. Similarly, much research has been undertaken to investigate the relationship between socioeconomic position and dental disease rates. Both anxiety and a lower socioeconomic position have been linked with poorer oral health-related quality of life. We know that early childhood dental experiences can set the tone for a patient’s attitudes towards, and relationships with, dentists and dental treatments. The aim of this review was to investigate whether children from a lower socioeconomic position are more likely to become dentally anxious. It aims to explore whether the treatment of children from lower socioeconomic backgrounds is different to their more affluent peers and, if so, whether this might impact how these individuals go on to perceive dentists and dental treatment. As dentists we must provide appropriate treatment and aim for the best dental health outcomes, whilst also considering the patient holistically. With children, this should involve fostering positive relationships and dental experiences where possible, to set them up for a positive and healthy dental future which is as anxiety free as possible.
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Title: An investigation of bispectral index monitoring when providing intravenous sedation for adults with severe cognitive disability Author(s): M. Keddie, H. Vincer, P. Shah, M. Doshi
Abstract:
Introduction When providing intravenous sedation for patients with severe disabilities who have limited verbal communication it can sometimes be challenging to identify when sedation endpoint is reached. Bispectral index monitoring can provide an objective measure of the depth of sedation.
Aim This study aims to assess the feasibility of bispectral index monitoring in adults with cognitive impairment with limited to no verbal communication undergoing dental treatment with midazolam conscious sedation.
Method Bispectral monitoring was applied to patients with a neurodisability or a learning disability who were undergoing dental treatment under intravenous sedation, across three sites. A researcher observed whether the sensor could be applied and how the bispectral index changed during sedation and recovery.
Results 31 patients were recruited. In most cases it was possible to apply sensors before, or soon after, midazolam was titrated. A pattern of a decrease in bispectral values towards the end point, and an increase towards recovery was noted. Fluctuations in bispectral readings were seen during treatment, likely due to facial muscle movements.
Conclusion Bispectral index monitoring could be a valuable adjunct when training dentists in sedation in special care dentistry and may be of particular use in patients with neurodisability.
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Title: A review of the awareness and use of airway assessment techniques in conscious sedation in dentistry Author(s): M. Ismail, S. Nayani-Low, B. Kerr Abstract:
Aim To evaluate the the understanding, proficiency, confidence with and anticipated usefulness of common airway assessment techniques when assessing patients for provision of conscious sedation amongst dental sedationists.
Methods An online questionnaire was sent to conscious sedation providers in dentistry in the UK. The questionnaire explored current practice, use and documentation of airway assessment and information regarding airway-related complications experienced.
Results 254 responses were received. 67% routinely carried out airway assessment whilst 40% documented this finding most or all the time. The average number of airway assessment techniques known was 3.96 of 8. The most common technique known was measurement of mouth opening (71%); this was the most used, the technique participants were most confident using, and the technique found to be the most useful. 11% had experienced an incident where obstruction or hypoxia had occurred where an airway assessment could have predicted this.
Conclusions The need for airway assessment is recognised within current guidelines and this study illustrates dentists do routinely carry out airway assessment. The technique used, documentation and level of training are varied. A uniform approach to training and the use of a formalised tool may help improve application of airway assessment in sedation in dentistry.
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