A question I get asked a lot... whether you are working in the NHS or in private practice or even the Community Dental Services, you may want to provide sedation for your patients. But how do you go about this?
Why offer sedation?
There might be many reasons why you decide to offer sedation for your patients depending on where you work, the needs of your patient base and the team that you work in. Some reasons might be:
- To enhance the skills you can offer your patients
- To treat patients under sedation yourself rather than refer onto another service or engage a mobile sedationist
- To cater to the needs of your patient group: for example, children, people who are particularly anxious, if you provide more complex invasive treatment (such as surgical dentistry), patients with strong gag reflexes or those with additional needs such as learning disabilities.
What are the options?
Once you decide on why you want to provide sedation, you will then need to look into what technique, or techniques, you would like to be trained in. For example, if you see only children, training in inhalation sedation only might be the best method. This might also depend on the environment you work in and what is practical for your set up. For example, in inhalation sedation you will need to account for access to the gases needed as well as scavenging - although there are plenty of solutions for these if you don't have piped in gases (please contact RA medical for advice on this). The sedation techniques are split into basic techniques and advanced techniques, as per the IACSD guidelines (read about this in a previous post here):
Basic techniques:
- Inhalation sedation in all ages using nitrous oxide
- Intravenous sedation (midazolam only) patients aged 12 years +
- Oral sedation (midazolam/tempazepam only) patients aged 12 years +
- Intranasal sedation (midazolam only) patients aged 12 years +
Advanced techniques (for more information about these, see this blog post here):
- Intravenous, oral or intranasal sedation (midazolam) patients under 12 years of age
- Any multi-drug technique
- Intravenous sedation using other drugs such as propofol, fentanyl or ketamine
- Inhaled sedative agents such as sevoflurane
What courses are there?
In order to provide sedation for your patients, following the implementation of the IACSD guidelines in 2015, any new starter in sedation must complete the relevant training either;
- As part of a deanery programme with relevant Work Based Assessments, supervision of cases and assessment of competency e.g. Dental Core Training or Speciality Training
- As part of a university accredited programme in sedation e.g. PG Certificates, Diplomas or Masters in Sedation
- On a IACSD Accredited sedation course - a full list of courses can be found on the Royal College of Surgeons
The advantage of the first two options is that as part of these programmes you will have the theoretical and practical element of the courses provided for you i.e. direct supervision and sign off of the relevant number of cases depending on the technique you are training in.
Some of the accredited sedation courses are only available for the employees of the relevant training provider (for example, within that Community Dental Service, as they were set up to enable services to provide in house training for their staff). Other accredited courses only provide the theoretical side of the training and you would need to find an accredited STAC trainer/supervisor to sign off your training cases. Some have blended approaches to learning, for example, theoretical online course and then signposting to a supervisor who you would have to agree with to either come to your place of work to supervise you, or go to a training centre.
Some of the sedation courses, for example SAAD which is probably one of the longest running, have had some backlogs as a result of COVID-19, so do contact them directly to find out more.
What next?
So you've done the relevant course... now you can do sedation by yourself?! But wait a minute, there will be ongoing requirements you will have to do as part of the guidelines that allow you to practice sedation. This includes:
- Ensuring your practice is safe for sedation. You can assess this via the SAAD practice safety checklist
- As well as completing an accredited course, you will need Intermediate Life Support (ILS) and/or the paediatric version (PILS), depending on the patients you are seeing, that will need to be refreshed every year
- Your team also has the relevant training. When providing sedation, both you and your nurse/assistant both require the relevant training. Training for dental nurses can be as part of an accredited course, or the NEBDN dental sedation nursing qualification.
- You need to keep up to date CPD relating to sedation - at least 12 hours of CPD per 5 year GDC cycle, as well as regular peer review, audits and reflection
