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Department of Health. A conscious decision. A review of the use of general anaesthesia and conscious sedation in primary dental care. 2000. https://webarchive.nationalarchives.gov.uk/ukgwa/20130107105354/ (accessed November 2024)
Grisolia BM, Dos Santos APP, Dhyppolito IM Prevalence of dental anxiety in children and adolescents globally: a systematic review with meta-analyses. Int J Paediatr Dent. 2021; 31:168-183 https://doi.org/10.1111/ipd.12712
Aburas S, Pfaffeneder-Mantai F, Hofmann A Dentophobia and dental treatment: an umbrella review of the published literature. Spec Care Dentist. 2023; 43:163-173 https://doi.org/10.1111/scd.12749
Mac Giolla Phadraig C, Newton T, Daly B BeSiDe time to move behavior support in dentistry from an art to a science: A position paper from the BeSiDe (Behavior Support in Dentistry) Group. Spec Care Dentist. 2022; 42:28-31 https://doi.org/10.1111/scd.12634
NHS England. Clinical guide for dental anxiety management. 2023. www.england.nhs.uk/long-read/clinical-guide-for-dental-anxiety-management/ (accessed November 2024)
Glassman P, Caputo A, Dougherty N Special Care Dentistry Association consensus statement on sedation, anesthesia, and alternative techniques for people with special needs. Spec Care Dentist. 2009; 29:2-8 https://doi.org/10.1111/j.1754-4505.2008.00055.x
Geddis-Regan AR, Gray D, Buckingham S The use of general anaesthesia in special care dentistry: a clinical guideline from the British Society for Disability and Oral Health. Spec Care Dentist. 2022; 42:(S1)3-32 https://doi.org/10.1111/scd.12652
Doshi M, Liu S, Shehabi Z Pain, anxiety control and behavioural support for older people. In: Doshi M, Geddis-Regan A (eds). Cham: Springer International Publishing; 2022
Roberts GJ, Mokhtar SM, Lucas VS, Mason C Deaths associated with GA for dentistry 1948–2016: the evolution of a policy for general anaesthesia (GA) for dental treatment. Heliyon. 2020; 6 https://doi.org/10.1016/j.heliyon.2019.e02671
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Sury MR, Palmer JH, Cook TM, Pandit JJ The state of UK dental anaesthesia: results from The NAP5 Activity Survey. A national survey by the 5th National Audit Project of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. SAAD Dig. 2016; 32:34-36
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General Anaesthesia in Special Care Dentistry. Part 1: Justifying and Planning the Use of General Anaesthesia

From Volume 51, Issue 11, December 2024 | Pages 780-785

Authors

Mili Doshi

BDS (Hons), MSc (Sed Spcare), Consultant in Special Care Dentistry, Surrey and Sussex NHS Health Care Trust

Articles by Mili Doshi

Email Mili Doshi

Zahra Shehabi

BDS, MFDS, MSc, MSpecCareDent

BDS, MFDS, MSc (Sed Spec Care), MSCD, MSc (Health Management), Consultant in Special Care Dentistry, Bart's Health NHS Trust

Articles by Zahra Shehabi

Sophie Liu

MBBS, FRCA, Consultant Paediatric Anaesthetist, Sheffield Children's Hospital

Articles by Sophie Liu

Andrew Geddis-Regan

BChD, BSc(Hons), MFDS RCS Ed, DSCD RCS Eng, PGCTLCP, PGCert

BSc (Hons), BChD, DSCD RCS Eng, MSCD RCS Ed, PhD, Consultant in Special Care Dentistry, University Dental Hospital of Manchester; Honorary Senior Lecturer in Dentistry, University of Manchester

Articles by Andrew Geddis-Regan

Abstract

General anaesthesia (GA) is sometimes necessary or appropriate to safely deliver comprehensive dental care for patients with disabilities and complex needs. GA may be indicated as a result of severe anxiety or cognitive dysfunction, where treatment with sedation or local anaesthesia has not been satisfactory or is contraindicated, or where a substantial amount of dental treatment is required. This article is the first of a three-part series that aims to expand upon some of the key practical considerations related to the planning and use of GA in dental care.

CPD/Clinical Relevance:

The use of general anaesthesia for patients with disabilities and complex needs requires careful consideration and planning.

Article

General anaesthesia (GA) is a medically induced loss of consciousness with concurrent loss of protective reflexes owing to anaesthetic agents.1 The nature and use of general anaesthesia has changed significantly over the past 30 years. The use of GA outside a hospital setting was banned in 2000 following a number of safety concerns.2

Dental anxiety is a common reason for not seeking or cooperating with dental care, and this state is highly prevalent worldwide.3,4 Various dental behaviour support (DBS) tools exist to support patients receiving dental care.5 Pharmacological and non-pharmacological approaches to manage anxiety and their appropriateness are summarized in NHS England commissioning guidance.6 Conscious sedation or other techniques detailed in this guidance are suitable to support most patients with dental anxiety. However, GA is necessary and appropriate for a smaller number of patients,7 particularly as GA is arguably one of the most complex and high-risk techniques available.8,9

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