CATEGORY 60 AUSTRALASIAN DENTIST LINICAL Oral anxiolysis, the providing of medications to allow patients to be in a state of mind and a sense of calm are used by many dentists to perform dentistry. Not every dentist has access to nitrous oxide sedation, not every patient is suitable for nitrous oxide, not every dentist has the option of being able to refer to a Aphra endorsed conscious sedation dentist .So because oral medication can be useful for fearful patients or invasive procedures many dentist provide some form of benzodiazepine to patients to enable treatment, but what level of education have they engaged to do these techniques? There are some courses that touch on these areas by good creditable practitioners, but how extensive is the level of education, say compared with the University of Sydney’s Diploma in Conscious Sedation recognized by Aphra/Dental Board of Australia. Having said that, not every dentist wants to do a two-year course to acquire a Diploma in Conscious Sedation. Also, dentist who achieve by examination a Diploma in conscious sedation through the university of Sydney, recognized by Aphra, still need annual accreditation / re-endorsement to keep this recognition to have the ability to provide conscious sedation to patients. Dr’s Walker and Preketes currently are clinical senior lectures and examiners in the Conscious Sedation Diploma at the UniversityofSydney,helpingdentistacquire the skills to provide intravenous sedation using midazolam, fentanyl, propofol and other drugs to provide conscious sedation. They both have referral-based sedation private practices providing intravenous sedation to patients who would not get the dentistry done they need, unless they were sedated for treatment. Both Doctors Walker and Preketes think little of preforming sensible and conscientious venipuncture and injection of sedative drugs to sedate patients and have practices equipped and staffed appropriately. Still Doctors Walker and Preketes are stoic advocates of nitrous oxide sedation, which they perform daily and are key opinion leaders and educators of nitrous oxide sedation, also not all patients are suitable for outpatient intravenous sedation for medical reasons or simply Oral anxiolysis /sedation a new course Certificate in Patient Care don’t have veins. Nitrous oxide sedation is an effective technique but not for everyone and so even in conscious sedation dental practices where intravenous sedation cannot be used i.e., no veins there is a need for oral anxiolysis /sedation. The recognition that conscious sedation in the form of intravenous sedation can unintentionally slip over to deep sedation or unconscious sedation is at the core of addressing monitoring and safety for the welfare of patients who are provided with intravenous conscious sedation. Oral medication can have the same problems and as such dentists require the same skills to deal with an over level of sedation than what was intended to be provided. General dentists are not permitted to provide conscious sedation unless they have a Diploma in Conscious sedation from the University of Sydney and a conscious sedation endorsement from Aphra/Dental board. The other standards that apply to the provision of anxiolysis/sedation is the Australian and New Zealand College of Anesthetist [ANZCA] Policy document PS-09 which provides standards for the provision of safe sedation. ANZCA PS-09 covers sedation by any route but excludes nitrous oxide sedation. Dr Walker has served on the consultation committees in the formulation of these documents. As mentioned before, there are several courses on oral medications to provide anxiolysis by good reputable practitioners, but as with intravenous sedation that can inadvertently drift to deep sedation, none seem to provide the skills to appropriately educate dentist on the potential skills needed if a patient goes fromoral anxiolysis to conscious sedation; nor should they as Dr Walker and Dr Preketes are primary educates and examiner on conscious sedation diploma and are key educators for dentist in this area. Dr Walker and Preketes recognize this huge deficiency in the current level of education, not everyone wants to do a 2-year qualification in conscious sedation but would like to be appropriately trained to provide oral anxiolysis and if this drifted to conscious sedation or worse have the skills to deal with this. Doctors Walker and Preketes provide intravenous sedation in their respective practices and as educators are the most qualified to provide a competent education framework to GP dentist to provide safe oral anxiolysis and any complication that may occur. Certificate in Patient Care So, Doctors Walker and Preketes have proposed an interim level of education in the form of a Certificate in Patient Care. This 4-module program is designed to provide the participants with the skills to better provide care for their patients in relation to anxiolysis/sedation and provide a safe environment for the application of the taught techniques. The Certificate in Patient Care has 4 modules as stated. The first module is a conventional nitrous oxide course with a higher emphasis on review of patient physiology. This is an excellent beginning to provide nitrous oxide sedation so that you can go back to your practice the next day and safely, effectively and competently provide nitrous oxide sedation to adults and children. A review of patient physiology is provided to start dentist on their journey
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