title: Assessing sedation need and managing referred dentally anxious patients: is there a role for the Index of Sedation Need?
abstract: OBJECTIVE
  To conduct an exploratory investigation of public dental service (PDS) practitioners' planned sedation modality using a structural equation modelling approach, in order to identify the explanatory value of using the Index of Sedation Need (IOSN), or its component parts, to predict sedation modality in patients referred with dental anxiety.
  
  
  METHODS
  A convenience sample of patients referred to the PDS for dental anxiety management was invited to take part. The IOSN was completed for each patient (patient dental anxiety, medical and behavioural indicators and dental treatment complexity) as well as the American Society of Anesthesiologists Physical Status Classification System and the Case Mix Tool. The practitioners completed details of their planned sedation modality and identified normative dental treatment need. The data were entered onto an SPSS v21 database and subjected to frequency distributions, t-tests, correlation analysis and exploratory partial structural equation modelling (SEM).
  
  
  RESULTS
  Ninety-five percent of patients were ranked as MDAS 3 or 4, indicating high dental anxiety; 69% had a medical condition, which might impact on dental treatment and 82% had a dental treatment need, which was classified as intermediate/complex according to the IOSN. Eighty-eight percent of the patients in accordance with the IOSN required sedation: 62% of patients were assessed as requiring intravenous sedation. The IOSN discriminated between patients who were assessed as requiring more complex sedation modalities and had a greater normative treatment need. The SEM showed that the patient dental anxiety (P <0.02) and dental treatment complexity (P <0.02) predicted planned sedation modality. Functional morbidity was less strong, as a predictor, and was significant at the ten percent level.
  
  
  CONCLUSIONS
  The IOSN is a useful and valid assessment of sedation need and predicted sedation modality for patients referred with high dental anxiety states and secondly, that component parts of the IOSN add explanatory value in practitioners' choice of planned sedation modality.
authors.affiliation: Dental Health Services Research Unit, University of Dundee, DD1 4HN.
authors.forename: S
authors.initials: S
authors.lastname: Yuan
authors.affiliation: Dental Health Services Research Unit, University of Dundee, DD1 4HN.
authors.forename: S J
authors.initials: SJ
authors.lastname: Carson
authors.affiliation: Dental Health Services Research Unit, University of Dundee, DD1 4HN.
authors.forename: M
authors.initials: M
authors.lastname: Rooksby
authors.affiliation: Public Dental Service, NHS Highland, IV2 7GE.
authors.forename: J
authors.initials: J
authors.lastname: McKerrow
authors.affiliation: Public Dental Service, NHS Highland, IV2 7GE.
authors.forename: C
authors.initials: C
authors.lastname: Lush
authors.affiliation: Dental Health Services Research Unit, University of Dundee, DD1 4HN.|Dental Public Health, NHS Tayside.
authors.forename: R
authors.initials: R
authors.lastname: Freeman
mesh_terms: D000328:Adult; D016854:Dental Anxiety / Q000188:drug therapy*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D012017:Referral and Consultation
chemical_list: D006993:Hypnotics and Sedatives