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Thursday, August 5, 1999 Published at 00:51 GMT 01:51 UK


Nervous dental patients denied treatment

Dentists claim patients are being denied dental treatment

Dentists' leaders are warning that thousands of patients may be being denied treatment because only a limited number of dentists and nurses are trained to provide sedation.

The British Dental Association is calling on the government to provide extra funding for training in sedation techniques.

It says too few dentists and dental nurses are being trained to sedate patients who are nervous about dental treatment, so that they can then receive local anaesthesia to control pain.

Sedation is given to nervous patients, either by injection or by inhalation of a mixture of gas and air. Once the patient is semi-conscious they can then receive local anaesthesia.

The BDA says that fear of pain during treatment is a major barrier to many patients seeking dental treatment.

Some patients, who are nervous or even develop phobias about going to the dentist, are unlikely to seek treatment unless they can be sedated.

However, the BDA believes that only a few dental schools provide the sedation training which is recommended by the General Dental Council (GDC).

Although the courses provide teaching on the theory of conscious sedation, a majority of the undergraduate courses are still unable to provide adequate practical training in sedation techniques, the BDA says.

The BDA also believes the availability of courses for practising dentists is too limited, with current courses over-subscribed.

The association wants a substantial part of the £3m saved from the reduction of dental general anaesthesia to be invested in the training of sedation techniques.

General anaesthesia restricted

[ image: Some patients are phobic about going to the dentist]
Some patients are phobic about going to the dentist
General dental anaesthesia was restricted by the GDC in 1998 and dentists have encouraged their patients to seek alternative methods of pain and anxiety control.

Since then the number of sedations for children and adults has increased in England and Wales by around 3,500.

However, during the same period the number of dental general anaesthetics fell by around 16,800.

This means, says the BDA, that there could be thousands of patients being denied dental treatment because there are a limited number of people trained to provide sedation.

The BDA also wants an increase in the fees paid for providing sedation, claiming that the current fee does not reflect the demands of the technique.

Dr John Renshaw, chair of the BDA's Working Party on Sedation, said: "Sedation techniques are proven to be of great benefit to anxious or dentally phobic patients for a range of dental treatments.

"The government needs to make funding for sedation a higher priority otherwise many patients who need treatment under sedation will be unable to receive it."

Dr Renshaw said it was difficult to ensure that a patient received the correct dose to be properly sedated.

He said: "The danger is that either the patient does not get enough so that they are even more frightened, or that they get too much and fall unconscious. The drugs involved are relatively powerful, and one needs to be competent to administer them."

The GDC introduced strict limits on the use of general anaesthesia following several high profile cases in which patients died while unconscious.

General anaesthesia may now only be administered by a consultant anaesthetist working in a specialist centre with well-established procedures for transporting ill patients to intensive care.

The technique is still necessary in certain cases, such as children suffering from serious abscesses, or adults who require multiple extraction.

A Department of Health spokeswoman said a review of general anaesthesia and sedation with dental treatment was underway under the leadership of the Chief Medical Officer.

She said: "Training is being considered as part of t he review. When ministers consider the report they will also consider any funding issues."

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