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References

Ransford NJ, Manley MCG, Lewis DA, Thompson SA, Wray LJ, Boyle CA, Longman LP. Intranasal/intravenous sedation for the dental care of adults with severe disabilities: a multicentre prospective audit. Br Dent J. 2010; 208:565-569
Manley MCG, Ransford NJ, Lewis DA, Thompson SA, Forbes M. Retrospective audit of the efficacy and safety of the combined intranasal/intravenous midazolam sedation technique for the dental treatment of adults with learning disability. Br Dent J. 2008; 205
Michael J Report of the independent inquiry into access to healthcare for people with learning disabilities.London: Department of Health; 2008
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The multidisciplinary use of intranasal/intravenous conscious sedation: four case reports

From Volume 41, Issue 10, December 2014 | Pages 907-910

Authors

Lucy Wray

BDS

Specialist in Special Care Dentistry, DipDSed, Senior Dental Officer, Solent NHS Trust, New Milton Dental Clinic, New Milton Health Centre, Spencer Road, New Milton, Hants

Articles by Lucy Wray

Graham Manley

BDS, DDPH, MSc, PhD

Head of Dental Department, The Royal Hospital for Neuro-disability, West Hill, Putney, London, SW15 3SW, UK

Articles by Graham Manley

Abstract

Conscious sedation provides the dentist with the opportunity to provide dental treatment for patients unable to accept care in the usual way. Often these challenging patients are in need of other medical interventions which they are also unable to accept. The use of conscious sedation utilizing intranasal midazolam improves access to dental care for those with profound needle phobia, movement disorders or a learning disability. The following four case reports describe the use of conscious sedation to provide dental treatment in conjunction with other necessary medical treatment. All four cases were treated in primary care by experienced dental sedationists who were familiar with treating this patient group.

Clinical Relevance: Experienced dental sedation teams may wish to consider combining dental treatment with other necessary medical interventions during the treatment window which sedation provides.

Article

The practice of dentistry, particularly within the field of Special Care Dentistry, requires the clinician to have a holistic approach to healthcare, recognizing that we are dealing with people not just teeth. Intranasal sedation is becoming a more widely used method for facilitating safe cannulation amongst certain patient groups. The evidence for the safety and efficacy of this technique was provided by articles by Ransford et al,1 and a related article by Manley et al.2 These articles described the successful use of intranasal and intravenous sedation in the treatment of 429 adults with severe disabilities. (Of these 429 patients, 71% had varying degrees of learning disability. The remainder had medical conditions which included epilepsy, cerebral palsy, brain injury, spina bifida, Huntington's disease and severe mental illness.)

Patients groups who may benefit from this technique include patients with movement disorders, moderate or severe learning disabilities or profound needle phobia. Anxiety relating to needles may be particular to intra-oral injections or to injections in any part of the body (total needle phobic). Many clinicians will be familiar with patients who present with multiple piercings or tattoos but will not allow any form of intra-oral injection for dental care.

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