ABSTRACT
Introduction Intravenous sedation (IVS) with propofol offers an alternative to inhalation sedation or general anaesthesia (GA) for dentally anxious young people who require treatment. It offers a greater level of anxiolysis than inhalation sedation and reduced morbidity when compared with GA.Methods Data were collected prospectively from a convenience sample of children requiring IVS. Participants completed the Children's Experiences of Dental Anxiety Measure (CEDAM) at the start of every visit. Patient demographics, treatment completed, surgery and recovery time were recorded. Feedback was obtained following their first visit.Results Treatment was successful for 91.5% (43/47) of patients. The average surgery and discharge time was 32.9 (8-105 minutes) and 33.1 (5-84 minutes), respectively. The CEDAM scores were between 14 and 30 (mean score 20.8). Thematic content analysis of the feedback was carried out and themes relating to communication, environment, appointment times, service satisfaction and advice to other patients emerged.Discussion CEDAM scores may have been lower than expected due to under-reporting by patients or clinicians' perception of higher anxiety levels. Feedback was reviewed regularly and improvements made where possible.Conclusion The majority of patients successfully received dental treatment under IVS. Changes have been made to the service to improve patient experience and maximise productivity.
ABSTRACT
Introduction The use of general anaesthesia in paediatric dentistry should be appropriate and justified. During the treatment of children, a clinician should have foresight into the future dental requirements of the patient and whether a future general anaesthetic will be required in quick succession. Efforts should be made when possible to avoid this.Aims This service evaluation was performed to gather information regarding repeat dental general anaesthetics within Sheffield Children's Hospital NHS Foundation Trust.Methods All children's records who had experienced a repeat dental general anaesthetic between 1 January 2015 and 31 December 2018 were analysed. Those who had experienced a repeat dental general anaesthetic within two years were investigated.Results Overall, 0.63% of children had a repeat dental general anaesthetic within a two-year period. These repeat dental general anaesthetics were mainly justified due to new dental caries. 43.9% had modifying factors, such as a complex medical history, that could have impacted the need for a second dental general anaesthetic.Conclusion The repeat rate in Sheffield Children's Hospital NHS Foundation Trust is low. We believe this is a result of specialist treatment planning and appropriate use of both 'extraction only' and 'restorative and extraction' GA lists.
Subject(s)
Anesthesia, Dental , Dental Care for Children , Dental Caries , Anesthesia, General , Child , Humans , State Medicine , Tooth ExtractionABSTRACT
Introduction Children and young people's (CYP) missed healthcare appointments may be an indicator of neglect. Healthcare providers are encouraged to consider the child as 'was not brought' (WNB) and to assess the need for early multidisciplinary information sharing to safeguard and promote welfare.Method A new WNB-CYP pathway (flowchart, template patient notes, template letters) for missed appointments was developed. After piloting at one community dental service (CDS) clinic for eight months, a service evaluation was conducted via retrospective review of records and semi-structured interviews with staff.Results Of 1,238 appointments for CYP, 134 were missed (WNB rate 10.8%) by 91 children. The WNB-CYP pathway was followed consistently 113 times (84.3%) and, when used, three quarters of WNBs were rebooked after communication with parents within three weeks. Written information was shared in 25 cases with general medical practitioners and other health and social care professionals. Staff reported high levels of engagement and pathway acceptability; it relieved uncertainty and supported decision-making, teamwork and inter-professional communication without increasing daily workload. Following minor amendments, the pathway was rolled out service-wide with similar success.Conclusion A new WNB-CYP pathway facilitated early and consistent sharing of safeguarding information with other professionals about missed CDS dental appointments and improved dental team confidence.