Queensway Anxiety Management

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Introduction
Referral Procedures
Assessment Visit
Patient Selection
Management Techniques
Preoperative Help
Consent
Treatment Appointment
Clinical/Admin. Follow-up
Audit
Reference For Referrers
Medical Considerations
Appendix

Introduction

Queensway Anxiety Management Clinic (QAMC) complies with all the General Dental Council (GDC) current guidance and recommendations. QAMC will continue to provide a consultant anaesthetist lead, primary care based, anxiety management service. All aspects of behavioural management and anxiety control will be explored with your patients. The small number of patients, for which an indication for general anaesthetic (GA) has been established, will be referred to the community services on your behalf.

It has been increasingly important NOT to prescribe a general anaesthetic for dental treatment unless other anxiety management techniques have been considered and tried first, and there is a justifiable dental treatment need. Please refer patients for dental treatment and allow us to take the responsibility of prescribing a GA if required.

There is consensus among policy makers and professionals that the use of general anaesthesia in dentistry should be minimised. A review of general anaesthesia and conscious sedation, “A conscious Decision 2000” from the Department of Health, recommended that general anaesthesia in dentistry should be restricted to a “hospital setting with critical care facilities” from January 2002.

The ethos of this referral service is to provide necessary dental treatment to your patients (children and adults) using the least invasive anxiety management technique possible. We promote where possible the use of conscious sedation. The choice of techniques and drugs will be governed by the Principal of minimum intervention, and the amount of any drug administered will be the minimum necessary to achieve co-operation. It is our aim to reduce both the need and demand for general anaesthesia by substituting it use with conscious sedation techniques.

At Queensway Anxiety Management Clinic (QAMC), conscious sedation will be a technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient will be maintained throughout the period of sedation. The drugs and techniques used will provide conscious sedation for dental treatment, carrying a margin of safety wide enough to render loss of consciousness unlikely. The level of sedation will be such that the patient remains conscious, retains protective reflexes, and is able to understand and respond to verbal commands. In the case of a patient who is unable to respond to verbal contact even when fully conscious the normal method of communicating with them will be maintained.

As a referral service Queensway Anxiety Management Clinic delivers dental care for more than 4000 children per year, using conscious sedation techniques. In the area of paediatric sedation we have developed specialist, evidence based expertise and have a protocol, which allows us to deliver the most appropriate sedation for the child patient. Our primary concern is the safe provision of dental care, using appropriate anxiety management techniques in a well-developed practice, with all the recommended safety-precautions in place.

In 1997/1998 the then Tees Health Authority had Dental General Anaesthetic (DGA) rates seven times the national average. A first wave Personal Dental Services pilot was developed in 1998 at QAMC to try and employ new approaches (substituting DGA with other anxiety management techniques). Now our dental and consultant anaesthetic team have reduced DGA in referred children from 100% to less than five per cent. Over 95% of children are treated using conscious sedation techniques.

From a recent audit of QAMC activity, we expect 25% of referred children to be treated with the help of relative analgesia. The remaining children will require a general anaesthetic to complete their dental treatment unless alternative conscious sedation techniques are used. We anticipate that five per cent of children referred to QAMC will require a general anaesthetic despite our best efforts to avoid this. This will leaves 95% of referred children that will benefit from conscious sedation techniques.

Our aim is to continue to reduce the exposure of children to general anaesthesia, and to act as a primary care based anxiety management service. Those children for whom sedation methods have failed and who will require DGA will be referred to a hospital setting.

Where there is a clear justification for a General anaesthetic and compliance with General Dental Council guidance can be demonstrated a general anaesthetic will be prescribed. When it is appropriate we will take the responsibility to prescribe a general anaesthetic of the highest quality to those patients whose clinical need dictates its use. In this practice therefore a general anaesthetic will only be prescribed to facilitate dental treatment when other anxiety management techniques are inappropriate or have been attempted without success. General anaesthesia for dental treatment must be positively indicated by standard clinical criteria and not solely as a result of preference, economic or time considerations.

These protocols address-

How patients are routinely referred to the clinic

How patients will be assessed and treated

How patients will be returned to the care of the referring dentist.

These protocols have been developed with the advice, expertise and experience of dental and anaesthetic colleagues who work in practice, community and hospital specialist centres. We expect the protocols to be updated as our unit develops and welcome any advice and constructive criticism which can be offered to improve the care which patients receive at the clinic. We operate an “open door” policy and colleagues are welcome to arrange a visit to the clinic at any time.

The protocols have been developed with the advice, expertise and experience of dental and anaesthetic colleagues who work in practice, community and hospital specialist centres. We expect the protocols to be updated as our unit develops and welcome any advice and constructive criticism which can be offered to improve the care which patients receive at the clinic. We operate an "open door" policy and colleagues are welcome to arrange a visit to the clinic at any time.