New sedation procedure which could allow patients to avoid potentially risky general anaesthetics

Sep 1 2004

Dental experts have developed a new sedation procedure which could relieve pressure on hospitals and allow patients to avoid potentially risky general anaesthetics.

Clinical trials on more than 600 children with extreme dental problems who would usually attend hospital for a general anaesthetic (GA) for dental treatment, found the new procedure was completely successful in 93 per cent of cases.

Researchers at the UK’s University of Newcastle upon Tyne carried out the Government-funded study at Queensway Anxiety Management Clinic in Billingham, Teesside. The team say the findings suggest the time is right to reform dental services so alternatives to hospital-based GAs for dental procedures can be offered in specialist practices like Queensway.

The results, which are published in the September issue of the academic journal Anaesthesia, showed that giving patients a sedative known as midazolam and a measured amount of two gases with normal local anaesthetic was a viable alternative to a GA for dental procedures.

The children, whose condition or anxiety was too severe to be treated using conventional techniques such as local anaesthetic alone, felt no pain under sedation, and although they remained conscious throughout they did not remember their treatment after it was completed. Not only did they avoid the risks of a general anaesthetic, they were sedated in a dentist’s chair, which suggests the procedure could be used as a way of reducing hospital waiting lists and freeing beds.

GAs for dental procedures have traditionally been used where dentists feel the patient’s care cannot be managed using conventional techniques. The UK Government banned dental surgeries from performing them in January 2002, following several patient deaths, and it transferred responsibility for dental GAs to hospitals.

The Newcastle University clinical trials tested three new sedative procedures on groups of children who had been referred to Queensway Anxiety Management Clinic.

In the group given a combination of nitrous oxide and sevoflurane and intravenous midazolam by a consultant anaesthetist, 249 out of the 267 children – 93 per cent - completed their treatment successfully.

Dr Paul Averley, principal dentist at Queensway Anxiety Management Clinic, who developed the techniques and is working on the programme of research in collaboration with Newcastle University’s School of Dental Sciences and Centre for Health Services Research, said:

“Dentists are often suspicious about procedures that involve sedating children with intravenous agents like midazolam. However, we showed that it worked very effectively when combined with inhalation agents and we saw no adverse reactions.

“The children were treated by a highly trained team, which included a consultant anaesthetist, and they also had have the benefit of shorter waiting times and treatment in familiar surroundings.

Dr Averley, who qualified as a dentist at Newcastle University in 1990, added: “It's two years since the Government ban on GDAs in dental practices and we now hope the profession can start to share best practice on evidence-based sedation techniques. Health authorities could consider establishing specialist services throughout the country, together with facilities where teams can be trained to administer the procedures.”

Commenting on the significance of this work, Dr Nick Girdler, Head of the Sedation Department at Newcastle Dental Hospital & School, said: "These results are very exciting. The technique gives real hope to children who are too scared to have teeth extracted or filled using standard sedation techniques.

“It complements other types of sedation for children, such as nitrous oxide sedation (laughing gas), and newer techniques including oral midazolam sedation (a sedative drink). It is hoped that this research will give children and parents more choice, especially if other specialist dental clinics, with appropriate anaesthetic support, can be set up to offer these services".