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Last Updated: Wednesday, 1 September, 2004, 23:22 GMT 00:22 UK
Alternative for dental sedation
The new technique uses two gases
Dentists have developed an alternative to general anaesthesia for children who need to be sedated for complex dental work.

The new method combines a sedative known as midazolam with a measured amount of two gases which cause relaxation and drowsiness.

Tests carried out by a team at the University of Newcastle upon Tyne were completely successful in 93% of cases.

Details of the procedure are published in the journal Anaesthesia.

The technique gives real hope to children who are too scared to have teeth extracted or filled using standard sedation techniques
Dr Nick Girdler
It will potentially be particularly useful for use on children, who more often require complex dental work, and who may be scared of going to hospital for a general anaesthetic.

The Newcastle team tried out the new method on more than 600 children with extreme dental problems who would usually attend hospital for a general anaesthetic (GA) for dental treatment.

All were treated at a specialist dental practice, the Queensway Anxiety Management Clinic in Billingham, Teesside.

The children, whose condition or anxiety was too severe to be treated using conventional techniques such as local anaesthetic alone, felt no pain under sedation.

And although they remained conscious throughout they did not remember their treatment after it was completed.

Not only did they avoid the risks of a general anaesthetic, they were sedated in a dentist's chair.

The researchers say their results suggest the procedure could be used as a way of reducing hospital waiting lists and freeing beds.

They are calling for a reform of dental services to allow alternatives to hospital-based GA for dental procedures to be offered in specialist practices.

The UK Government banned dental surgeries from performing them in January 2002, following several patient deaths, and it transferred responsibility for dental GAs to hospitals.

Three methods

Taylor Mendoza
Taylor Mendoza underwent the new procedure
The Newcastle team tested three new sedative procedures on groups of children who had been referred to Queensway Anxiety Management Clinic.

In the group given a combination of nitrous oxide and sevoflurane and intravenous midazolam by a consultant anaesthetist, 249 out of 267 children completed their treatment successfully.

Dr Paul Averley, principal dentist at Queensway Anxiety Management Clinic, developed the techniques.

He said: "Dentists are often suspicious about procedures that involve sedating children with intravenous agents like midazolam.

"However, we showed that it worked very effectively when combined with inhalation agents and we saw no adverse reactions.

"The children were treated by a highly trained team, which included a consultant anaesthetist, and they also had have the benefit of shorter waiting times and treatment in familiar surroundings."

Less scary

Dr Nick Girdler, head of the Sedation Department at Newcastle Dental Hospital & School, said: "These results are very exciting.

"The technique gives real hope to children who are too scared to have teeth extracted or filled using standard sedation techniques."

Five-year-old Taylor Mendoza was petrified of going to the dentist and was referred to Queensway Anxiety Management Clinic by her dentist because she was too frightened for him to treat her properly.

Her father Dave said: "She was quite nervous when she first arrived at Queensway but as soon as she was given the sedation she calmed down and relaxed.

"She came out very proud of herself and smiling as if nothing had happened. We're very happy with the outcome."

A spokesperson for the British Dental Association said: "This is an interesting study that widens the evidence base for this treatment.

"The BDA welcomes anything that adds to the deeper understanding of sedation procedures."

Prof Raman Bedi, Chief Dental Officer for England, said: "About 7% of our child population have very high levels of anxiety about having dental treatment.

"These children need additional help if they require dental treatment, so I welcome new evidence-based approaches that tackle this problem.

"The initial findings of the research team at the Newcastle Dental School appear encouraging."




WATCH AND LISTEN
The BBC's Gill Higgins
"Two gases make children calm and relaxed, another drug makes them sleepy"



SEE ALSO:
Anaesthesia ban for dentists
21 Jul 00  |  Health


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