Chapter 4

Patient selection

INTRODUCTION

Before a patient can receive treatment with any form of conscious sedation they must attend an assessment appointment to allow the clinician to assess the patient’s suitability and the method to be used for the intended treatment. Correctly managing a patient’s treatment with any form of conscious sedation is essential to provide safe sedation. To do this the clinician must take into account the knowledge, skills and experience of not only himself or herself but also that of the team, as well as the express wish of the patient, coupled with their medical, dental and social history [1].

THE ASSESSMENT APPOINTMENT

It is at this appointment that the patient’s treatment pathway commences, as the clinician will start to effectively manage a patient by taking and recording their medical, dental and social history. They will listen to the patient’s opinions and preferences. A clinical dental examination is undertaken and any X-rays that are required are taken and assessed. The clinician will either undertake a few medical checks himself or herself or request that the dental nurse, acting as the second appropriate person does so. The clinician may utilise a questionnaire as a tool to establish the patient’s anxiety levels such as the Corah anxiety scale. The patient is asked to complete a questionnaire relating to the treatment and how they felt in certain situations before, during and after the appointment, with each question being awarded a numerical score. From the response the clinician totals the score to establish the level of the patient’s concern and whether they may possibly need referral to a specialist clinician. Once in receipt of all the required information the clinician can discuss the treatment options available with the patient, take written consent and go through the pre and post-operative instructions relating to the form of sedation being provided. The patient will leave the surgery with an appointment for treatment and written pre and post-sedation instructions which he/she can refer to.

MEDICAL HISTORY

Medical history is essential in order to establish which form of sedation can safely be provided to each individual patient and whether they can be treated within a dental surgery environment or be referred to a hospital setting. When taking a medical history from a patient, a form with a list of questions covering a wide range of conditions should be given (Table 4.1). Any medical history questionnaire used should be designed to enable the patient to indicate ‘yes’ or ‘no’ to the questions to make such questionnaires user-friendly. The clinician can then discuss the information provided by the patient in more detail and if necessary, seek further clarification from the patient’s doctor or a colleague who may have previously treated the patient. A clear picture of the patient’s medical status can then be formed before providing treatment with any form of conscious sedation [1].

Table 4.1 Medical history questions.