Conscious sedation can help a patient undergo dental treatment. There are several reasons why they may need sedation – anxiety, medical needs or complex treatment.

We consider conscious sedation when we review the 'safe' key question. This relates to:

Key lines of enquiry

• S1: Safeguarding and protection from abuse (S1.9 and S1.10)
• S2: Managing risks (S2.1 and S2.6)
• S3: Safe care and treatment (S3.2)
• S4: Medicines management (S4.2)
• S5: Track record (S5.1)
• S6: Learning when things go wrong (all).

Regulations

• Regulation 12 (safe care and treatment)
• Regulation 11 (need for consent)
• Regulation 18 (staffing)
• Regulation 15 (premises and equipment).

Standards for conscious sedation in dental care

To demonstrate safe and effective sedation care, providers must follow the below standards:

• Standards for Conscious Sedation in Provision of Dental Care: Report of the Intercollegiate Advisory Committee for Sedation in Dentistry (2015)

Practitioners should have an awareness of the below guidance:

• Conscious Sedation in Dentistry: Scottish Dental Clinical Effectiveness Programme (2017)

Conscious sedation services

Sedation services may be commissioned through NHS dental services or provided under private contract.

The two common techniques generally adopted in the primary dental care setting are:

• inhalation sedation with nitrous oxide and oxygen (children, young people and adults)
• intravenous sedation - by administration of a titrated dose of midazolam (adults).

Other types of sedation

These are:

• oral and transmucosal sedation with midazolam on adults
• intravenous midazolam sedation on young people
• advanced techniques using a combination of drugs or routes and drugs such as ketamine, propofol and sevofluorane or midazolam on children.

What we expect to see on inspection

Practice teams must be suitably trained and experienced. They must also maintain their competency in sedation.

During inspection we will explore:

• training and competency of the sedation team:
  • accredited training (if started sedation provision after introduction of IACSD Standards) and evidence of clinical supervision
  • evidence of a clinical logbook and maintenance of competency
  • relevant continuing professional development
  • immediate life support and paediatric life support (if applicable)
• processes for reviewing critical incidents and ‘never events’ relevant to sedation
• sedation related audit and governance arrangements
• how patients are assessed and prepared for conscious sedation
• the sedation process, including monitoring, to ensure safe delivery
• recovery, discharge and aftercare arrangements
• the clinical environment is conducive to providing safe care
• sedation equipment is available, maintained and serviced.

If a provider employs a visiting sedationist, we expect systems and process to check:

• they are suitably qualified and competent to provide sedation services
• equipment and medicines used by the visiting sedationist are fit for purpose
• a copy of records is maintained by the practice and stored appropriately in the patients record
• they comply with sedation standards.