Additional Procedures for Patients with Learning Disabilities undergoing Dental Treatment under General Anaesthesia

Publications all seem to come at once... the latest I've co-authored has just been published in Learning Disability Practice and is about additional procedures for patients with learning disabilities having general anaesthetic for their dental treatment.

I have written about the use of GA in Special Care Dentistry previously here. GA is an important adjunct for patients who have additional needs who are not able to cope with dental treatment under less restrictive measures. This can be patients with cognitive issues, severe dental phobia, severe mental health issues or patients with learning disabilities.

When coordinating dental care for these patients, GA or sedation episodes can be excellent opportunities to potentially carry out additional procedures which would otherwise either not be possible for these patients, or very difficult. It can also mean that patients do not have to have multiple anaesthetic episodes for multiple procedures which is unnecessary and can be traumatising for the patient.

Examples of Additional Procedures

Blood tests
Ear nose and throat procedures such as removal of ear wax (suctioning), examinations
Gynaecological procedures e.g. smear tests, coil (re)placements
Additional images e.g. MRI scans
Vaccinations e.g flu, COVID
ECGs
Personal care e.g. hair cuts, finger or toenail cutting

Coordination of care can sometimes be the trickiest part of planning for additional procedures, for example liaison between different medical specialities. Often, as what we advocate in this paper, this can be done by Learning Disability Nursing teams.

Not only will co-ordination of care avoid multiple GA episodes, but can pick up potentially undiagnosed issues in these patients - something known as diagnostic overshadowing.

What is important when planning for additional procedures in these patients is that decisions are made in their best interests if they lack capacity to consent and the least restrictive measure is taken. For example, GAs are not given just for blood tests, but is there an option for acclimatisation, behaviour management or anxiety management in order to optimise getting bloods?

To read the full article click here.

Have you organised multiple procedures for patients having their dental treatment done under GA or sedation? Please share your experiences in the comments below.