A dental risk management protocol for electroconvulsive therapy.
This article describes the results of an evaluation of a system to use trained junior psychiatric doctors to perform the pre-ECT oral assessment. All junior doctors were given a 1-hour training session in making oral assessments, and their ability to diagnose was tested by dental follow-up visits to patients they had assessed. Seventy-one patients were seen by both doctor and dentist, and the sensitivity for doctors ranged between 92% for the presence of dentures or removable bridges to 8% for the presence of teeth vulnerable to fracture. Where the doctors made a positive diagnosis, these were not always correct; the positive predictive value ranging from 92% for dentures or removable bridges to 25% for teeth vulnerable to fracture. It is concluded that the use of trained doctors is better than no assessment but falls short of that provided by a dentist with experience of psychiatric patients undergoing ECT.
South Staffordshire Health Authority and School of Dentistry, University of Birmingham, Birmingham, UK. a.j.morris@bham.ac.uk
A John
AJ
Morris
Susan A
SA
Roche
Peter
P
Bentham
Jan
J
Wright
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019091:Critical Pathways; D003479:Curriculum; D003824:Denture, Complete; D003832:Denture, Partial, Removable; D004565:Electroconvulsive Therapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education; D008875:Middle Aged; D009055:Mouth / Q000293:injuries*; D010348:Patient Care Team; D011570:Psychiatry / Q000193:education; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation; D018570:Risk Assessment; D012308:Risk Management; D018677:Tooth Injuries / Q000209:etiology / Q000517:prevention & control*