title: Estimating the need for dental sedation: evaluating the threshold of the IOSN tool in an adult population.
abstract: OBJECTIVE
  The aim of this study was, through a service evaluation, to assess the use of the IOSN tool in determining whether threshold values were appropriate for identification of IV sedation and general anaesthetic (GA) cases from a referral population.
  
  
  METHODS
  A total of 105 patients were taken from a dental minor oral surgery referral service within a north west primary care trust over the course of six months. The IOSN tool was completed to assess: treatment complexity, medical and behavioural factors and patient anxiety levels. Each patient was then followed through to treatment. The type of sedation modality they received was compared to their IOSN score previously calculated and these results evaluated.
  
  
  RESULTS
  The findings suggest that 94% of patients were treated within primary care by the MOS service, of which 58% received local anaesthetic (LA) alone and 42% were treated by LA with IV sedation. There was a general marked trend as the IOSN score increased so did the treatment modality from LA, through sedation to GA. Logistic regression using the components of the IOSN tool to predict sedation use indicated the IOSN predictors distinguished between those who required sedation and those who didn't (chi-square = 56.411, p <0.0001, df = 3) with treatment complexity (Exp B = 10.836, p <0.0001) and anxiety (Exp B = 4.319, p <0.0001) shown to be significant factors in determining sedation need.
  
  
  CONCLUSIONS
  The data collected have shown that there is a positive relationship between the IOSN score and the type of treatment modality the patient received, suggesting that the threshold values are correctly set. It is concluded that IOSN tool is a useful means of aiding the clinician in both assessing and referring patients for that sedation need.
authors.affiliation: The School of Dentistry, The University of Manchester, Higher Cambridge Street, Manchester, M15 6FH, UK.
authors.forename: T
authors.initials: T
authors.lastname: Liu
authors.forename: I A
authors.initials: IA
authors.lastname: Pretty
authors.forename: M
authors.initials: M
authors.lastname: Goodwin
mesh_terms: D000328:Adult; D000766:Anesthesia, Dental / Q000706:statistics & numerical data*; D000768:Anesthesia, General / Q000706:statistics & numerical data; D000771:Anesthesia, Intravenous / Q000706:statistics & numerical data; D000772:Anesthesia, Local / Q000706:statistics & numerical data; D016292:Procedural Sedation / Q000706:statistics & numerical data*; D016854:Dental Anxiety / Q000523:psychology; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D013511:Minor Surgical Procedures / Q000706:statistics & numerical data; D020380:Needs Assessment / Q000706:statistics & numerical data*; D019647:Oral Surgical Procedures / Q000706:statistics & numerical data; D010347:Patient Care Planning; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D013218:State Dentistry / Q000706:statistics & numerical data; D016896:Treatment Outcome