Implementation of the Indicator of Sedation Need in an Oral Surgery department

  • Alison Wright

Student thesis: Master's ThesisMaster of Dental Science


Background: Intravenous (IV) sedation is used to provide dental treatment for patients experiencing anxiety, which is one of the most common reasons for failure to attend dental appointments (Armfield, 2012). Use of IV sedation can vary between practitioners and the Indicator of Sedation Need (IOSN) has been created to guide clinical decision-making in this area. Previous studies have identified the validity of the tool in general dental practice, however further investigation into whether this applies to patients referred to an Oral Surgery (OS) Department is warranted to test the tool in different clinical settings.

Aims: This study aimed to determine whether the decision to list patients for oral surgery care under IV sedation was associated with their Indicator of Sedation Need (IOSN) score.

Materials and Methods: Eighty-eight consecutive adult patients were recruited prospectively from Oral Surgery consultant clinics in two secondary care sites in NHS Tayside. Patient anxiety levels were assessed using the Modified Dental Anxiety Scale (MDAS), the resulting score of which was combined with medical and behavioural factors alongside treatment complexity scores to give an overall IOSN score. Clinicians were blinded to this information and listed patients for treatment under local anaesthetic (LA), IV sedation or general anaesthetic (GA) using their clinical judgement. Planned treatment modalities were later compared with the IOSN scores and an Exact Contingency Table Analysis (ECTA) was used to assess whether introducing this tool would affect listing of patients for treatment in the department.

Results: Sixty-six percent (n=58) of patients were listed for treatment under LA, 25% (n=22) under IV sedation and 9% (n=8) under GA. When the IOSN score was considered, 51% (n=45) of the total sample were eligible for IV sedation; of these, 11% (n=5) scored above 9, suggestive of a very high need for sedation with possible consideration of GA, although only one of these patients was listed for a GA. Three of these patients chose IV sedation and one was listed for treatment with LA. Many who would have been eligible for IV sedation according to the IOSN opted for LA (n=21). Of the 22 patients whose treatment was planned with IV sedation, 68.2% (n=15) satisfied the IOSN criteria; for the other 31.8% (n=7), IV sedation was justified due to high treatment complexity and interestingly, patients in this group all reported low dental anxiety.

Conclusions: The data reveals that according to the IOSN, just over half of the patients attending the OS department were suitable for treatment with IV sedation but many of these patients were listed for treatment under LA. This suggests that whilst the IOSN may be useful in decision-making, it may overestimate sedation need in this setting.
Date of Award2021
Original languageEnglish
SupervisorMichaelina Macluskey (Supervisor), Graham Ogden (Supervisor) & Stephanie Sammut (Supervisor)

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