Report urges safety standards for dental anaesthesia

BMJ 1995; 311 doi: (Published 19 August 1995) Cite this as: BMJ 1995;311:467

National safety standards to protect patients in Britain having dental treatment under general anaesthesia are urgently required, according to a report published last week. The quality of training, facilities, staff, and equipment varies from clinic to clinic and between hospitals in the NHS, says the report from the Clinical Standards Advisory Group.

The report warns that being unconscious during dental treatment carries special risks because the dentist and anaesthetist are both working around the mouth and airway, increasing the likelihood of breathing problems.

Functioning and up to date equipment as well as properly trained staff must be available to deal with problems, including dangerous reactions to anaesthetic drugs, when they occur. The report calls for national standards to be established to ensure that safety is the top priority wherever and whenever patients need a general anaesthetic.

“The biggest problem is the wide variety of anaesthetic practice,” said Professor Leo Strunin, professor of anaesthesia at the Royal London Hospital. “A lot of community dental anaesthesia is carried out by practitioners outside the mainstream of anaesthesia. It's very difficult for them to keep up to date with developments, and at the moment there's no way of keeping track of them and their work. One option would be for dentists to take responsibility for the standard of anaesthetists they take on and insist that they are accredited or at least have some recognised training in anaesthesia.”

National surveys carried out for the report show that more than a third of dental general anaesthetics are given by doctors other than anaesthetists. A quarter of dental clinics surveyed had no electrocardiograph, the simplest form of heart monitoring, and nearly a fifth had no way of measuring patients' blood pressure during treatment.

The report criticises dentists for offering general anaesthesia when local pain killing injections would be safer and just as good.

According to the Faculty of Dental Surgery, general anaesthesia should be reserved for patients with learning disabilities, patients in whom attempts at local pain relief have failed, patients who are allergic to local anaesthetic, and nervous adults or children who are having multiple extractions.

Other recommendations in the report include better education for dentists and for patients, urging them to avoid unnecessary general anaesthesia; the development of standard consent forms; the promotion of specialist centres to provide dental anaesthesia.

The Department of Health has welcomed the report and endorsed the call for national safety standards, which it says is in line with government policies. But it says that any additional funds to improve standards will have to be found locally.—ALISON TONKS, BMJ


Dentists should avoid unnecessary general anaesthesia

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