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References

Coulthard P. Control of pain and anxiety, 3rd edn. In: Coulthard P, Horner K, Sloan P, Theaker E (eds). Edinburgh: Churchill Livingstone; 2013
Coulthard P, Bridgman C, Gough L, Longman L, Pretty IA, Jenner T. Estimating the need for dental sedation – Paper 1. The Indicator of Sedation Need (IOSN) – a novel assessment tool. Br Dent J. 2011; 211:(5)
Spielberger CD. Notes and Comments. Trait-State anxiety and motor behaviour. J Motor Behav. 1971; 3:(3)265-279
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The indicator of sedation need (IOSN)

From Volume 40, Issue 6, July 2013 | Pages 466-471

Authors

Paul Coulthard

Lecturer in Oral Surgery, Department of Oral and Maxillofacial Surgery, University Dental Hospital of Manchester

Articles by Paul Coulthard

Abstract

Conscious sedation in dentistry is usually indicated because a patient's anxiety can prohibit the necessary dental treatment being undertaken. It may also be indicated because of unpleasant or lengthy treatment or to prevent exacerbation of a patient's medical or behavioural condition by anxiety. The indicator of sedation need (IOSN) tool has been developed to help support dentists in their clinical decision-making and uses information about a patient's anxiety, medical and behavioural status and treatment complexity. The IOSN has been used to measure sedation need and has shown that 5.1% of patients attending general dental practices have a high need of conscious sedation. IOSN has also been used to investigate the need for conscious sedation in the general population among dental practice attenders and those who don't attend. The proportion was found to be 6.7%.

Clinical Relevance: Some patients require conscious sedation in order to access dental care. The indicator of sedation need (IOSN) tool helps in the decision-making process.

Article

Patient anxiety remains a significant barrier to accessing dental care and the prevalence of dental anxiety in the UK has not changed in the last 30 years. It is not surprising that the most common indication for a patient to need conscious sedation for dental treatment is anxiety. However, there are other reasons too. An unpleasant or lengthy treatment, or a patient's medical or behavioural condition that may be exacerbated by anxiety and prohibit dental care, should also be considered.1

The indicator of sedation need (IOSN) tool has been developed to help support dentists in their clinical decision-making and uses information about a patient's anxiety, medical and behavioural status and treatment complexity.2 This may challenge those dentists who rarely consider the use of, or refer patients for, conscious sedation. It similarly may challenge those who use conscious sedation based on ‘demand’ rather than ‘need’. In the UK, we are fortunate that inhalation sedation, intravenous sedation and general anaesthesia services are available, although some patients never get access to the services that they need because they are not offered. The IOSN tool will hopefully make access to services more equitable for patients.

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