The role of sedation techniques in special care dentistry

sedation in special care dentistry

Dr Shilpa Shah has developed a range of sedation techniques to suit the needs of patients whose ability to access dental care is affected by factors such as disability or dental anxiety.

Shilpa Shah dedicates her efforts to championing dentistry and ensuring equitable dental access for everyone. Her unwavering commitment elevates others as she develops her clinical skills by generously sharing her knowledge with her peers.

Her profound passion for dentistry and the potential difference she can make to lives is a relentless driving force. And her enthusiasm for the enabling qualities of sedation propels this clinical delivery ever higher.

Treating anxious patients

Victoria Dental & Healthcare in Manchester is a multi-disciplinary private medical and dental clinic. Its comprehensive range of tailored sedation options sets it apart from other clinics.

Shilpa started here in 2012 and developed the clinic’s sedation services. She discovered her passion for treating anxious patients early on. Having worked across specialisms, she learnt valuable techniques which often involved sedation and general anaesthetic.

‘I learnt how to work with complex patients and enjoyed the difference I could make. For me, high-quality dentistry should be accessible to everyone with suitable options for care – and sedation is a key part of this.’

Developing sedation services

Victoria Dental & Healthcare offers access to simple and advanced sedation techniques. These include paediatric inhalation sedation services, adolescent and adult IV sedation, oral and intranasal sedation and advanced anaesthetist-led multi-drug sedation service.

Shilpa explains: ‘We started with simple sedation and have grown and developed the services and treatments offered to ensure we can provide tailored treatment options without the need for referral.’

The service is available to dentists who wish to refer patients for routine work, sedation services or anxiety management. Sedation services have further diminished in the wake of the pandemic. Dentists have had to either step up or refer to services such as Shilpa’s, which means demand has skyrocketed.

‘Make sedation safely accessible to all’

Shilpa also extends sedation services to other dental practices. In 2014, she established the mobile sedation service Dental Sedation Solutions to make sedation safely accessible to all.

‘The waiting lists for referrals to secondary care sedation clinics increased, and dentists had to look at other resources, many of whom are now calling on our services to provide sedation in-house,’ she says. ‘We travel to clinics to offer sedation via private referrals, especially implant surgery. This service extends wherever needed across the North West and even Wales, Birmingham and Liverpool. Some locations might not be viable, but we do our best.’

Shilpa works three to four days across two private dental practices and practises one day a week at Manchester Dental Hospital. For the rest of her time, she is a mobile sedationist travelling to numerous clinics and managing sedation referrals for a team of anaesthetists.

Sharing knowledge

Shilpa’s relentless enthusiasm also sees her regularly lecturing on sedation in several postgraduate courses and mentoring dentists through their sedation training.

She is incredibly active on social media platforms, too, and this is where her pride in her team shines through – in their clinical skills and the exceptional results they achieve.

‘In sharing stories, I can reach people too anxious to visit the dentist. Dentistry is very image-driven, so Instagram is ideal for showcasing our work. I have an amazing team, many of whom found me through Instagram. Our pre-op assessment includes consent requests for sharing images. The kids love it and are often happy to pose for a photo.’

Adapting to additional needs

One Instagram post truly encapsulates the fundamental reasons she enjoys her role.

A young man with autism required multiple fillings but had significant fear related to dentistry. Shilpa and her team provided a tailored approach.

Shilpa recalls: ‘This young gentleman came to see us having never been able to receive dentistry due to his autism. He required multiple fillings, all teeth were restorable, and he was told by another team he needed general anaesthetic. We provided initial treatment under oral and IV sedation, as he was primarily scared of needles.

‘He was treated in quadrants over four visits. We gradually reduced doses to lighten the sedation and introduced The Wand, a computer-assisted anaesthesia system, as his understanding of treatment improved, and he became more compliant.’

After this initial phase of treatment, he was happy to sit in the chair and understood that coming to the dentist was not painful.

Support systems

Shilpa adds: ‘We managed routine check-ups and simple cleaning without sedation every six months as long as mum or dad was by his side. More recently, he required another filling and we decided to try this with pre-medication only. The hospital environment put him in a heightened state of anxiety, so his parents chose to avoid this route.

‘When he first attended, sitting in the chair was a struggle, and he would stand next to the door showing he wanted to leave. He is now happy coming to the dentist and sits in the chair and opens his mouth immediately. An excellent example of safely executed sedation techniques and special care dentistry.’

She values parental input and accompanying adults are always welcome inside the surgery.

‘Parents and carers are a patient’s support system and safety net. Our care would not be possible without their complete faith and trust in our team.’

Ongoing education

Shilpa keeps an eye on any modern dental technologies but admits she was a late adopter of The Wand from Dental Sky. With a pen-like appearance, it can be an inobtrusive way to deliver local anaesthetic.

‘I happened upon The Wand in my hospital job role, and my colleagues were keen on it. It is particularly well-suited to patients with fear or anxiety,’ Shilpa says. ‘But I always believed my controlled delivery skills were good enough. It became a game-changer when I began treating needle phobics and young children, and now I use it all the time, having developed my confidence with it.

‘It enhanced my work without me realising it and reframed the image of using a needle. I only refer to it as a “magic wand” – the kids are mesmerised by it.’

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