Retrospective audit of the efficacy and safety of the combined intranasal/intravenous midazolam sedation technique for the dental treatment of adults with learning disability.
BACKGROUND
The provision of dental care for adults with severe learning disability presents problems. The approach to treatment has often been provided under general anaesthesia tending to result in exodontia rather than restorative care. This paper presents an alternative to this option using conscious sedation.


METHODS
A multi-centred retrospective audit was reported on using data from Canterbury, Warwick, Dorset and Cardiff. Patients included adults with varying degrees of disability for whom treatment using local anaesthesia, inhalation sedation, and the acceptance of intravenous cannulation was not possible. Sedation was provided by midazolam first administered by the intranasal followed by the intravenous route.


RESULTS
From a total of 222 episodes of sedation 128 (57.65%) accepted treatment well and 75 (33.78%) presented slight problems which did not compromise treatment. In 19 cases (8.55%) treatment with sedation was not possible and a referral was made for general anaesthesia.


CONCLUSIONS
Results showed that a range of different treatments were carried out including advanced restorative care. This paper proposes that the technique described is safe and effective in providing a good standard of dental care for adults with severe learning disability.
Manley
M C G
MC
Dental Department, Canterbury Health Centre, 26 Old Dover Road, Canterbury, Kent, CT1 3JH. graham.manley@ekentmht.nhs.uk
Ransford
N J
NJ
Lewis
D A
DA
Thompson
S A
SA
Forbes
M
M
D000281:Administration, Intranasal; D000328:Adult; D000336:Aerosols; D000766:Anesthesia, Dental / Q000379:methods* / Q000706:statistics & numerical data; D000771:Anesthesia, Intravenous; D016292:Procedural Sedation / Q000379:methods* / Q000706:statistics & numerical data; D019230:Dental Audit; D003730:Dental Care for Persons with Disabilities / Q000379:methods* / Q000706:statistics & numerical data; D005792:General Practice, Dental / Q000379:methods; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007275:Injections, Intravenous; D007859:Learning Disabilities; D008874:Midazolam / Q000008:administration & dosage*; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D006113:United Kingdom
D000336:Aerosols; D006993:Hypnotics and Sedatives; D008874:Midazolam