Conscious sedation, general anaesthesia for patients with special needs

Abstract

Aim: This study aimed to identify indications for dental treatment under general anaesthetic (GA) and conscious sedation for adult patients with special needs in public dental clinics and recommend pathways to provide safe and effective care. Materials and Methods: Following ethics approval from relevant institutions (Approval No: EC00172; Reference No: 49013), de-identified data was collected and analysed from relevant hospital record software, dental record software and patient paper charts. A total of 444 patients (> 18 years old) who underwent 607 conscious sedation or GA treatment sessions (1st January 2015 -31st December 2018) were included. Treatment was provided by specialists in Special Needs Dentistry (SND) or postgraduate students in SND or general dentists. Results: Overall, 395 of the 444 patients (89.0%) had conditions that affected their dental management, with the most common being medical conditions (87.4%), followed by intellectual disability (74.7%), physical disability (33.6%) and psychiatric conditions (16.8%). Statistically significant differences were seen between patient cohorts treated using relative analgesia (RA), intravenous (IV) sedation and GA for multiple parameters including elements of medical complexity. Using public dental cost parameters, RA was the most cost-effective and clinically efficacious. Conclusions: The study showed under-utilisation of RA and IV sedation compared to GA for patients with special needs, although RA was superior for clinical productivity.Referrals for patients with special needs should be triaged by SND team members (specialists or postgraduate students), to determine the appropriate modality for care (behaviour management/conscious sedation/GA) by clinicians within their scope of practice.