How Shilpa Shah is creating a legacy – and a brighter future

Dental Sky explains how Shilpa Shah balances compassionate care with environmental sustainability to shape a bright future for dentistry.

Shilpa Shah is mindful of two critical aspects of dentistry: ensuring compassionate care for the most anxious patients and delivering this in the most environmentally sustainable way.

At first glance, these two might seem mutually exclusive. As a dental sedationist who offers a mobile service, Shilpa’s carbon footprint is arguably high. But having seen the benefits of sedation early in her career – in oral and maxillofacial surgery, community dentistry, special care and paediatrics – she has made sedation dentistry her home. Albeit with more than just a passing interest in the ‘rethink, reduce, re-use, and recycle’ concept.

Shilpa practises part-time at Victoria Dental & Healthcare in Manchester. The practice offers a range of sedation techniques, including paediatric inhalation sedation, IV sedation for adolescents and adults and oral and intra-nasal techniques. She also operates Dental Sedation Solutions, a mobile team of dental sedationists and anaesthetists committed to helping all patients receive necessary care.

Greener dentistry

Shilpa’s work has a notable environmental impact. Inhalational anaesthetic agents are potent greenhouse gases that last in the earth’s atmosphere for years. Inhaled anaesthesia and analgesia contribute to climate change. The use of all anaesthetic equipment, drugs and gases, together with their packaging, has a carbon footprint. Sometimes, her services require transport. This all adds up.

However, sedation is vital to the profession. Firstly, it broadens access to dental care. This in turn makes for greener dentistry, eradicating the potential need for travel to hospitals and reducing the chance of more complex procedures later down the line, or the use of general anaesthesia. It also ensures more inclusive dentistry, which matters to Shilpa.

‘Nitrous oxide is not environmentally friendly. However, by offering sedation, we open doors for patients who might not otherwise be able to access dental care. We enhance their oral health by addressing dental fear and desensitising them – particularly important for those with severe anxiety. The comparative carbon footprint of a short inhalation sedation is significantly less than a day-case hospital trip for a general anaesthetic.’

Childhood hospital admissions

This also relieves the pressure on our hospitals. Last year, data revealed that children in some parts of England waited up to 18 months on average for dental procedures under general anaesthetic (GA), principally tooth extractions.

In an interview with LBC, chair of the British Dental Association (BDA) Eddie Crouch described ‘the absolute nightmare’ of having to treat children presenting with the most severe cases of tooth decay. This is now the leading cause of six- to 10-year-olds being taken to hospital.

He told the radio news outlet: ‘The worst time to see a child is when they’re presenting to you in pain, having had many nights of lost sleep. They’re anxious, frightened, upset [and] may have an infection in their mouth.

‘If children cannot get access to see a dentist early, and the dentist can’t prevent these problems, then when they eventually do get seen in other areas of the health service – their GP, A&E or other areas under stress. These children are presenting with problems that can’t be sorted by a high street dentist. They will then need to go into a hospital and have a really awful and dangerous procedure – [including the] use of general anaesthetic.

‘I’ve seen children who have lost all their baby teeth in one incident, going into hospital and having them all removed.’

Relieving pressure on secondary care

Shilpa’s services, therefore, have a significant role in addressing these issues. The waiting lists for referrals to secondary care sedation clinics for adults and children increased post-COVID-19. She provides comprehensive treatment for children and teenagers, focusing on anxiety management, prevention and minimally invasive dentistry alongside access to sedation when required.

Her mobile team improves access to safe advanced sedation for complex procedures in private primary care, which is not readily accessible in all NHS secondary care services. Sedation referrals are accepted for paediatric dentistry at the age of five, and the process is quick and easy, so young patients get treatment promptly. The simplest and safest techniques are deployed before considering general anaesthetic whenever possible.

Environmental factors in dentistry

But she is ever mindful of what her services mean for the environment. A self-proclaimed ‘David Attenborough admirer’, she chose to study coral biodiversity and eco-tourism work for her dental elective, conducting scientific research in Honduras on the impact of tourism. It was here, in the waters of Central America, where her passion for protecting the planet began.

She tries hard to reduce her carbon footprint whenever her services are delivered. And she maintains that all dental teams can make a difference by practising sustainable dentistry.

‘There is massive waste in healthcare – dentistry especially. During COVID-19, most things became single-use disposable items. We now use many more single-use products without objective scientific evidence. Particularly in inhalation sedation, where individuals began to use disposable breathing apparatuses, which wasn’t necessary. Whatever we use to deliver dental care, we should always ask ourselves: is it necessary?’

She adds: ‘Dentistry produces a lot of plastic waste, but we can reduce our environmental impact by continuously re-examining how we deliver care. I only prepare to use essential items and will only open a packaged item if needed. I often look for alternatives that are kinder to the planet. We should seek ways to adopt more sustainable methods. Minimising our impact should be mandatory.’

Many practices call on her services to provide sedation in-house, and the team travels to clinics to offer sedation via private referrals. The paediatric services at Victoria Dental & Healthcare also relieve the pressure on A&E and GPs, which is significant given the current challenges facing NHS dentistry.

‘There is a significant difference in the carbon footprint when a child undergoes a day-stay general anaesthetic with a full theatre team versus the 10-15 minutes it takes to administer inhalation sedation and provide an emergency dental extraction.’

Pain-free anaesthesia

Her comprehensive paediatric dental care includes acclimatisation, ‘happy air’ sedation, and The Wand to deliver local anaesthetic (LA). A computer-assisted system, The Wand administers LA via a pen-like device. It is pain-free and offers single-tooth anaesthesia.

Shilpa says: ‘Despite having some plastic waste, we have an increased acceptance of anxious children accepting dental care, often at their first visit, providing them immediate relief. I have successfully managed to provide pain-free dental extractions to children as young as three years old using The Wand. Children under five years in the UK are not permitted to have sedation in a dental practice, so they are often referred by their dentist for general anaesthetic.

‘I am increasingly using The Wand, and people are coming to me because of it. Some patients already know what it is and are trying to find a dentist who uses it.

You can often see it in photos on my Instagram page, and my dental nurse will get it ready even during a consultation because she knows I will show it to the patient to explain how it works. My website has lots of specific information for patients, such as options for needle phobics or those with a strong gag reflex. We’ve added some patient journeys with photos for children to reduce apprehension before attending. They see the stages and know what to expect.’

Catering to special needs

She adds: ‘During the consultation appointments, patients can also try on the inhalation mask. Many of our patients have autism, ADHD, and sensory issues, so they need to feel the mask. We use Super Smellies pens from RA Medical to add a pleasant scent to the nasal masks – and patients love them! This further reduces costs and plastic waste, as we previously used single-use plastic scented masks.’

‘I recently had a referral for an eight-year-old with special educational needs after she had visited her dentist, who was unable to treat her. I spoke to her parents, and explained options of The Wand and sedation. Also, I said that although it is a needle, we will not volunteer to use that word in the surgery (using the correct vocabulary is crucial). They opted to try this on their first visit, and treatment was completed with ease without the need for sedation.

‘I now take The Wand with me and teach dentists how to use it when I provide mentoring. It’s an investment that pays for itself. It ensures patient comfort and satisfaction; everyone can be treated with it in routine dental care. It should be integrated early into undergraduate training.’

Changing with the times

In addition to her sedation roles, Shilpa practises in several clinics in South Manchester, the Manchester Dental Hospital’s restorative department, regularly lectures on sedation in several postgraduate courses, and is a Sedation Training Accreditation Committee-approved mentor – supervising willing dentists who train in sedation.

Without the commitment from practitioners like Shilpa, many patients would go undiagnosed, untreated and become a burden on secondary healthcare later down the line. She remains up to speed with new thinking and cutting-edge technology thanks to her multiple roles.

‘We must change with the times. As dentists, we can easily become deskilled and develop tunnel vision, so I maintain many roles and services within primary and secondary care. I know dentists already harnessing AI, and I think this is great. I want to stay ahead of the curve and invest in the best tools to help me do so.’

And, as Shilpa notes in one of her Instagram posts: ‘There’s a lot of planning behind the scenes for us to achieve successful outcomes in paediatric dentistry. Undoubtedly, The Wand and IHS sedation are invaluable tools at our disposal.’


For more information about The Wand, visit www.dentalsky.com/wand_dental.

This article is sponsored by Dental Sky.

Favorite
Get the most out of your membership by subscribing to Dentistry CPD
  • Access 600+ hours of verified CPD courses
  • Includes all GDC recommended topics
  • Powerful CPD tracking tools included
Register for webinar
Share
Add to calendar